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VACCINATION
STB2153 Virology &Immunology
Semester 2 2016_17
Vaccination
Active immunity produced by vaccine
Source: CDC. MMWR April 2, 1999. 48: 242-264 Numbers in yellow indicate
* Provisional 2004 Data at or near record lows in 2004
Comparison of Pre-Vaccine Era
Estimated Annual Morbidity and Current
Morbidity,
Vaccine-Preventable Diseases (post-1990
Vaccines)
Pre-Vaccine Era
Estimated Annual Percent
Disease Morbidity 2003 Decrease
BCG No
scar
Hep B
DPT DT
OPV
HIB
Measles
*
MMR
Vaccine development
Passive Immunity
Protection transferred from another
person or animal
Temporary protection that wanes with
time
Passive Immunity
Transfer of antibody produced by one
human or other animal to another
Temporary protection
Transplacental most important
source in infancy
Passive Immunization
IgG - immediate protection - no memory
3. Microbial extracts
4. Vaccine conjugates
5. Toxoids
Local Reactions
Systemic
Reactions
Allergic Reactions
Emotional
Problems with vaccines
Localized - at site of injection
Anaphylaxis to Ag or non-microbial
content vaccine (eggs)
Contamination with pathogen
Reversion of attenuation
Lack of efficacy if another concurrent
infection (rubella & polio vaccine)
Organisms with lots of serotypes
Autism and Vaccines
Theory posed that
MMR vaccine might
play a role in autism
Weight of scientific
evidence does not
support
American Academy of
Pediatrics Review and
Institute of Medicine
Review conclude no
association
Inactivated Vaccines
Whole
viruses
bacteria
Fractional
protein-based
toxoid
subunit
polysaccharide-based
pure
conjugate
Live Attenuated Vaccines
Severe reactions possible
Whole-cell vaccines
Viral polio, hepatitis A,
rabies, influenza
Bacterial pertussis, typhoid
cholera, plague
Inactivated Vaccines
Fractional vaccines
Subunit hepatitis B, influenza,
acellular pertussis,
human papillomavirus,
anthrax, Lyme
ex vivo in vivo
1) purification Direct application:
of target cells
viral vectors
2) gene transfer
non-viral vector
HSV-1 (gD,gB,ICP-27)
HBV (HBsAG)
Passive Active
to increase initiates an immune
the pre-existing immune response
response against an unrecognised
to the cancer or poorly antigenic tumor
How is a DNA Vaccine made?
DNA is isolated
-The DNA sequence which would code for a specific protein is isolated from
the genome of the infectious organism.
2
Common Vectors for Gene
Therapy
How does it work?
2
How does it work?
The infectious organisms protein is produced
Translation of the mRNA occurs and the protein is now
actively being produced in the muscle cells of the person .
The immune system responds to the foreign
protein
The immune system recognizes the proteins are incorrect
and attacks them with killer T cells and memory B cells.
A lasting immune protection is created and
maintained
Memory B cells create antibodies for the specific proteins,
and thus the person is protected from the proteins and
consequently the infectious organism itself.
DNA vaccines
Gene for antigenic protein
(1)
Antigenic
(2) protein
Antigenic
Cellular Fragment MHC 1 peptide
DNA of antigenic
peptide
T cell response Humoral response
DNA for pathogen specific antigen
gene
(DNA)
I II III IV V
RNA
2
antigen
(protein)
Current attempts with naked DNA
vaccination in infectious diseases
Tuberculosis
Lyme disease
HIV
Helicobacter pylori
hepatitis B and C
Influenza Malaria
Papilloma T cells recognise liver cell
Cytomegalovirus with malarial parasite inside
Produce IFN-gamma
IFN-gamma stimulate
antigen presentation
T cells recognise liver cell
with malarial parasite inside
Important: too much IFN-gamma
is also too bad. Produce IFN-gamma
(it is pro-inflammatory)
IFN-gamma stimulate
antigen presentation
DNA Vaccines vs. Traditional Vaccines
In
contrast to conventional
vaccines, DNA vaccines elicit cell-
mediated as well as antibody-
mediated immune responses.
The cell-mediated response
The plasmid is taken up by an antigen-
presenting cell (APC) like a dendritic cell.
The gene(s) encoding the various components
are transcribed and translated.
The protein products are degraded into
peptides.
These are exposed at the cell surface nestled in
MHC class I molecules where they serve as a
powerful stimulant for the development of cell-
mediated immunity.
The antibody-mediated response
If the plasmid is taken up by other cells (e.g.
muscle cells),
the proteins synthesized are released and can
be engulfed by antigen-presenting cells
(including B cells).
In this case, the proteins are degraded in the
MHC class II pathway and presented to helper T
cells.
These secrete lymphokines that aid B cells to
produce antibodies [View].
Safety Problem
tumor induction
due to chromosomal integration
tolerance
due to long-term presentation of antigen
adverse reactions and immunopathology
due to co-administration of cytokine and/or immun
stimulatory genes
auto-immune reactions
correlated with the induction of anti-DNA antibodies
biologic activity (apart from immunogenicity)
of the expressed antigen
The Long and Winding
Road to an AIDS
Vaccine
Adults and children estimated to be
living with HIV as of end 2004
Western & Central Eastern Europe
Europe & Central Asia
North America 610 000 1.4 million
1.0 million [480 000 760 000] [920 000 2.1 million] East Asia
[540 000 1.6 million] 1.1 million
Caribbean North Africa & Middle East [560 000 1.8 million]
440 000 540 000
[230 000 1.5 million] South & South-East Asia
[270 000 780 000]
7.1 million
Sub-Saharan Africa [4.4 10.6 million]
Latin America 25.4 million Oceania
1.7 million [23.4 28.4 million]
35 000
[1.3 2.2 million]
[25 000 48 000]
4
AIDS Vaccine Approaches
Recombinant subunit
vaccines
Poxviruses
Adenoviruses
DNA vaccines
Whole inactivated HIV
Peptide-based vaccines
Live attenuated HIV
Steps in the Development of an
AIDS Vaccine
Design of candidate vaccine
Which HIV proteins?
How to deliver?
Testing of immune responses
Mice & rabbits>Monkeys
Efficacy testing
Key role of nonhuman primate studies
Human clinical trials
Phase I>Phase IIPhase III
Delivery path
FDA, WHO, Financing, Infrastructure and
immunization
Lessons learned from
Macaque AIDS Vaccine
Studies
Ability of live attenuated SIV vaccines to
provide potent protection against challenge
Difficulty in inducing sterile protection
against SIV
Importance of CD8+ T lymphocyte
responses in controlling SIV replication
Lack of efficacy of standard envelope
vaccines in inducing protection against SIV
Lessons learned from
Macaque AIDS Vaccine
Studies
Improved efficacy of combination SIV
vaccines in inducing protection against
SIV challenge
Ability of live attenuated AIDS vaccines
to cause disease
Preclinical studies of
safety/immunogenicity of recombinant
adenovirus vaccines
Human Clinical Trials
Phase I
Initial safety trials, also provides info on immune responses
10-30 volunteers
8-12 months for completion
Phase II
Provide expanded information on safety and immunogenicity
50-500 volunteers, generally including at-risk-populations
18-24 months
Phase III
Definitive tests of vaccine efficacy in at-risk-populations
5,000-10,000 volunteers
36 months
Human Clinical Trials of AIDS
Vaccines
Phase I (n>70) Phase II (n=5) Phase III (n=3)
FluBlk: A
Recombinant
Hemagglutinin
Protein Vaccine for
Influenza
Manon Cox
VRBPAC
February 27, 2007 A Vaccine Company for the 21st Century
* Estimate=NA (Not Available) if the unweighted sample size for the numerator was <30 or (CI half width)/Estimate >0.5 or (CI half width)>10
Self-reported by respondent. Individual racial groups do not include Hispanic children. Children of Hispanic ethnicity may be of any race
4 or more doses of DTP, 3 or more doses of poliovirus vaccine, 1 or more doses of any MCV, 3 or more doses of Hib, and 3 or more doses of HepB
Children Receiving Autism Services
by Quarter, California, 2002-2005
DTP/DT/DTaP
3 doses 94.1 (0.5) 94.3 (0.5) 94.9 (0.6) 96.0 (0.5) 95.9 (0.5)
4 doses 81.7 (0.8) 82.1 (0.8) 81.6 (0.9) 84.8 (0.8) 85.5 (0.8)
Poliovirus 89.5 (0.6) 89.4 (0.7) 90.2 (0.7) 91.6 (0.7) 91.6 (0.7)
Hib 3 doses 93.4 (0.5) 93.0 (0.6) 93.1 (0.6) 93.9 (0.6) 93.5 (0.6)
MMR 1 dose 90.5 (0.6) 91.4 (0.6) 91.6 (0.7) 93.0 (0.6) 93.0 (0.6)
Hepatitis B 3
90.3 (0.6) 88.9 (0.7) 89.9 (0.7) 92.4 (0.6) 92.4 (0.6)
doses
Varicella 1 dose 67.8 (0.9) 76.3 (0.8) 80.6 (0.9) 84.8 (0.8) 87.5 (0.7)
PCV
3 doses -- -- 40.8 (1.1) 68.1 (1.0) 73.2 (1.0)
4 doses -- -- -- 35.8 (1.0) 43.4 (1.1)
New Approach
Vaccine production:
Viral or bacterial genes inserted into
plant chromosomes to make transgenic
plants or transgenic animals.
Products can be harvested or the
plant can be used as foods