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vaccine

 
Dictionary: vac·cine   (văk-sēn', văk'sēn') pronunciation
 
n.
    1. A preparation of a weakened or killed pathogen, such as a bacterium or virus, or of a portion of the pathogen's structure that upon administration stimulates antibody production or cellular immunity against the pathogen but is incapable of causing severe infection.
    2. A preparation from the cowpox virus that protects against smallpox.
  1. Computer Science. A software program designed to detect and stop the progress of computer viruses.

[From Latin vaccīnus, of cows, from vacca, cow.]


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How Products are Made: How is a vaccine made?
 

Background

The development of vaccines to protect against viral disease is one of the hallmarks of modern medicine. The first vaccine was produced by Edward Jenner in 1796 in an attempt to provide protection against smallpox. Jenner noticed that milkmaids who had contracted cowpox, a relatively innocuous infection, seemed to be resistant to smallpox, a disease of humans that regularly reached epidemic levels with extremely high mortality rates.

Jenner theorized (correctly) that cowpox, a disease of animals, was similar to smallpox. He concluded that the human reaction to an injection of cowpox virus would somehow teach the human body to respond to both viruses, without causing major illness or death. Today, smallpox is totally eradicated. Only two frozen samples of this virulent virus exist (one in the United States, the other in Russia), and as of mid-1995 there is serious scientific debate about whether to destroy the samples, or keep them for further laboratory study.

A virus is a small bit of RNA (Ribonucleic acid) and/or DNA (deoxyribonucleic acid), the material in all living cells that instructs the cell how to grow and reproduce. Viruses cannot reproduce by themselves, but only by taking over the nucleus of a host cell and instructing the cell to make additional viruses. When a virus successfully invades an organism, it takes over the cell growth process in the host.

Under ordinary circumstances, the human body responds to viral invasion in several different ways. Generalized immunity to a virus can be developed by the cells in the body that are targets of viral invasion. In this situation, viruses are prevented from gaining access to host cells. A more common protection is the body's ability to develop blood and lymph cells that destroy or limit the efficacy of the invading virus. Often, an infected human body will "leam" how to respond to a specific virus in the future, so that a single infection, especially from a relatively benign virus, usually teaches the body how to respond to additional invasions from the same virus. The common cold, for example, is caused by one of several hundred viruses. After recovering from a cold, most people are resistant to the particular virus that caused the particular cold, although similar cold viruses will still cause similar or identical symptoms. For some innocuous viruses, a person might even develop immunity without becoming visibly ill.

Virus Families

There are usually several variations or strains of any particular virus. Depending on the number of varieties, a biologist might group viruses as types or strains. Vaccines frequently are made from more than one group of related viruses; a preventive reaction to the multivalent vaccination will probably cause immunity to almost all of the group's variants, or at least to those variants which a person is likely to encounter. Choice of the specific members of the group to use in a vaccine are made with painstaking care and deliberation.

The Manufacturing
Process

Manufacturing an anti-virus vaccine today is a complicated process even after the arduous task of creating a potential vaccine in the laboratory. The change from manufacturing a potential vaccine in small quantities to manufacturing gallons of safe vaccine in a production situation is dramatic, and simple laboratory procedure may not be amenable to a "scale up" situation.

The Seed

  • Manufacturing begins with small amounts of a specific virus (or seed). The virus must be free of impurities, including other similar viruses and even variations of the same type of virus. Additionally, the seed must be kept under "ideal" conditions, usually frozen, that prevent the virus from becoming either stronger or weaker than desired. Stored in small glass or plastic containers, amounts as small as only 5 or 10 cubic centimeters, but containing thousands if not millions of viruses, will eventually lead to several hundred liters of vaccine. Freezers are maintained at specified temperatures; charts and/or dials outside of the freezer keep a continuous record of the temperature. Sensors will set off audible alarm signals and/or computer alarms if the freezer temperature goes out of range.

Growing the virus

  • After defrosting and warming the seed virus under carefully specified conditions (i.e., at room temperature or in a water bath), the small amount of virus cells is placed into a "cell factory," a small machine that, with the addition of an appropriate medium, allows the virus cells to multiply. Each type of virus grows best in a medium specific to it, established in pre-manufacturing laboratory procedures, but all contain proteins from mammals in one form or another, such as purified protein from cow blood. The medium also contains other proteins and organic compounds that encourage the reproduction of the virus cells. As far as the virus is concerned, the medium in a cell factory is a host for reproduction. Mixed with the appropriate medium, at appropriate temperature, and with a predetermined amount of time, viruses will multiply.
  • In addition to temperature, other factors must be monitored, including the pH of the mixture. pH is a measure of acidity or basicity, measured on a scale from 0 to 14, and the viruses must be kept at a defined pH within the cell factory. Plain water, which is neither acidic or basic (neutral) has a pH of 7. Although the container in which the cells are growing is not very large (perhaps the size of a 4-8 quart pot), there are an impressive number of valves, tubes, and sensors connected to it. Sensors monitor pH and temperature, and there are various connections for adding media or chemicals such as oxygen to maintain the pH, places to withdraw samples for microscopic analysis, and sterile arrangements for adding the components of the cell factory and withdrawing the intermediate product when it is ready.
  • The virus from the cell factory is then separated from the medium, and placed in a second medium for additional growth. Early methods of 40 or 50 years ago used a bottle to hold the mixture, and the resulting growth was a single layer of viruses floating on the medium. It was soon discovered that if the bottle was turned while the viruses were growing, even more virus could be produced because a layer of virus grew on all inside surfaces of the bottle. An important discovery in the 1940s was that cell growth is greatly stimulated by the addition of enzymes to a medium, the most commonly used of which is trypsin. An enzyme is a protein that also functions as a catalyst in the feeding and growth of cells.

    In current practice, bottles are not used at all. The growing virus is kept in a container larger than but similar to the cell factory, and mixed with "beads," near microscopic particles to which the viruses can attach themselves. The use of the beads provides the virus with a much greater area to attach themselves to, and consequently, a much greater growth of virus. As in the cell factory, temperature and pH are strictly controlled. Time spent in growing virus varies according to the type of virus being produced, and is, in each case, a closely guarded secret of the manufacturer.

Separation

  • When there is a sufficient number of viruses, they are separated from the beads in one or more ways. The broth might be forced through a filter with openings large enough to allow the viruses to pass through, but small enough to prevent the beads from passing. The mixture might be centrifuged several times to separate the virus from the beads in a container from which they can then be drawn off. Still another alternative might be to flood the bead mixture with another medium which washes the virus off the beads.

Selecting the strain

The eventual vaccine will be either made of attenuated (weakened) virus, or a killed virus. The choice of one or the other depends on a number of factors including the efficacy of the resulting vaccine, and its secondary effects. Ru vaccine, which is developed almost every year in response to new variants of the causative virus, is always an attenuated vaccine. The virulence of a virus can dictate the choice; rabies vaccine, for example, is always a killed vaccine.

  • If the vaccine is attenuated, the virus is usually attenuated before it goes through the production process. Carefully selected strains are cultured (grown) repeatedly in various media. There are strains of viruses that actually become stronger as they grow. These strains are clearly unusable for an attenuated vaccine. Other strains become too weak as they are cultured repeatedly, and these too are unacceptable for vaccine use. Like the porridge, chair, and bed that Goldilocks liked, only some viruses are "just right," reaching a level of attenuation that makes them acceptable for vaccine use, and not changing in strength. Recent molecular technology has made possible the attenuation of live virus by molecular manipulation, but this method is still rare.
  • The virus is then separated from the medium in which it has been grown. Vaccines which are of several types (as most are) are combined before packaging. The actual amount of vaccine given to a patient will be relatively small compared with the medium in which it is given. Decisions about whether to use water, alcohol, or some other solution for an injectable vaccine, for example, are made after repeated tests for safety, sterility, and stability.

Quality Control

To protect both the purity of the vaccine and the safety of the workers who make and package the vaccine, conditions of laboratory cleanliness are observed throughout the procedure. All transfers of virus and media are conducted under sterile conditions, and all instruments used are sterilized in an autoclave (a machine that kills organisms by heat, and which may be as small as a jewel box or as large as an elevator) before and after use. Workers performing the procedures wear protective clothing which includes disposable tyvek gowns, gloves, booties, hair nets, and face masks. The manufacturing rooms themselves are specially air conditioned so that there is a minimal number of particles in the air.

The Approval Process

In order for prescription drugs to be sold in the United States, a drug manufacturer must meet strict licensing requirements established by law and enforced by the Food and Drug Administration (FDA).

All prescription drugs must undergo three phases of testing, although data from the second phase can sometimes be used to meet third phase requirements. Phase 1 testing must prove that a medicine is safe, or at least that no untoward or unexpected effects will occur from its administration. If a medicine passes Phase I testing, it must next be tested for efficacy—it must do what it is supposed to do; medicine cannot be sold that is useless, or that makes claims for an effect that it does not have. Finally, Phase III testing is designed to quantify the effectiveness of a medicine or drug. Although vaccines are expected to have effectiveness close to 100%, certain medicines might well be acceptable even if they have limited effectiveness, as long as the prescribing physician knows the odds.

The entire manufacturing process is reviewed carefully by the FDA which examines records of procedures as well as visiting the manufacturing site itself. Each step in the manufacturing process must be documented, and the manufacturer must demonstrate a "state of control" for the manufacturing process. This means that scrupulous records must be kept for every step in the process, and there must be written instructions for each step of the process. Except in cases of grievous error, the FDA does not determine if each step in a process is correct, but only that it is safe and is documented sufficiently to be performed as the manufacturer stipulates.

The Future

Producing a usable, safe antiviral vaccine involves a large number of steps which, unfortunately, cannot always be done for each and every virus. There is still much to be done and learned. The new methods of molecular manipulation have caused more than one scientist to believe that the vaccine technology is only now entering a "golden age." Refinements of existing vaccines are possible in the future. Rabies vaccine, for example, produces side effects which make the vaccine unsatisfactory for mass immunization; in the United States, rabies vaccine is now used only on patients who have contracted the virus from an infected animal and are likely, without immunization, to develop the fatal disease.

The HIV virus, which biologists believe causes AIDS, is not currently amenable to traditional vaccine production methods. The AIDS virus rapidly mutates from one strain to another, and any given strain does not seem to confer immunity against other strains. Additionally, a limited, immunizing effect of either attenuated or killed virus cannot be demonstrated in either the laboratory or in test animals. No HIV vaccine has yet been developed.

Where To Learn More

Books

Dulbecco, Renato and Harold S. Ginsberg. Virology. 2nd edition. J.B. Lippincott Company, 1988.

Plotkin, Stanley A. and Edward A. Mortimer, Jr., eds. Vaccines. W.B. Saunders Company, 1988.

[Article by: Lawrence H. Berlow]


 
Dental Dictionary: vaccine
Top
(vaksēn′)

Agent prepared to produce active immunity that usually kills microbes, attenuated live microbes, or variant strains of microbes and can induce antibody production without producing disease.

 

Preparation containing either killed or weakened live microorganisms or their toxins, introduced by mouth, by injection, or by nasal spray to stimulate production of antibodies against an infectious agent. This confers immunity to that agent, since the B lymphocytes remain sensitized to it and respond to later infection by producing more antibodies. The first vaccine, against smallpox, was introduced by Edward Jenner in 1798. Vaccines have been developed against diseases caused by bacteria (e.g., typhoid, whooping cough, tuberculosis) and by viruses (e.g., measles, influenza, rabies, poliomyelitis). Effectiveness varies, and a small percentage of people have adverse reactions. Those with immunodeficiency disorders should not receive live vaccines.

For more information on vaccine, visit Britannica.com.

 

A preparation containing killed or attenuated micro-organisms (i.e. micro-organisms that have lost their virulence), such as viruses, that is introduced into the human body to stimulate the formation of antibodies and thereby confer immunity against subsequent infections of the micro-organism.

 

A vaccine is a medical preparation given to a person to provide immunity from a disease. Vaccines use a variety of different substances ranging from dead microorganisms to genetically engineered antigens to defend the body against potentially harmful antigens. Effective vaccines change the immune system by promoting the development of antibodies that can quickly and effectively attack disease causing microorganisms or viruses when they enter the body, preventing disease development.

Vaccine Development

The development of vaccines against diseases including polio, smallpox, tetanus, and measles is considered among one of the great accomplishments of medical science. Researchers are continually attempting to develop new vaccinations against other diseases. In particular, vigorous research into vaccines for Acquired Immune Deficiency Syndrome (AIDS), cancer and Severe Acute Respiratory Syndrome (SARS) is currently underway.

The first successful vaccine was developed from cowpox as a treatment for smallpox. Coined by Louis Pasteur (1822–1895), the etymology of the term vaccine reflects this achievement. It is taken from the Latin for cow (vacca) and the word vaccinia, the virus that causes cowpox.

Smallpox. The first effective vaccine developed treated smallpox, a virulent disease that killed thousands of its victims and left thousands of others disfigured. In one of the first forms of inoculation, the ancient Chinese developed a snuff made from powdered smallpox scabs that was blown into the nostrils of uninfected individuals. Some individuals died from the therapy; however, in most cases, the mild infection produced offered protection from later, more serious infection.

In the late 1600s, European peasants employed a similar method of immunizing themselves against smallpox. In a practice referred to as "buying the smallpox," peasants in Poland, Scotland, and Denmark reportedly injected the smallpox virus under the skin to obtain immunity.

Lady Mary Wortley Montague, the wife of the British ambassador to Turkey brought information on immunization back to Europe in the early 1700s. Montague reported that the Turks injected a preparation of smallpox scabs into the veins of susceptible individuals. Those injected generally developed a mild case of smallpox from which they recovered rapidly. Montague convinced King George I to allow trials of the technique on inmates in Newgate Prison. Although some individuals died after receiving the injections, the trials were successful enough that variolation, or the direct injection of smallpox, became accepted medical practice. Variolation also was credited with protecting United States soldiers from smallpox during the Revolutionary War.

Edward Jenner (1749–1823), an English country physician, observed that people who were in contact with cows often developed cowpox, which caused pox sores but was not life threatening. Those people never developed smallpox. In 1796, Jenner tested the hypothesis that cowpox could be used to protect humans against smallpox. He injected a healthy eight-year-old boy with cowpox obtained from a milkmaid's sore. The boy was moderately ill and recovered. Jenner then injected the boy twice with the smallpox virus, and the boy did not get sick.

Modern knowledge of the immune system suggests that the virus that causes cowpox is similar enough to the virus that causes smallpox that the vaccine simulated an immune response to smallpox. Exposure to cowpox antigen stimulated the boy's immune system, producing cells that attacked the original antigen as well as the smallpox antigen. The vaccine also conditioned the immune system to produce antibodies more quickly and more efficiently against future infection by smallpox.

During the two centuries since its development, the smallpox vaccine gained popularity, protecting millions from contracting the disease. In 1979, following a major cooperative effort between nations and several international organizations, world health authorities declared smallpox the only infectious disease to be eradicated from the planet.

Rabies. In 1885 Louis Pasteur (1822–1895) saved the life of Joseph Meister, a nine year old who had been attacked by a rabid dog. Pasteur's series of experimental rabies vaccinations on the boy proved the effectiveness of the new vaccine.

Pasteur's rabies vaccine, the first human vaccine created in a laboratory, was made of an extract gathered from the spinal cords of rabies-infected rabbits. The live virus was weakened by drying over potash. The new vaccination was far from perfect, causing occasional fatalities and temporary paralysis. Individuals had to be injected 14 to 21 times.

The rabies vaccine has been refined many times. In the 1950s, a vaccine grown in duck embryos replaced the use of live virus, and in 1980, a vaccine developed in cultured human cells was produced. In 1998, the newest vaccine technology—genetically engineered vaccines—was applied to rabies. The new DNA vaccine cost a fraction of the regular vaccine. While only a few people die of rabies each year in the United States, more than 40,000 die worldwide, particularly in Asia and Africa. The less expensive vaccine will make vaccination far more available to people in less developed nations.

Polio. In the early 1900s polio was extremely virulent in the United States. At the peak of the epidemic, in 1952, polio killed 3,000 Americans, and 58,000 new cases of polio were reported.

In 1955 Jonas Salk (1914–1995) developed a vaccine for poliomyelitis. The Salk vaccine, a killed virus type, contained the three types of poliovirus that had been identified in the 1940s. In the first year the vaccine was distributed, dozens of cases of polio were reported in individuals who had received the vaccine or had contact with individuals who had been vaccinated. This resulted from an impure batch of vaccine that had not been completely inactivated. By the end of the incident, more than 200 cases had developed and 11 people had died.

In 1961, an oral polio vaccine developed by Albert B. Sabin (1906–1993) was licensed in the United States. The Sabin vaccine, which uses weakened, live polio viruses, quickly overtook the Salk vaccine in popularity in the United States, and is currently administered to all healthy children. Because it is taken orally, the Sabin vaccine is more convenient and less expensive to administer than the Salk vaccine.

Advocates of the Salk vaccine, which is still used extensively in Canada and many other countries, contend that it is safer than the Sabin oral vaccine. No individuals have developed polio from the Salk vaccine since the 1955 incident. In contrast, the Sabin vaccine has a very small but significant rate of complications, including the development of polio. However, there has not been one new case of polio in the United States since 1975, or in the Western Hemisphere since 1991. Though polio has not been completely eradicated, there were only 144 confirmed cases worldwide in 1999.

Influenza. Developing a vaccine against the influenza virus is problematic because the viruses that cause the flu constantly evolve. Scientists grapple with predicting what particular influenza strain will predominate in a given year. When the prediction is accurate, the vaccine is effective. When they are not, the vaccine is often of little help. However, the flu shot has had enough success that pediatricians are now recommending the vaccine for children older than 6 months.

Aids Vaccine Research

Since the emergence of AIDS in the early 1980s, research for a treatment for the disease has resulted in clinical trials for more than 25 experimental vaccines. These range from whole-inactivated viruses to genetically engineered types. Some have focused on a therapeutic approach to help infected individuals to fend off further illness by stimulating components of the immune system; others have genetically engineered a protein on the surface of HIV to prompt immune response against the virus; and yet others attempted to protect uninfected individuals. The challenges in developing a protective vaccine include the fact that HIV appears to have multiple viral strains and mutates quickly.

In January 1999, a promising study was reported in Science magazine of a new AIDS vaccine created by injecting a healthy cell with DNA from a protein in the AIDS virus that is involved in the infection process. This cell was then injected with genetic material from cells involved in the immune response. Once injected into the individual, this vaccine "catches the AIDS virus in the act," exposing it to the immune system and triggering an immune response. This discovery offers considerable hope for development of an effective vaccine. As of April, 2003, a vaccine for AIDS had not been proven in clinical trials.

Cancer Vaccine Research

Stimulating the immune system is considered key by many researchers seeking a vaccine for cancer. Currently numerous clinical trials for cancer vaccines are in progress, with researchers developing experimental vaccines against cancer of the breast, colon, and lung, among others. Promising studies of vaccines made from the patient's own tumor cells and genetically engineered vaccines have been reported. Other experimental techniques attempt to penetrate the body in ways that could stimulate vigorous immune responses. These include using bacteria or viruses, both known to efficiently circulate through the body, as carriers of vaccine antigens. These bacteria or viruses could be treated or engineered to make them incapable of causing illness.

Vaccine Production

The classic methods for producing vaccines use biological products obtained directly from a virus or a bacteria. Depending on the vaccination, the virus or bacteria is either used in a weakened form, as in the Sabin oral polio vaccine; killed, as in the Salk polio vaccine; or taken apart so that a piece of the microorganism can be used. For example, the vaccine for Streptococcus pneumoniae, which causes pneumonia, uses bacterial polysaccharides, carbohydrates found in bacteria which contain large numbers of monosaccharides, a simple sugar. The different methods for producing vaccines vary in safety and efficiency. In general, vaccines that use live bacterial or viral products are extremely effective when they work, but carry a greater risk of causing disease. This is most threatening to individuals whose immune systems are weakened, such as individuals with leukemia. Children with leukemia are advised not to take the oral polio vaccine because they are at greater risk of developing the disease. Vaccines which do not include a live virus or bacteria tend to be safer, but their protection may not be as great.

The classic types of vaccines are all limited in their dependence on biological products, which often must be kept cold, may have a limited life, and can be difficult to produce. The development of recombinant vaccines—those using chromosomal parts (or DNA) from a different organism—has generated hope for a new generation of man-made vaccines. The hepatitis B vaccine, one of the first recombinant vaccines to be approved for human use, is made using recombinant yeast cells genetically engineered to include the gene coding for the hepatitis B antigen. Because the vaccine contains the antigen, it is capable of stimulating antibody production against hepatitis B without the risk that live hepatitis B vaccine carries by introducing the virus into the blood stream.

DNA vaccines. As medical knowledge has increased—particularly in the field of DNA vaccines—researchers are working towards developing new vaccines for cancer, melanoma, AIDS, influenza, and numerous others. Since 1980, many improved vaccines have been approved, including several genetically engineered (recombinant) types which first developed during an experiment in 1990. These recombinant vaccines involve the use of so-called "naked DNA." Microscopic portions of a virus's DNA are injected into the patient. The patient's own cells then adopt that DNA, which is then duplicated when the cell divides, becoming part of each new cell. Researchers have reported success using this method in laboratory trials against influenza and malaria. These DNA vaccines work from inside the cell, not just from the cell's surface, as other vaccines do, allowing a stronger cell-mediated fight against the disease. Also, because the influenza virus constantly changes its surface proteins, the immune system or vaccines cannot change quickly enough to fight each new strain. However, DNA vaccines work on a core protein, which researchers believe should not be affected by these surface changes.

Vaccination programs. The Children's Vaccine Initiative, supported by the World Health Organization, the United Nations' Children's Fund, and other organizations, are working diligently to make vaccines easier to distribute in developing countries. More than four million people, mostly children, die every year from preventable diseases. Annually, measles kills 1.1 million children worldwide; whooping cough (pertussis) kills 350,000; hepatitis B 800,000; Haemophilus influenzae type b (Hib) 500,000; tetanus 500,000; rubella 300,000; and yellow fever 30,000. Another 8 million die from diseases for which vaccines are still being developed. These include pneumococcal pneumonia (1.2 million); acute respiratory virus infections (400,000), malaria (2 million); AIDS (2.3 million); and rotavirus (800,000). In August 1998, the Food and Drug Administration approved the first vaccine to prevent rotavirus—a severe diarrhea and vomiting infection.

Effective vaccines have limited many of the life-threatening infectious diseases. In the United States, children starting kindergarten are required to be immunized against polio, diphtheria, tetanus, and several other diseases. Other vaccinations are used only by populations at risk, individuals exposed to disease, or when exposure to a disease is likely to occur due to travel to an area where the disease is common. These include influenza, yellow fever, typhoid, cholera, and Hepatitis A and B.

The measles epidemic of 1989 was a graphic display of the failure of many Americans to be properly immunized. A total of 18,000 people were infected, including 41 children who died after developing measles, an infectious, viral illness whose complications include pneumonia and encephalitis. The epidemic was particularly troubling because an effective, safe vaccine against measles has been widely distributed in the United States since the late 1960s. By 1991, the number of new measles cases had started to decrease, but health officials warned that measles remained a threat.

This outbreak reflected the limited reach of vaccination programs. Only 15% of the children between the ages of 16 and 59 months who developed measles between 1989 and 1991 had received the recommended measles vaccination. In many cases parents erroneously reasoned that they could avoid even the minimal risk of vaccine side effects "because all other children were vaccinated."

Nearly all children are immunized properly by the time they start school. However, very young children are far less likely to receive the proper vaccinations. Problems behind the lack of immunization range from the limited health care received by many Americans to the increasing cost of vaccinations. Health experts also contend that keeping up with a vaccine schedule, which requires repeated visits, may be too challenging for Americans who do not have a regular doctor or health provider.

Internationally, the challenge of vaccinating large numbers of people has also proven to be immense. Also, the reluctance of some parents to vaccinate their children due to potential side effects has limited vaccination use. Parents in the United States and several European countries have balked at vaccinating their children with the pertussis vaccine due to the development of neurological complications in a small number of children given the vaccine. Because of incomplete immunization, whooping cough remains common in the United States, with 30,000 cases and about 25 deaths due to complications annually. One response to such concerns has been testing in the United States of a new pertussis vaccine that has fewer side effects.

Vaccines against biological weapons. The United States Centers for Disease Control have identified six diseases that are the most likely to be used in biological weapons. They are smallpox, anthrax, plague, botulism, tularemia and viral hemorrhagic fevers. Vaccines against these diseases are in various stages of development and dissemination.

After smallpox was eradicated from the United States in 1972, vaccination against the disease was discontinued. As a result, there are a substantial number of people in the United States that have never been exposed to the virus. A majority of those vaccinated may have waning immunity because the smallpox vaccine provides a high level of immunity for approximately five years, with declining immunity thereafter. The United States has recently stockpiled enough vaccine to control an outbreak in case of a crisis, and plans are underway to increase vaccine production until stockpiles include enough vaccine to inoculate the entire U.S. population against smallpox.

Anthrax is of particular note as a biological weapon because it is an airborne pathogen that can be used in conjunction with traditional weapons. A vaccine against anthrax has recently been developed and it consists of a series of six subcutaneous injections. Because antibiotics are effective against the disease, the vaccine is currently only administered to populations at high risk, such as military personnel and researchers who handle the bacterium that causes anthrax.

Tularemia is caused by the bacterium Francisella tularensis, which is an extremely infectious airborne pathogen. Tularemia is usually treated with antibiotics, but a vaccine has been developed and the Food and Drug Administration is currently testing it. To date the vaccine has only been administered to laboratory workers who contact the pathogen on a regular basis.

Vaccines against several diseases that are of concern as biological weapons have not yet been developed. Plague is caused by a bacterium Yersina pestis that is often carried by rat mites. Although research is ongoing, there is no vaccine against this disease and one is unlikely to be developed for several years. Botulism is caused by a toxin produced by the bacterium Clostridium botulinum. Although an antitoxin that reduces the severity of the symptoms is available, there is no vaccine against botulism. Viral hemorrhagic fevers are caused by any one of several viruses including Ebola, Marburg, Lassa and Machupo. No vaccine against these pathogens is currently available.

Further Reading

Books

Joellenbeck, L. M., L. L. Zwanziger, J. S. Durch, et al. The Anthrax Vaccine: Is It Safe? Does It Work? Washington, DC: National Academies Press, 2002.

Preston, R. The Demon in the Freezer. New York: Random House, 2002.

Periodicals

Bradley, K. A., J. Mogridge, M. Mourey, et al. "Identification of the Cellular Receptor for Anthrax Toxin." Nature no. 414 (2001): 225–29.

Friedlander, A. M. "Tackling Anthrax." Nature no. 414 (2001): 160–61.

Henderson, D. A. "Smallpox: Clinical and Epidemiologic Features." Emerging Infectious Diseases no. 5 (1999): 537–39.

Rosenthal, S. R., M. Merchlinsky, C. Kleppinger, et al. "Developing New Smallpox Vaccines." Emerging Infectious Diseases no. 7 (2001): 920–26.

Electronic

Centers for Disease Control and Prevention. "Smallpox Factsheet: Vaccine Overview." Public Health Emergency Preparedness and Response. December 9, 2002. <http://www.bt.cdc.gov/agent/smallpox/vaccination/facts.asp>(31 December 2002).

Rhode Island Department of Health: Bioterrorism Preparedness Program "History of Biological Warfare and Current Threat." <http://www.healthri.org/environment/biot/history.htm> (March 12, 2003).

 
Health Dictionary: vaccine
Top
(vak-seen)

A substance prepared from dead or living microorganisms that is introduced into the body through inoculation. The vaccine causes the development of antibodies, which produce immunity to the disease caused by the microorganism.

 

A suspension of attenuated or killed microorganisms (viruses, bacteria or rickettsiae), administered for prevention, amelioration or treatment of infectious diseases.

  • anti-idiotype v. — antibody made to antigenic determinants located in the variable domains of immunoglobulin molecules. Proposed as a means of regulating antibody responses and also as a substitute antigen for vaccination.
  • v.-associated sarcoma — see sarcoma.
  • attenuated v. — a vaccine prepared from live microorganisms that have lost their virulence but retained their ability to induce protective immunity. Attenuated microorganisms including particularly bacteria and viruses may be found naturally or they may be produced in the laboratory, for example by adaptation to a new medium or cell culture or they may be produced by recombinant DNA technology.
  • autogenous v. — a vaccine prepared from cultures of material derived from a lesion of the animal to be vaccinated, e.g. wart vaccine.
  • bacterial v. — a preparation of attenuated or killed bacteria, used to immunize against organisms injected, or sometimes for pyrogenetic effects in treatment of certain noninfectious diseases.
  • biosynthetic v. — a formulation containing a protective, noninfectious, immunogenic subunit produced in or by a biological system.
  • caprinized v. — a vaccine, usually a virus, attenuated by serial passage through goats, e.g. caprinized rinderpest vaccine. In highly susceptible cattle this vaccine may cause significant reactions and lapinized vaccines are preferred.
  • core v. — one that should always be included in the basic immunization program for the species.
  • dead v. — inactivated vaccine; one with organisms that have been killed.
  • DNA v. — DNA sequences that code for immunogenic proteins located in appropriately constructed plasmids which include strong promoters, which when injected into an animal are taken up by cells and the immunogenic proteins are expressed and elicit an immune response. No vaccines of this type are licensed and concerns about safety have not been resolved.
  • heterotypic v. — one developed from a virus that is antigenically distinct but related to that causing the disease for which the animal is being immunized, e.g. measles vaccine used to protect dogs from canine distemper.
  • homotypic v. — one developed from the same virus as that causing the disease the animal is being immunized against.
  • human diploid cell v. — an inactivated rabies vaccine made from rabies virus grown on human embryo lung fibroblast cells.
  • inactivated v. — see dead vaccine (above).
  • killed virus (KV) v. — see dead vaccine (above).
  • live v. — a vaccine prepared from live, usually attenuated, microorganisms.
  • v. lymph — material containing vaccinia virus collected from vaccinial vesicles of inoculated calves; used for active immunization against smallpox.
  • mixed v. — see mixed bacterial vaccine.
  • modified live virus (MLV) v. — see attenuated vaccine (above).
  • polyvalent v. — one prepared from more than one strain or species of microorganisms.
  • recombinant v. — one created by recombinant DNA technology.
  • subunit v. — one containing only specific antigenic proteins of the infectious agent.
  • synthetic peptide v. — using synthetic short peptides which correspond with major epitopes of viral proteins to elicit a protective antibody response.
  • virus-vectored v. — use of viruses as vectors to carry selected genes from another virus for immunization.
 
Word Tutor: vaccine
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pronunciation

IN BRIEF: Microbes given as an injection to produce or increase immunity to a disease.

pronunciation Scientists are working hard to develop a vaccine for the incurable disease.

 
Wikipedia: Vaccine
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A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains a small amount of an agent that resembles a microorganism. The agent stimulates the body's immune system to recognize the agent as foreign, destroy it, and "remember" it, so that the immune system can more easily recognize and destroy any of these microorganisms that it later encounters.

Vaccines can be prophylactic (e.g. to prevent or ameliorate the effects of a future infection by any natural or "wild" pathogen), or therapeutic (e.g. vaccines against cancer are also being investigated; see cancer vaccine).

The term vaccine derives from Edward Jenner's 1796 use of the term cow pox (Latin variolæ vaccinæ, adapted from the Latin vaccīn-us, from vacca cow), which, when administered to humans, provided them protection against smallpox.

Contents

History

Sometime during the 1770s Edward Jenner heard a milkmaid boast that she would never have the often-fatal or disfiguring disease smallpox, because she had already had cowpox, which has a very mild effect in humans. In 1796 Jenner took pus from the hand of a milkmaid with cowpox, inoculated an 8-year-old boy with it, and six weeks later variolated the boy's arm with smallpox, afterwards observing that the boy did not catch smallpox.[1] Since vaccination against smallpox was much safer than smallpox inoculation, the latter fell into disuse and was eventually banned in England in 1849.[citation needed] In 1885, Louis Pasteur generalized Jenner's idea by developing what he called a rabies vaccine (now termed an antitoxin), and in the 19th century vaccines were considered a matter of national prestige, and compulsory vaccination laws were passed.[1]

The 20th century saw the introduction of several successful vaccines, including those against diphtheria, measles, mumps, and rubella. Major achievements included the development of the polio vaccine in the 1950s and the eradication of smallpox during the 1960s and 1970s. As vaccines became more common, many people began taking them for granted. However, vaccines remained elusive for many important diseases, including malaria and HIV.[1]

Types

Avian flu vaccine development by reverse genetics techniques.

Vaccines are dead or inactivated organisms or purified products derived from them.

There are several types of vaccines currently in use.[2] These represent different strategies used to try to reduce risk of illness, while retaining the ability to induce a beneficial immune response.

Killed

Vaccines containing killed microorganisms - these are previously virulent micro-organisms which have been killed with chemicals or heat. Examples are vaccines against flu, cholera, bubonic plague, polio and hepatitis A.

Attenuated

Vaccines containing live, attenuated virus microorganisms - these are live micro-organisms that have been cultivated under conditions that disable their virulent properties, or which use closely-related but less dangerous organisms to produce a broad immune response. They typically provoke more durable immunological responses and are the preferred type for healthy adults. Examples include yellow fever, measles, rubella, and mumps. The live tuberculosis vaccine is not the contagious strain, but a related strain called "BCG"; it is used in the United States very infrequently.

Toxoid

Toxoids - these are inactivated toxic compounds in cases where these (rather than the micro-organism itself) cause illness. Examples of toxoid-based vaccines include tetanus and diphtheria. Not all toxoids are for micro-organisms; for example, Crotalis atrox toxoid is used to vaccinate dogs against rattlesnake bites.

Subunit

Protein subunit - rather than introducing an inactivated or attenuated micro-organism to an immune system (which would constitute a "whole-agent" vaccine), a fragment of it can create an immune response. Characteristic examples include the subunit vaccine against Hepatitis B virus that is composed of only the surface proteins of the virus (produced in yeast) and the virus-like particle (VLP) vaccine against human papillomavirus (HPV) that is composed of the viral major capsid protein.

Conjugate

Conjugate - certain bacteria have polysaccharide outer coats that are poorly immunogenic. By linking these outer coats to proteins (e.g. toxins), the immune system can be led to recognize the polysaccharide as if it were a protein antigen. This approach is used in the Haemophilus influenzae type B vaccine.

Experimental

A number of innovative vaccines are also in development and in use:

  • Recombinant Vector - by combining the physiology of one micro-organism and the DNA of the other, immunity can be created against diseases that have complex infection processes
  • DNA vaccination - in recent years a new type of vaccine, created from an infectious agent's DNA called DNA vaccination, has been developed. It works by insertion (and expression, triggering immune system recognition) into human or animal cells, of viral or bacterial DNA. Some cells of the immune system that recognize the proteins expressed will mount an attack against these proteins and cells expressing them. Because these cells live for a very long time, if the pathogen that normally expresses these proteins is encountered at a later time, they will be attacked instantly by the immune system. One advantage of DNA vaccines is that they are very easy to produce and store. As of 2006, DNA vaccination is still experimental.
  • T-cell receptor peptide vaccines are under development for several diseases using models of Valley Fever, stomatitis, and atopic dermatitis. These peptides have been shown to modulate cytokine production and improve cell mediated immunity.
  • Targeting of identified bacterial proteins that are involved in complement inhibition would neutralize the key bacterial virulence mechanism[3].

While most vaccines are created using inactivated or attenuated compounds from micro-organisms, synthetic vaccines are composed mainly or wholly of synthetic peptides, carbohydrates or antigens.

Valence

Vaccines may be monovalent (also called univalent) or multivalent (also called polyvalent). A monovalent vaccine is designed to immunize against a single antigen or single microorganism.[4] A multivalent or polyvalent vaccine is designed to immunize against two or more strains of the same microorganism, or against two or more microorganisms.[5] In certain cases a monovalent vaccine may be preferable for rapidly developing a strong immune response.[6]

Developing immunity

The immune system recognizes vaccine agents as foreign, destroys them, and 'remembers' them. When the virulent version of an agent comes along the body recognizes the protein coat on the virus, and thus is prepared to respond, by (1) neutralizing the target agent before it can enter cells, and (2) by recognizing and destroying infected cells before that agent can multiply to vast numbers.

When two or more vaccines are mixed together in the same formulation, the two vaccines can interfere. This most frequently occurs with live attenuated vaccines, where one of the vaccine components is more robust than the others and suppresses the growth and immune response to the other components. This phenomenon was first noted in the trivalent Sabin polio vaccine, where the amount of serotype 2 virus in the vaccine had to be reduced to stop it from interfering with the "take" of the serotype 1 and 2 viruses in the vaccine.[7] This phenomenon has also been found to be a problem with the dengue vaccines currently being researched, where the DEN-3 serotype was found to predominate and suppress the response to DEN-1, -2 and -4 serotypes.[8]

Vaccines have contributed to the eradication of smallpox, one of the most contagious and deadly diseases known to man. Other diseases such as rubella, polio, measles, mumps, chickenpox, and typhoid are nowhere near as common as they were a hundred years ago. As long as the vast majority of people are vaccinated, it is much more difficult for an outbreak of disease to occur, let alone spread. This effect is called herd immunity. Polio, which is transmitted only between humans, is targeted by an extensive eradication campaign that has seen endemic polio restricted to only parts of four countries.[1] The difficulty of reaching all children as well as cultural misunderstandings, however, have caused the anticipated eradication date to be missed several times.

Schedule

See also: Vaccination policy

In order to provide best protection, children are recommended to receive vaccinations as soon as their immune systems are sufficiently developed to respond to particular vaccines, with additional 'booster' shots often required to achieve 'full immunity'. This has led to the development of complex vaccination schedules. In the United States, the Advisory Committee on Immunization Practices, which recommends schedule additions for the Centers for Disease Control and Prevention, recommends routine vaccination of children against: hepatitis A, hepatitis B, polio, mumps, measles, rubella, diphtheria, pertussis, tetanus, HiB, chickenpox, rotavirus, influenza, meningococcal disease and pneumonia. The large number of vaccines and boosters recommended (up to 24 injections by age two) has led to problems with achieving full compliance. In order to combat declining compliance rates, various notification systems have been instituted and a number of combination injections are now marketed (e.g., Pneumococcal conjugate vaccine and MMRV vaccine), which provide protection against multiple diseases.

Besides recommendations for infant vaccinations and boosters, many specific vaccines are recommended at other ages or for repeated injections throughout life—most commonly for measles, tetanus, influenza, and pneumonia. Pregnant women are often screened for continued resistance to rubella. The human papillomavirus vaccine is currently recommended in the U.S. and UK for ages 11–25. Vaccine recommendations for the elderly concentrate on pneumonia and influenza, which are more deadly to that group. In 2006, a vaccine was introduced against shingles, a disease caused by the chickenpox virus, which usually affects the elderly.

In Australia, a massive increase in vaccination rates was observed when the federal government made certain benefits (such as the universal 'Family Allowance' welfare payments for parents of children) dependent upon vaccination compliance. As well, children were not allowed into school unless they were either vaccinated or their parents completed a statutory declaration refusing to immunize them, after discussion with a doctor, and other bureaucracy. (Similar school-entry vaccination regulations have been in place in some parts of Canada for several years.) It became easier and cheaper to vaccinate one's children than not to. When faced with the annoyance, many more casual objectors simply gave in.[citation needed]

Effectiveness

Vaccines do not guarantee complete protection from a disease. Sometimes this is because the host's immune system simply doesn't respond adequately or at all. This may be due to a lowered immunity in general (diabetes, steroid use, HIV infection) or because the host's immune system does not have a B cell capable of generating antibodies to that antigen.

Even if the host develops antibodies, the human immune system is not perfect and in any case the immune system might still not be able to defeat the infection.

Adjuvants are typically used to boost immune response. Adjuvants are sometimes called the dirty little secret of vaccines [2] in the scientific community, as not much is known about how adjuvants work. Most often aluminium adjuvants are used, but adjuvants like squalene are also used in some vaccines and more vaccines with squalene and phosphate adjuvants are being tested. The efficacy or performance of the vaccine is dependent on a number of factors:

  • the disease itself (for some diseases vaccination performs better than for other diseases)
  • the strain of vaccine (some vaccinations are for different strains of the disease) [3]
  • whether one kept to the timetable for the vaccinations (see Vaccination schedule)
  • some individuals are 'non-responders' to certain vaccines, meaning that they do not generate antibodies even after being vaccinated correctly
  • other factors such as ethnicity or genetic predisposition

When a vaccinated individual does develop the disease vaccinated against, the disease is likely to be milder than without vaccination.[citation needed]

The following are important considerations in the effectiveness of a vaccination program:[citation needed]

  1. careful modelling to anticipate the impact that an immunisation campaign will have on the epidemiology of the disease in the medium to long term
  2. ongoing surveillance for the relevant disease following introduction of a new vaccine and
  3. maintaining high immunisation rates, even when a disease has become rare.

In 1958 there were 763,094 cases of measles and 552 deaths in the United States.[9][10] With the help of new vaccines, the number of cases dropped to fewer than 150 per year (median of 56).[10] In early 2008, there were 64 suspected cases of measles. 54 out of 64 infections were associated with importation from another country, although only 13% were actually acquired outside of the United States; 63 of these 64 individuals either had never been vaccinated against measles, or were uncertain whether they had been vaccinated.[10]

Controversy

James Gillray, The Cow-Pock—or—the Wonderful Effects of the New Inoculation! (1802)

Opposition to vaccination, from a wide array of vaccine critics, has existed since the earliest vaccination campaigns.[11] Disputes have arisen over the morality, ethics, effectiveness, and safety of vaccination. The mainstream medical opinion is that the benefits of preventing suffering and death from serious infectious diseases greatly outweigh the risks of rare adverse effects following immunization.[12][13] Some vaccination critics say that vaccines are ineffective against disease[14] or that vaccine safety studies are inadequate.[13][14] Some religious groups do not allow vaccination,[15] and some political groups oppose mandatory vaccination on the grounds of individual liberty.[11]

Economics of development

One challenge in vaccine development is economic: many of the diseases most demanding a vaccine, including HIV, malaria and tuberculosis, exist principally in poor countries. Pharmaceutical firms and biotechnology companies have little incentive to develop vaccines for these diseases, because there is little revenue potential. Even in more affluent countries, financial returns are usually minimal and the financial and other risks are great.[16]

Most vaccine development to date has relied on 'push' funding by government, universities and non-profit organizations[17].[citation needed] Many vaccines have been highly cost effective and beneficial for public health.[16] The number of vaccines actually administered has risen dramatically in recent decades. This increase, particularly in the number of different vaccines administered to children before entry into schools[18] may be due to government mandates and support, rather than economic incentive.[citation needed]

Many researchers and policymakers are calling for a different approach, using 'pull' mechanisms to motivate industry. Mechanisms such as prizes, tax credits, or advance market commitments could ensure a financial return to firms that successfully developed a HIV vaccine. If the policy were well-designed, it might also ensure people have access to a vaccine if and when it is developed.[citation needed]

Intellectual property

Intellectual property can also be viewed as an obstacle to the development of new vaccines. Because of the weak protection offered through the patent of the final product, the protection of the innovation regarding vaccines is often made through the patent of processes used on the development of new vaccines as well as the protection of secrecy.[19]

Preservatives

Many vaccines need preservatives to prevent serious adverse effects such as the Staphylococcus infection that, in one 1928 incident, killed 12 of 21 children inoculated with a diphtheria vaccine that lacked a preservative.[20] Several preservatives are available, including thiomersal, phenoxyethanol, and formaldehyde. Thiomersal is more effective against bacteria, has better shelf life, and improves vaccine stability, potency, and safety, but in the U.S., the European Union, and a few other affluent countries, it is no longer used as a preservative in childhood vaccines, as a precautionary measure due to its mercury content.[21] Although controversial claims have been made that thiomersal contributes to autism, no convincing scientific evidence supports these claims.[22]

Delivery systems

Woman receiving rubella vaccination, Brazil, 2008.

There are several new delivery systems in development, which will hopefully make vaccines more efficient to deliver. Possible methods include liposomes and ISCOM (immune stimulating complex).[23]

The latest developments in vaccine delivery technologies have resulted in oral vaccines. A polio vaccine was developed and tested by volunteer vaccinations with no formal training; the results were very positive in that the ease of the vaccines increased dramatically. With an oral vaccine, there is no risk of blood contamination. Oral vaccines are likely to be solid which have proven to be more stable and less likely to freeze; this stability eliminates the need for a "cold chain": the resources required to keep vaccines within a restricted temperature range from the manufacturing stage to the point of administration, which, in turn, will decrease costs of vaccines. Finally, a microneedle approach, which is still in stages of development, seems to be the vaccine of the future, the microneedle, which is "pointed projections fabricated into arrays that can create vaccine delivery pathways through the skin".[24]

Plasmids

The use of plasmids has been validated in preclinical studies as a protective vaccine strategy for cancer and infectious diseases. However, the crossover application into human studies has been met with poor results based on the inability to provide clinically relevant benefit. The overall efficacy of plasmid DNA immunization depends on increasing the plasmid's immunogenicity while also correcting for factors involved in the specific activation of immune effector cells. [25]

Use in nonhumans

Vaccinations of animals are used both to prevent their contracting diseases and to prevent transmission of disease to humans[26]. Both animals kept as pets and animals raised as livestock are routinely vaccinated. In some instances, wild populations may be vaccinated. This is sometimes accomplished with vaccine-laced food spread in a disease-prone area and has been used to attempt to control rabies in raccoons.

Where rabies occurs, rabies vaccination of dogs may be required by law. Other canine vaccines include canine distemper, canine parvovirus, infectious canine hepatitis, adenovirus-2, leptospirosis, bordatella, canine parainfluenza virus, and Lyme disease among others.

Trends

Vaccine development has several trends:[27]

  • Until now, most vaccines have been aimed at infants and children, but adolescents and adults are increasingly being targeted.
  • Combinations of vaccines are becoming more common; vaccines containing five or more components are used in many parts of the world.
  • New methods of administering vaccines are being developed, such as skin patches, aerosols via inhalation devices, and eating genetically engineered plants.
  • Vaccines are being designed to stimulate innate immune responses, as well as adaptive.
  • Attempts are being made to develop vaccines to help cure chronic infections, as opposed to preventing disease.
  • Vaccines are being developed to defend against bioterrorist attacks such as anthrax, plague, and smallpox.

Principles that govern the immune response can now be used in tailor-made vaccines against many noninfectious human diseases, such as cancers and autoimmune disorders.[28] For example, the experimental vaccine CYT006-AngQb has been investigated as a possible treatment for high blood pressure.[29] Factors that have impact on the trends of vaccine development include progress in translatory medicine, demographics, regulatory science, political, cultural, and social responses.[30]

See also

References

  1. ^ a b c Stern AM, Markel H (2005). "The history of vaccines and immunization: familiar patterns, new challenges". Health Aff 24 (3): 611–21. doi:10.1377/hlthaff.24.3.611. PMID 15886151. http://content.healthaffairs.org/cgi/content/full/24/3/611. 
  2. ^ The Main Types of Vaccines
  3. ^ Meri S, Jördens M, Jarva H. Microbial complement inhibitors as vaccines. Vaccine. 2008 Dec 30;26 Suppl 8:I113-7. Review.PMID: 19388175
  4. ^ Monovalent at Dorland's Medical Dictionary
  5. ^ Polyvalent vaccine at Dorlands Medical Dictionary
  6. ^ "Questions and answers on monovalent oral polio vaccine type 1 (mOPV1) “Issued jointly by WHO and UNICEF”". http://www.pediatriconcall.com/fordoctor/medical_original_articles/oral_polio_vaccine.asp. 
  7. ^ Sutter RW, Cochi SL, Melnick JL (1999). "Live attenuated polio vaccines". in Plotkin SA, Orenstein WA (eds.). Vaccines. Philadelphia: W. B. Saunders. pp. 364–408. 
  8. ^ Kanesa-thasan N, Sun W, Kim-Ahn G, et al. (2001). "Safety and immunogenicity of attenuated dengue virus vaccines (Aventis Pasteur) in human volunteers". Vaccine 19 (23–24): 3179–3188. doi:10.1016/S0264-410X(01)00020-2. PMID 11312014. 
  9. ^ Orenstein WA, Papania MJ, Wharton ME (May 2004). "Measles elimination in the United States". J. Infect. Dis. 189 Suppl 1: S1–3. PMID 15106120. http://www.journals.uchicago.edu/cgi-bin/resolve?JID20785. 
  10. ^ a b c "Measles--United States, January 1-April 25, 2008". MMWR Morb. Mortal. Wkly. Rep. 57 (18): 494–8. May 2008. PMID 18463608. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5718a5.htm. 
  11. ^ a b Wolfe R, Sharp L (2002). "Anti-vaccinationists past and present". BMJ 325 (7361): 430–2. doi:10.1136/bmj.325.7361.430. PMID 12193361. http://bmj.bmjjournals.com/cgi/content/full/325/7361/430. 
  12. ^ Bonhoeffer J, Heininger U (2007). "Adverse events following immunization: perception and evidence". Curr Opin Infect Dis 20 (3): 237–46. doi:10.1097/QCO.0b013e32811ebfb0. PMID 17471032. 
  13. ^ a b Demicheli V, Jefferson T, Rivetti A, Price D (2005). "Vaccines for measles, mumps and rubella in children". Cochrane Database Syst Rev 19 (4). doi:10.1002/14651858.CD004407.pub2. PMID 16235361. Lay summary – Cochrane press release (PDF) (2005-10-19). 
  14. ^ a b Halvorsen R (2007). The Truth about Vaccines. Gibson Square. ISBN 9781903933923. 
  15. ^ Sinal SH, Cabinum-Foeller E, Socolar R (2008). "Religion and medical neglect". South Med J 101 (7): 703–6. doi:10.1097/SMJ.0b013e31817997c9 (inactive 2008-10-26). PMID 18580731. 
  16. ^ a b Goodman, Jesse L. (2005-05-04). "Statement of Jesse L. Goodman, M.D., M.P.H. Director, Center for Biologics, Evaluation and Research Before the Committee on Energy and Commerce United States House of Representatives". http://www.fda.gov/ola/2005/influenza0504.html. Retrieved on 2008-06-15. 
  17. ^ Olesen O.F., Lonnroth A., Mulligan B. (2009). "Human vaccine research in the European Union". Vaccine 27 (5): 640-5. doi:10.1016/j.vaccine.2008.11.064. PMID 19059446. 
  18. ^ Ihara T. The strategy for prevention of measles and rubella prevalence with measles-rubella (MR) vaccine in Japan. Vaccine. 2009 Mar 5. [Epub ahead of print]PMID: 19366578
  19. ^ Hardman Reis T (2006). "The role of intellectual property in the global challenge for immunization". J World Intellect Prop 9 (4): 413–25. doi:10.1111/j.1422-2213.2006.00284.x. 
  20. ^ "Thimerosal in vaccines". Center for Biologics Evaluation and Research, U.S. Food and Drug Administration. 2007-09-06. http://www.fda.gov/cber/vaccine/thimerosal.htm. Retrieved on 2007-10-01. 
  21. ^ Bigham M, Copes R (2005). "Thiomersal in vaccines: balancing the risk of adverse effects with the risk of vaccine-preventable disease". Drug Saf 28 (2): 89–101. doi:10.2165/00002018-200528020-00001. PMID 15691220. 
  22. ^ Offit PA (2007). "Thimerosal and vaccines—a cautionary tale". N Engl J Med 357 (13): 1278–9. doi:10.1056/NEJMp078187. PMID 17898096. http://content.nejm.org/cgi/content/full/357/13/1278. 
  23. ^ Morein B, Hu KF, Abusugra I (2004). "Current status and potential application of ISCOMs in veterinary medicine". Adv Drug Deliv Rev 56 (10): 1367–82. doi:10.1016/j.addr.2004.02.004. PMID 15191787. 
  24. ^ Giudice EL, Campbell JD (2006). "Needle-free vaccine delivery". Adv Drug Deliv Rev 58 (1): 68–89. doi:10.1016/j.addr.2005.12.003. PMID 16564111. 
  25. ^ Lowe et al. (2008). "Plasmid DNA as Prophylactic and Therapeutic vaccines for Cancer and Infectious Diseases". Plasmids: Current Research and Future Trends. Caister Academic Press. ISBN 978-1-904455-35-6. 
  26. ^ Patel JR, Heldens JG. Immunoprophylaxis against important virus disease of horses, farm animals and birds. Vaccine. 2009 Mar 13;27(12):1797-1810. Review. PMID: 19402200
  27. ^ Plotkin SA (2005). "Vaccines: past, present and future". Nat Med 11 (4 Suppl): S5–11. doi:10.1038/nm1209. PMID 15812490. 
  28. ^ Spohn G, Bachmann MF (2008). "Exploiting viral properties for the rational design of modern vaccines". Expert Rev Vaccines 7 (1): 43–54. doi:10.1586/14760584.7.1.43. PMID 18251693. 
  29. ^ Samuelsson O, Herlitz H (2008). "Vaccination against high blood pressure: a new strategy". Lancet 371 (9615): 788–9. doi:10.1016/S0140-6736(08)60355-4. PMID 18328909. 
  30. ^ Poland GA, Jacobson RM, Ovsyannikova IG. Trends affecting the future of vaccine development and delivery: The role of demographics, regulatory science, the anti-vaccine movement, and vaccinomics. Vaccine. 2009 May 26;27(25-26):3240-4. Epub 2009 Feb 5.PMID: 19200833

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Translations: Vaccine
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Dansk (Danish)
n. - vaccine

Nederlands (Dutch)
vaccin

Français (French)
n. - vaccin

Deutsch (German)
n. - Impfstoff

Ελληνική (Greek)
n. - (ιατρ.) εμβόλιο, βατσίνα

Italiano (Italian)
vaccino

Português (Portuguese)
n. - vacina (f) (Med.)

Русский (Russian)
вакцина, относящийся к коровьей оспе

Español (Spanish)
n. - vacuna

Svenska (Swedish)
n. - vaccin

中文(简体)(Chinese (Simplified))
疫苗

中文(繁體)(Chinese (Traditional))
n. - 疫苗

한국어 (Korean)
n. - 우두창, 두묘, 백신

日本語 (Japanese)
n. - ワクチン, 痘苗

العربيه (Arabic)
‏(الاسم) لقاح, طعم‏

עברית (Hebrew)
n. - ‮חיסון, תרכיב‬


 
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