Vaccines Have Serious Side Effects

The Revised Authoritative Guide To Vaccine Legal Exemptions

Comprehensive, authoritative information about vaccine exemptions you can trust, from Alan Phillips, J.D., a leading vaccine rights attorney with years of experience helping clients throughout the U.S. legally avoid vaccines in a wide variety of vaccine-refusal settings. Critical details for parents, students, immigrants, healthcare employees, military personnel and contractors, agencies, attorneys and clientsvirtually anyone concerned with legally avoiding vaccines in the United States. This Guide provides and explains: Important background information about the legal system; How state and federal statutes, regulations, constitutions and legal precedent interact to define the boundaries of your legal exemption rights; How to deal with local authorities and to avoid mistakes that cost others their exemption; Where legal technicalities and practical reality differand what to do about it; Read more...

The Revised Authoritative Guide To Vaccine Legal Exemptions Summary


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Active Specific Immunotherapy Tumor Vaccines

Tumor vaccine therapy is based on the premise that tumor antigen presented in the context of an adjuvant or other stimulatory immune signal may induce the immune system to generate an effective response against tumor. The main challenge of any active antitumor immunization strategy is to elicit an immune response against antigens to which the immune system is tolerant. A diverse set of vaccination strategies has been created in pursuit of this goal. The strategies fall into two main categories those that immunize with an identified TAA and those that use either whole cells or components of whole cells. Tumor-specific antigen strategies include the use of purified antigenic peptide, whole proteins containing the antigenic peptide, and naked DNA that codes for the antigen, all administered in the context of a nonspecific adjuvant (e.g., Freund's incomplete adjuvant) or immunostimulatory cytokines such as GM-CSF (granulocyte-macrophage colony-stimulating factor). Whole-cell strategies...

Measles Mumps and Rubella Vaccine

The measles-mumps-rubella (MMR) vaccine should be given to children 12 to 15 months of age. The second MMR or measles-mumps-rubella-varicella (MMRV) vaccine is recommended before school entry at 4 to 6 years of age, but it can be given earlier in the event of an outbreak or as a requirement for travel, provided the second dose is given at least 28 days after the first. Physicians should review their records to ensure that all children receive the second MMR or MMRV by 11 to 12 years of age. Children may be immunized with MMR even if there is a pregnant or immunosuppressed family member, because the vaccine viruses are not transmitted (AAP Red Book, 2009, 47).

Haemophilus Influenzae Type b Conjugate Vaccine

The use of H. influenzae type b (Hib) conjugate vaccines has lowered the U.S. incidence of invasive Hib disease in children younger than 5 years of age by 99 . Vaccines currently available in the United States, such as HbOC (HibTITER), PRP-OMP (PedvaxHIB), and PRP-T (ActHIB, OmniHIB), are given beginning at age 2 months. ActHIB reconstituted with Tripe-dia as Trihibit is licensed only for the fourth dose of Hib and DTaP, while PRP-T (Hiberix) is licensed for use as a booster in children 15 months through 4 years of age (CDC,2009). PRP-OMP-HepB (Comvax) is administered at 2, 4, and 12 to 15 months of age and DTaP-IPV PRP-T (Pentacel) at 2, 4, 6, and 15 to18 months of age (AAP Red Book, 2009, 318-321). The schedule of administration varies according to the type of vaccine, as shown in eTables 23-3 and 23-4. Children age 15 to 59 months of age usually need only 1 dose of any Hib conjugate vaccine. Children with conditions predisposing to invasive Hib disease, such as sickle cell anemia,...

Acellular Pertussis Vaccine

Acellular pertussis vaccines combined with diphtheria and tetanus toxoids (DTaP) are used in the United States for the primary and booster doses in children. These vaccines (DAP-TACEL, Infanrix, Tripedia) are immunogenic and produce fewer adverse local and systemic reactions, such as fever and irritability, than do whole-cell pertussis vaccines. Whenever possible, the same DTaP vaccine should be used throughout the entire vaccination series, b ecause there are no data on safety or efficacy when different formulations of these vaccines are interchanged. However, if the previously used vaccine is not known or is unavailable, any of the DTaP vaccines licensed for use in children may be given to complete the immunization series. Combination vaccines such as DTaP-IPV-HepB (Pedi-arix) and DTaP-IPV-Hib (Pentacel) are licensed for use as the first 3 doses and first 4 doses, respectively, of their components, whereas DTaP-IPV (Kinrix) is licensed only as the booster fifth dose of DTaP and...

Conjugate Pneumococcal Vaccine

The 13-valent conjugate pneumococcal vaccine (PCV13) covers 64 of the serotypes that cause invasive pneumococ-cal disease in children younger than 5 years old. The vaccine stimulates effective antibodies to all 13 serotypes in over 90 of recipients after three doses and is given to infants at 2, 4, 6, and 12 to 15 months of age. Children 7 to 11 months old require 2 doses 2 months apart, followed by a third dose at 12 to 15 months of age (2 or more months later). Children 12 to 23 months old require 2 doses 2 months apart. Only 1 dose is required for all healthy children 24 to 59 months of age. Children age 24 to 71 months at high risk for invasive pneumococcal disease should receive 2 doses of vaccine at least 8 weeks apart if they have not been previously immunized (CDC, 2010).

Conjugate Meningococcal Vaccine

Tetravalent meningococcal polysaccharide-protein conjugate vaccine (MCV4, Menactra, Sanofi Pasteur and Menveo, Novartis) has been licensed in the United States for use in persons 2 to 10 years old and 11 to 55 years old. Routine immunization of all children age 11 to 18 years and especially 11 to 12 years at a health-care visit is recommended. The vaccines contain serogroups A, C, Y, and W-135, as does the current meningococcal polysaccharide vaccine (MPSV4). Serogroups C, Y, and W-135 cause 75 of all cases of menin-gococcal disease in persons older than 11 years in the United States (Bilukha and Rosenstein, 2005). Neither vaccine is protective against serogroup B, which accounts for most of the remaining cases. Persons 2 to 55 years with terminal complement or properdin deficiencies, anatomic or functional asplenia, and HIV should receive two doses 2 months apart (CDC, 2011). Travelers to countries with hyperendemic or epidemic Neisseria meningitidis (e.g., sub-Saharan Africa, Mecca...

Human Papillomavirus Vaccine

Although most human papillomavirus (HPV) infections spontaneously resolve, high-risk HPV types are found in 99 of cervical cancers with types 16 and 18, accounting for about 70 of cervical cancers worldwide. HPV is also believed to account for 90 of anal cancers 40 of vulvar, vaginal, or penile cancers and 12 of oral and pharyngeal cancers. Types 6 and 11 HPV account for 90 of genital warts and laryngeal papillomatosis. The bivalent HPV (types 16, 18) vaccine (Cervarix) and the quadrivalent HPV (types 6, 11, 16, 18) vaccine (Gardasil) are licensed for use in U.S. females age 10 to 25 and 9 to 26 years, respectively. Both are recommended for routine vaccination at age 11 or 12 years and are ideally given before onset of sexual intercourse. The bivalent HPV vaccine is given in a 3-dose series at time 0, 1, and 6 months and the quadrivalent HPV vaccine in a 3-dose series at time 0, 2, and 6 months, with the third dose following the first dose by at least 24 weeks (CDC Pink Book, 2009,...

National Childhood Vaccine Injury

The National Childhood Vaccine Injury Act of 1986 was passed to provide compensation for children inadvertently injured by any of the routinely recommended childhood vaccines and to provide liability protection for manufacturers and for health care providers who administer the vaccines. The intent of the law is to ensure a stable supply of vaccine and allow routine immunizations to continue. The physician or other health care provider must maintain permanent documentation of the date, vaccine type, manufacturer, lot number, and name, address, and title of the person administering the vaccine. A list of reportable but not necessarily compensable events is available from the Health Resources and Services Administration. Significant adverse events Centers for Disease Control and Prevention developmental screening for health care providers excellent information about child development and screening with helpful links and patient material. Centers for Disease Control and Prevention,...

Failures in vaccination

Vaccines may be ineffective for various reasons and owners must be aware that the veterinary surgeon may refuse to vaccinate their animal if an underlying illness or complications are suspected. Newly acquired puppies should not be brought to the surgery until they have had time to settle, as stress will have a negative effect on the immune system, causing vaccine failure. Older animals presented for vaccination without a current vaccine certificate will, depending on age and health, be given a full booster vaccination to ensure that the animal is truly protected against all infectious diseases (Table 21.3). Primary vaccine courses should be administered when the passive immunity received from the mother has decreased, as maternally derived antibody (MDA) interferes with the neonate's ability to respond to a vaccine. Delaying vaccination until MDA wanes may result in some puppies or kittens becoming infected and suffering the disease. Animals suffering systemic disease will suffer...

Haemophilus influenzae Type b Vaccine

Haemophilus influenzae is a bacterial respiratory pathogen that causes a wide spectrum of disease ranging from colonization of the airways to bacterial meningitis. It causes considerable morbidity and mortality, especially in children less than 5 years of age. H influenzae is either encapsulated or unencapsulated. The encapsulated strains can be further differentiated into six antigenically distinct serotypes, a through f. H in-fluenzae type b was primarily found in cerebrospinal fluid and blood of children with meningitis, while the unencapsulated strains were found in the upper respiratory tract of adults. Before the introduction of the vaccine, H influenzae was responsible for 20,000 to 25,000 cases of invasive disease annually and was the most common cause of bacterial meningitis. Since the introduction of the vaccine, invasive disease due to H influenzae type b has been nearly eliminated. The H influenzae type b vaccine is a protein conjugate that utilizes a carrier-hapten for...

Use of Measles Mumps and Rubella Vaccine

Measles, mumps, and rubella vaccines are available as single component vaccines or as combinations. Most authorities recommend use ofthe measles, mumps, and rubella combination vaccine and discourage use ofthe single- or double-component vaccines. Two doses of the measles, mumps, and rubella vaccine are recommended for all individuals born after 1957. The first dose should be administered soon after the first birthday and the second prior to entering school. For high-risk adolescents and adults who do not have adequate immunity, two doses ofthe vaccine should be separated by a minimum of 28 days.11 Measles, mumps, and rubella vaccine is a live virus vaccine that should be used with caution in immunosuppressed children, such as those with cancer receiving chemotherapy, solid organ or bone marrow transplantation, or receiving other immun-osuppressive drugs, such as steroids in a dose equivalent to prednisone 1 mg kg day or higher or 20 mg day for 2 weeks or longer. If possible, vaccines...

Pneumococcal Vaccines

Streptococcus pneumoniae is the most common bacterial cause of community-acquired respiratory tract infections. Spneumoniae causes approximately 3,000 cases of meningitis, 50,000 cases of bacteremia, 500,000 cases of pneumonia, and over 1 million cases of otitis media each year. The increasing prevalence of drug-resistant S pneumoniae has highlighted the need to prevent infection through vaccination. Both licensed pneumococcal vaccines are highly effective in preventing disease from the common S pneumoniae sero-types that cause human disease. The 23-valent pneumococcal polysaccharide vaccine contains 23 serotypes that are responsible for causing more than 80 of invasive Spneumoniae infections in adults. The vaccine includes those serotypes that are associated with drug resistance. Use of the vaccine will not prevent the development of antibiotic-resistant Spneumoniae, but is likely to prevent infection from drug-resistant strains. The 23-valent pneumococcal polysaccharide vaccine has...

The routine vaccines Diphtheria Tetanus and Pertussis Vaccines Diphtheria Toxoid

Diphtheria is a bacterial respiratory infection characterized by membranous pharyngitis. The membrane may cover the pharynx, tonsillar areas, soft palate, and uvula. Diphtheria may also cause anal, cutaneous, vaginal, and conjunctival infections. The impact of diphtheria is not from the causative bacteria, Corynebacterium diphtheriae, but rather from complications attributed to its exotoxin, such as myocarditis and peripheral neuritis. In the late 1800s, annual death rate from diphtheria ranged from 46 to 196 cases per 100,000. Mortality from diphtheria dropped in the 1900s mostly due to the availability of diphtheria antitoxin, which elicited passive immunity. Diphtheria is rarely reported in the United States since the introduction of vaccination with diphtheria toxoid however, diphtheria continues to be a major problem in developing countries. In the 1940s, diphtheria toxoid was combined with tetanus toxoid and whole cell pertussis vaccines, and later with the acellular pertussis...

Disease Against Which Vaccination Is Resorted Onlybduring Epidemics

Modern techniques of inoculation and vaccination began - no one knows when or where - with variolation (artificial infection with smallpox of healthy people), an effort to produce immunity through mild cases of the disease. In China, smallpox scabs were blown up the nostril, seemingly a dangerous method because it might infect the respiratory tract, but the scabs were apparently aged first, attenuating the virus. Elsewhere, variolation generally involved scratching infected matter into the skin. If variolation was expert, the infection was mild and death rates no more than 4 percent. Jenner published his results in 1798. Vaccination may have been practiced before by common folk, like variolation, but now one of the elite had printed an account of the technique for the whole world to read, and that made all the difference. England led the way - more than 100,000 were vaccinated there by 1801 - and the rest of the world followed. Within 3 years of Jenner's publication, his work was...

Vaccine administration schedules

Most vaccines are administered in two- to four-shot series in order to elicit the best protection. Childhood and adult immunization schedules are revised frequently and published annually by the CDC Advisory Committee on Immunization Practices. Current immunization schedules can be found at The childhood schedule is published in January and the adult schedule in October of each year. Recommendations will be published throughout the year in the Morbidity and Mortality Weekly Report (MMWR) as new vaccines are licensed or new information necessitates a change in previous recommendations. Table 86-2 Vaccine Reportable Events

Vaccines toxoids antitoxins and antisera

A vaccine is a substance given to stimulate active immunity against a known disease or diseases. They may be live, con Killed or dead vaccines contain inactivated pathogen - these tend to be less effective than live vaccines and may contain an adjuvant to enhance their effect. Some inactivated vaccines contain purified versions of toxins produced by the pathogen in question, in order to stimulate immunity to that toxin. These products are called toxoids. In certain circumstances, it may be necessary to give immediate protection against a disease rather than waiting for the animal's own immune system to respond to a vaccine. This type of passive immunity is achieved by administering antibodies to an animal that have been produced by another animal (usually of the same species). These antibodies are known as antitoxins and they are administered in fluid known as antiserum. Although passive immunity is immediate, it does not last long.

CD40LIL2 BCLL Tumor Vaccines

We are treating patients with chronic B-lymphocytic leukemia using a vaccine in which human CD40 ligand and human IL2 are expressed transgenically.19 CD40 ligand has a number of immuno-stimulatory effects. It activates and matures dendritic cells, co-stimulates T cells, and it stimulates the B leukemia cells themselves through their CD40 receptor. B-CLL activation is, in turn, accompanied by up-regulation of MHC Class II molecules and of co-stimulator molecules CD80 and CD86 on the malignant cells, improving their ability to present their own tumor-associated antigens. In animal studies we found that the effects of CD40 lig-and were potentiated if the vaccine also expressed Interleukin 2, because this cytokine amplified immune responses made to the CD40L tumor vaccine.20 We used this vaccine to treat eight patients between 46 and 71 years of age, looking for evidence of toxicity, an immune response to the tumor, and a tumor response.

Targeting Side Population Tumor Cells with Tumor Vaccines

Side Population Was Higher

Fig. 7-5 Normal and malignant Side Population (SP) Cells. a) Normal side population cells (gating shown) with high Hoechst dye efflux. b) Malignant SP cells from patient with B-CLL. After vaccination with hCD40L and hIL2 expressing autologous B-CLL, most patients had a temporary decline in SP cells, which then reappeared. In this patient, however, the cells disappeared during vaccination and did not return Fig. 7-5 Normal and malignant Side Population (SP) Cells. a) Normal side population cells (gating shown) with high Hoechst dye efflux. b) Malignant SP cells from patient with B-CLL. After vaccination with hCD40L and hIL2 expressing autologous B-CLL, most patients had a temporary decline in SP cells, which then reappeared. In this patient, however, the cells disappeared during vaccination and did not return Malignant cells from B-CLL patients also contain a Side Population. Like other tumor SP cells, B-CLLL SP have a more primitive phenotype than the non-SP B-CLL, and over-express...


The fact that many of the fatal and debilitating diseases to which cats and dogs can succumb are relatively rare is entirely due to vaccination programmes. Unfortunately many pet owners do not realise this and do not understand that immunity can only be maintained through booster vaccinations. It is the job of veterinary staff to educate their clients in this subject and to encourage them by incorporating free health checks and sending booster reminders. Particular care should be taken in ensuring that pets entering boarding establishments and breeding bitches and queens are up to date with their vaccinations.

Poliovirus Vaccine

The last indigenous case of wild-type poliomyelitis in the United States occurred in 1979, and the last identified imported case occurred in 1993. From 1980 to 1996, there were approximately eight cases per year of vaccine-associated paralytic poliomyelitis (VAPP) caused by oral poliovirus vaccine (OPV) in the United States. In 2000, inactivated poliovirus vaccine (IPV) was recommended for all routine childhood polio vaccinations in the United States, and only one case of VAPP was imported from Central America in 2005 (AAP Red Book, 2009, 541).

Rotavirus Vaccine

Rotavirus is responsible for up to 500,000 deaths from diarrhea worldwide and 20 to 60 U.S. deaths in each year. Before the introduction of rotavirus vaccines (RV1 or Rotarix, RV5 or RotaTeq), rotavirus caused 3 million infections per year in the United States, resulting in more than 400,000 physician visits and 55,000 to 70,000 hospitalizations per year (CDC Pink Book, 2009, 245-256). RV1 is given as 2 oral doses at 2 and 4 months of age, and RV5 is given as 3 oral doses at 2, 4, and 6 months of age. The minimum interval between doses of either vaccine is 4 weeks. Neither vaccine should be started for infants age 15 weeks, 0 days or older, and all doses must given by 8 months, 0 days of age. The vaccine-specific package insert should be seen for full prescribing indications and contraindications.

Varicella Vaccine

Two SC doses of monovalent varicella (VZV) vaccine or MMRV are indicated in children age 12 months through 12 years. The doses should be separated by at least 3 months, with the second dose routinely recommended at age 4 to 6 years before kindergarten or first grade. Persons 13 years or older who do not have evidence of immunity to varicella should receive 2 doses of VZV vaccine at least 28 days apart because MMRV is not licensed in this age group. A second dose of varicella vaccine should be given to people who previously received only 1 dose. The vaccine is generally contra-indicated in pregnant women, immunodeficient persons, or those receiving high doses of systemic corticosteroids ( 20 mg day of prednisone or equivalent) for 14 days or more. However, VZV vaccine may be considered for HIV-infected patients with a CD4+ T-lymphocyte count of 15 or greater. Vaccine-strain VZV has been rarely transmitted, and vaccinated patients who develop a rash should avoid contact with...

Hepatitis A Vaccine

Inactivated vaccines, HAVRIX and VAQTA, are licensed in the United States for use in children age 1 year and older. TWINRIX is a combined hepatitis A and hepatitis B vaccine licensed for use in persons at least 18 years old. Physicians should consult the package insert for proper dosing because there are different formulations of these vaccines. Childhood vaccination against HAV is recommended for all U.S. children 12 to 23 months of age and should be considered for unimmunized children ages 2 to 18 years old. Indications for immunization with hepatitis A vaccine include travel to or residence in countries or areas endemic for hepatitis A, residence in Native American or Alaskan Native communities with high rates of HAV infection, persons who receive clotting-factor concentrates, persons with chronic liver disease, injection drug users (IDUs), men who have sex with men (MSM), and people at risk of occupational (e.g., handlers of primates), household, and sexual exposure (AAP Red Book,...

Hepatitis B Vaccine

Hepatitis B virus (HBV) is endemic in Southeast Asia, the Pacific Islands, China, Africa, parts of the Middle East, and the Amazon Basin. More than 350 million people worldwide have chronic HBV infection. Although transmission in U.S. children is less likely because of high coverage with HBV vaccine, the risk of perinatal transmission of HBV from an infected mother to her infant varies from 10 to as high as 90 , depending on whether the mother is negative or positive for hepatitis B e antigen (HBeAg) (CDC Pink Book, 2009, 99-122). Immunization with the pediatric formulations of hepatitis B vaccine is recommended for all infants soon after birth or before hospital discharge. HBV vaccine should be given to newborns of mothers positive for hepatitis B surface antigen (HBsAg) or infants of mothers whose HBsAg status is unknown. An infant born to an HBsAg-positive mother should receive an initial dose of 5 .g Recombivax HB or 10 .g Engerix-B and 0.5 mL of hepatitis B immune globulin (HBIG)...

Influenza Vaccine

Routine annual immunization with trivalent inactivated influenza (TIV) vaccine is now recommended for all persons 6 months of age and older, including these with high-risk conditions such as HIV, chronic pulmonary (including asthma), cardiac, renal, or metabolic diseases those receiving immunosuppressive or long-term aspirin therapy those who have hemoglobinopathies, and those with any condition (e.g., cognitive dysfunction, seizure disorder, neuromus-cular disorder) that could compromise respiratory function. TIV vaccine is also recommended for pregnant women and persons who are household contacts of high-risk patients, including health care workers. Several TIV products are now available, and providers should read the prescribing information regarding the appropriate age and dosing of these vaccines. Live, attenuated influenza vaccine (LAIV) is approved for use in healthy persons age 2 through 49 years and not pregnant. LAIV should not be used in persons with asthma or those in...

Types of vaccine

There are two types of vaccine used within current veterinary practice and they both have advantages and disadvantages (Table 21.4) Live attenuated (modified) vaccine- contains live organisms that have been attenuated by culturing the pathogen in controlled conditions, e.g. canine parvovirus, feline infectious enteritis. These stimulate a good immune response but have the risk of causing the disease Killed (inactivated) vaccine- contains dead organisms killed by ultraviolet, heat or sublethal chemicals such as formalin, e.g. leptospirosis. As the dead organisms can not replicate within the body, several doses are required to produce sufficient antibody levels

Vaccine management

A course of two or sometimes three vaccinations are given to provide protection to the vulnerable young animal whose immune system is underdeveloped. The first vaccination is given as the maternally derived antibody levels begin to fall, and antibodies will be formed within 7-10 days. A second dose is given 2-3 weeks later, stimulating the production of yet more antibodies with a quicker response time of 12-24 h. This initial course provides antibodies for several months and should be reinforced 1 year later with a 'booster' vaccine to 'top-up' the acquired immunity. Failure to present the animal for the initial booster may result in a two-dose vaccine programme comparable to the primary course. In addition, the animal can gain natural active immunity when exposed to disease, creating further antibodies and protection. The vaccines are administered by the following routes Subcutaneous route - this is the most common route and is given in the scruff. The site of injection needs to be...

Zoster Vaccine

Zoster vaccine is a more concentrated form of the varicella vaccine. It is recommended for use in individuals 60 years of age and older. Use of the zoster vaccine has shown a 60 reduction in the incidence of zoster and postherpetic neuralgia. There is decreased effectiveness of the vaccine with increasing age. The varicella vaccine is relatively new and has only been recommended for use since 1996, therefore its true impact on chickenpox and zoster is not yet known. Continued use of the varicella vaccine will undoubtedly change the epidemiology of both of these diseases. As the prevalence of chickenpox declines, the rate of zoster will likely increase in the elderly making vaccination with the zoster vaccine more prudent.1

Combination vaccines

Lead to missed vaccinations and increased expense for return visits. Use of com bination vaccines decreases the number of injections and increases the likelihood that the immunization schedule would be completed. Many factors have to be considered when developing combination vaccines. First the selected components need to be given on a similar schedule and all components should already be licensed in the United States. The excipients contained in the individual vaccines may interfere with another component when combined, altering a component's immunogenicity. Finally, the immunogenicity of the combination must be similar (within 10 ) to the immune response when the components are administered separately.20 There are several combination vaccines available in the United States. One of the most popular pediatric combinations is Pediarix, a combination of diphtheria and tetanus toxoids, acellular pertussis, inactivated poliovirus, and hepatitis B vaccines. Pentacel was recently approved...

Vaccine safety

Vaccination is one of the most powerful tools used to prevent disease. As with all drugs, most vaccines have been reported to cause adverse reactions. The reactions are either acute, such as local reactions, or are related to the risk of developing another disease. Health care professionals are to give vaccine information sheets to individuals or caregivers prior to vaccination these provide information about the risks and benefits of each vaccine. Vaccine safety is monitored by the FDA and CDC through a passive reporting system that allows anyone, health professionals or lay public, to report any event. Health care professionals are bound by federal regulation to report certain adverse events (Table 86-2). Additionally, any serious, life-threatening or unusual reactions should also be reported. The Vaccine Adverse Event Reporting System (VAERS) can be found at http vaccine. One of the limitations of the VAERS data is that it does not contain denominator data. Therefore...


Vaccines are major public health tools that are responsible for the eradication of smallpox, the prevention of childhood diseases, and the control of many injurious illnesses. Treatment with a vaccine results in the development of antibodies specific for some target, known as an antigen. The antigen can be a virus, for example, but it is really a protein that is part of the virus. When the antibody binds to the protein on the virus, the virus is prevented from infecting the cells of the vaccinated host. Antibody molecules are Y-shaped proteins that bind to the antigen at the tip of the two arms of the Y. The binding is highly specific for the antigen in the vaccine, and the antibody can be thought of as a specific deactivator or blocker. Although we most often think of antibodies as protecting us against infectious diseases, antibodies can also be made against specific drug molecules. In 1973, Drs. B. Wainer, F. Fitch, R. Rothberg, and C.R. Schuster published a paper in Nature showing...

HPV Vaccination

The second scenario focuses on what effect a vaccine against HPV could have. There is a clear rationale in vaccinating young females to prevent cervical cancer. Vaccinating males has been suggested to reduce the total HPV burden in the population as a whole 2 often described as the herd effect . It is attractive to consider vaccinating both males and females to prevent HPV-related malignancies. In particular, cost-effectiveness analysis favors male vaccination in the circumstance of poor uptake by females. It is estimated that the cost of investigating and treating HPV in males between age 15 and 24 is 2.9 billion per annum.23 This is the same direct medical costs as for HIV, whereas genital herpes costs one-tenth of this and hepatitis B only 5.8 million. HPV is implicated in up to 90 of early penile cancer. This scenario goes to the extreme position of how much a national program of vaccinating all males aged up to 22 years, from the year 2012, would impact on the incidence of penile...


Worldwide vaccination programs have had unparalleled success during this century to reduce the incidence of serious infectious diseases. Neurological sequelae of vaccinations have been reported, although assigning a causative relationship for vaccine injuries is difficult because randomized double-blind placebo controlled studies have not been systematically conducted. There are five types of vaccines available whole-killed organisms, live-attenuated viruses, toxoids or components, conjugated vaccines, and recombinant vaccines ( Xab e,, 55 12 ). TABLE 55-12 -- TYPES OF VACCINES TABLE 55-12 -- TYPES OF VACCINES Vaccines composed of whole-killed organisms include the influenza, poliomyelitis (IPV), pertussis, and rabies vaccines. Administration of the inactive antigens provokes an immune response that creates immunity without causing the disease. Vaccines made from whole-killed organisms may cause a variety of immune-mediated reactions. Pertussis. Standard pertussis vaccine prepared...

Structure of The Cochrane Collaboration

Cochrane Review Groups are supported in review preparation by Methods Groups, Centres and Fields. Cochrane Methods Groups provide a forum for methodologists to discuss development, evaluation and application of methods used to prepare Cochrane reviews. They play a major role in the production of the Cochrane Handbook for Systematic Reviews of Interventions (the Handbook) and, where appropriate, chapters contain information about the relevant Methods Group. Cochrane Centres are located in different countries and together they represent all regions and provide training and support for review authors and CRGs in addition to advocacy and promotion of access to Cochrane reviews. Cochrane Fields focus on broad dimensions of health care, such as the setting of care (e.g. primary care), the type of consumer (e.g. children), or the type of intervention (e.g. vaccines). People associated with Fields help to ensure that priorities and perspectives in their sphere of interest are reflected in the...

Acquired immune deficiency syndrome

(AIDS), first identified in 1981, is an infectious disease characterized by failure of the body's immunologic system. Affected individuals become increasingly vulnerable to many normally harmless microorganisms, eventually leading to severe morbidity and high mortality. The infection, spread sexually and through blood, has a high fatality rate, approaching 100 percent. Caused by a human retrovirus known as HIV-1, AIDS can now be found throughout the world -in both industrialized countries and developing nations. Public-health officials throughout the world have focused attention on this pandemic and its potentially catastrophic impact on health, resources, and social structure. Treatments for the disease have been developed, but no cure or vaccine currently exists.

Active Immunotherapy Dendritic Cell Therapy

Dendritic cell therapy is a logical extension of the strategies developed for tumor vaccination. Whereas tumor vaccines seek to place tumor antigen in an immunostimulatory context designed to activate antigen uptake and presentation by APCs, dendritic cell therapy allows for the direct manipulation of the APC. Recent improvements in technique now allow for the isolation and in vitro expansion of dendritic cells in a manner practical for clinical application. One of the chief benefits of directly manipulating dendritic cells in vitro is that the cells can be activated and exposed to antigen in a precisely controlled environment that avoids any immunosuppressive influence that may exist in vivo. Once loaded with antigen and stimulated to an activated state, dendritic cells can then be readministered and mediate T-cell activation. Many different strategies are employed to deliver antigen and create an activated state. Dendritic cells have been loaded with antigenic peptide, tumor...

Effectiveness of Early Detection and Intervention

Two vaccines are designed to protect against the major strains of high-risk HPV. The quadrivalent HPV vaccine (types 6, 11, 16, 18) is currently approved by the U.S. Food and Drug Administration (FDA) for a three-injection series, which is maximally effective if given before the first sexual experience. Pap screening is still necessary even if the woman is fully vaccinated.

Treatment and Control

The attenuated live yellow fever virus vaccine (17D) has been used for over 50 years in the successful immunization of millions of people. A live attenuated dengue virus vaccine is being tried. A killed Japanese encephalitis virus vaccine is given to millions of people in the Orient. A killed RSSE virus vaccine is used extensively in parts of the former Soviet Union. Killed virus vaccines against EEE, western equine encephalitis, Venezuelan equine encephalitis, and Rift Valley fever virus are used primarily to protect livestock. Laboratory workers studying these viruses are routinely immunized.

Occupationally acquired infections

The main concern of healthcare workers relates to the risk of infection with blood-borne viruses, notably HIV. Hepatitis B remains the major infectious occupational hazard for surgeons and other healthcare workers who, prior to the availability of a vaccine, were up to ten times more likely to become infected than members of the general population. Table 7.4 summarises the relative risks of infection with HIV and hepatitis B virus. Hepatitis B virus is far more infectious than HIV and it is fortunate that most healthcare workers respond to the hepatitis B vaccine, thereby gaining protection.

Postexposure prophylaxis PEP with antiretroviral drugs

Non-responder, or a vaccine booster for those whose anti-HBs antibody titre has waned. The administration of prophylactic azidothymidine (AZT) for those who have sustained an injury from a known HIV-positive patient has been controversial but recent evidence suggests that, in combination with other antiretroviral drugs, it can further reduce the risk of infection. Such prophylaxis is now officially recommended for significant injuries and should be administered promptly, ideally within 1 h of the injury. However, the treatment is not without side-effects and the risk assessment of the injury should be made in conjunction with a physician who is experienced in this area.

Transdermal patch systems

The drugs that have made it into the transdermal market include sco-polamine, nitroglycerine, nicotine, clonidine, fantanyl, estradiol, testosterone, lidocaine, and oxybutinin (Langer, 2004). Recent additions to this list include lidocaine-tetracaine, selegiline, methyl phenidate, and rotigotine. However, the future focus is production of transdermal systems capable of delivering peptides and proteins including insulin, growth hormone, and vaccine across the skin.

Health Care Infection Control Practices

All health-care providers who have direct contact with patients should complete the hepatitis B vaccine series. In certain populations, testing for immunity before vaccination may be indicated. Typical preemployment Student Health Service screening includes a purified protein derivative (for tuberculosis) and various serologic testing, including testing for hepatitis B virus.

Empirical Findings on Humans and Rats

Even rats seem to appreciate this argument. When an inhibitory cue, that is, one with negative associative strength, is repeatedly presented without the outcome so that the actual outcome is 0 whereas the expected outcome is negative, associative models would predict that the cue reduces its strength toward 0. That is, in a noncausal world, we would unlearn our preventive causes whenever they are not accompanied by a generative cause. For example, when we inoculate child after child with polio vaccine in a country and there is no occurrence of polio in that country, we would come to believe that the polio vaccine does not function anymore (rather than merely that it is not needed). To the contrary, even for rats, the inhibitory cue retains its negative strength (Zimmerhart-Hart & Rescorla, 1974). In other words, when an outcome in question never occurred, both when a conditioned inhibitory cue was present and when it was not, the rats apparently treated the zero AP value as...

Adding value to milk through the use of milk protein genomics

Nevertheless, the development of somatic nuclear transfer techniques that facilitate targeted genetic modifications has driven transgenic research over the past 5 years. Small interfering RNA techniques and lentiviral vectors have also contributed to this cause, as have modified episomal vectors designed to promote high levels of expression of therapeutic genes (Manzini et al, 2006). The use of transgenic animals as bioreactors to synthesize valuable proteins in large quantities is probably the major application for new transgenic animals. Goats and rabbits are the most popular target species, in addition to the cow, for producing a range of proteins including enzymes such as alpha-glucosidase, hormones such as human growth hormone and large proteins such as lactoferrin, albumin, collagen and vaccines (e.g. for malaria). The development of a recombinant human antithrombin III expressed in goat's milk is the closest of these products to commercial release (Niemannn and Kues, 2007).

Epidemiology And Etiology Hepatitis A

United States have a lower prevalence. This is primarily due to vaccination programs, The number of infections and hospitalizations due to HAV infection annually have decreased markedly since the introduction of the hepatitis A vaccine in 1996. ,5 Hepatitis B is a bloodborne infection affecting more than 2 billion people worldwide. Approximately 400 million people have chronic infection, which may lead to cirrhosis and complications of ESLD.8 There are 500,000 to 700,000 deaths annually due to hepatitis B.9 Despite having an effective vaccine against HBV, more than 300,000 newly diagnosed infections emerge each year. Fewer than 1 of individuals in North America and western Europe are chronically infected compared with 8 to 10 in developing areas such as Southeast Asia.8

The Role Of C3 In Shaping The Lymphocyte Repertoire

Besides its role in aiding the formation of the normal mature B cell repertoire, C3 is also of crucial importance during the generation of humoral immune responses. Direct evidence that the attachment of C3 split products to the antigen enhances humoral responses comes from experiments with recombinant proteins 83 , chemically engineered constructs 84 and naked DNA vaccines 85 . In a similar manner humoral responses can be improved by conjugating antigen to antibodies recognizing CR2 86 . Antibody dependent enhancement of humoral responses is also dependent on complement and CR2 in the case of IgM and IgG3 87 88 89 .

Likely and Emerging Pathogens

Both the pentavalent bovine-human reassortment (RV5) and the oral, live-attenuated monovalent (RV1) rotavirus vaccines are effective for prevention of severe gastroenteritis. The RV5 vaccine series is recommended for children at ages 2, 4, and 6 months, whereas the RV1 vaccine should be administered to children 2 and 4 months of age.

Inherited Deficiencies Of The Late Complement Components

Vaccination of LCCD individuals with tetravalent meningoccoccal polysaccharides is currently proposed as an effective measure to prevent the risk of infections in these patients. The goal is to favour the production of opsonizing antibodies that promote intracellular killing of bacteria by phagocytes. Ross and colleagues (1987) have provided in vitro evidence that support the beneficial effect of vaccination showing that the serum obtained form a C8 deficient patients vaccinated with the bivalent A-C meningococcal vaccine was able to promote efficient phagocytic killing of meningococci of different serogroups. LCCD patients have now been vaccinated by several groups with menigococcal capsular polysaccharide vaccine and the data that have been collected indicate the following 1. the antibody response in these patients is not different from that observed in C-sufficient patients (Andreoni, 1993 Platonov, 1995 Fijen, 1998) 2. the antibody-mediated phagocytic killing of meningococci...

Prevention and Treatment

Although other prophylactic regimens are available to prevent systemic viral or fungal infections, a survival benefit has not been demonstrated. Inactivated influenza and 23-valent pneumococcal vaccines are recommended for HIV patients who are still able to mount a significant immune response and should be initiated early in the disease, with annual influenza vaccine each year thereafter. Live vaccines should not be used.

Disease Patterns Since 1960

Most African states became independent after 1960, but they have not been able to effect radical improvements in health conditions. Colonial medical services and their successors in sovereign African countries have tended to stress therapy over prevention, and to favor cities over the rural areas. There has been some real progress. Smallpox has been eradicated, thanks to a concerted worldwide campaign. Vaccines, many developed only after 1960, have begun to make inroads against measles, diphtheria, polio, cerebrospinal meningitis, and other common infections, but new vaccines are urgently needed for other diseases, including malaria and the bacterial and viral agents of childhood diarrheas. The most urgent need is to improve rural water supplies and sanitation, which would greatly reduce the incidence of a host of infections. Greater attention to nutrition and to infant and child health is also essential.

Pulmonary Complications of Sickle Cell Disease

Patients with sickle cell disease have complications that can manifest with pulmonary signs and symptoms. For example, patients with sickle cell disease are especially vulnerable to capsular bacteria such as Streptococcus pneumoniae (pneumo-coccus) and Haemophilus influenzae, and they can present with acute lobar pneumonia, sepsis, or even pneumonia-related ARDS. Pneumococcal and Hib vaccines, in combination with penicillin prophylaxis, have significantly reduced (but not eliminated) rates of serious infections with these organisms (Hord et al., 2002).

Acquired Immune Deficiency Syndrome AIDS

Although precise epidemiological data remain unknown, public health officials throughout the world have focused attention on this pandemic and its potentially catastrophic impact on health, resources, and social structure. Treatments for the disease have been developed, but there is currently no cure or vaccine.

Influenza and Novel Influenza A H1N1 Virus

Treatment should not be delayed pending results of testing or withheld in the absence of testing. Antiviral treatment is most effective when started as early as possible after the onset of symptoms (i.e. within first 2 days). The highest priority is to treat pregnant women with influenza-like symptoms as soon as possible. The currently novel influenza A (H1N1) virus is sensitive to the neuraminidase inhibitor antiviral medications zanamivir (Relenza) and oseltamivir (Tamiflu). Pregnancy should not be considered a contraindication to oseltamivir or zanamivir use. Because pregnant women may be at higher risk, the benefits of treatment or chemoprophy-laxis with oseltamivir or zanamivir outweigh the theoretic risks of antiviral use. The Advisory Committee on Immunization Practices recommends that 2009 10 H1N1 monovalent flu and the seasonal flu vaccine be given to all pregnant women at any time during pregnancy. The American College of Obstetricians and Gynecologists (ACOG) and AAFP also...

Immunizations in Pregnancy

Immunizations that are not live, attenuated viruses are not contraindicated in pregnancy. Measles, mumps, and rubella (MMR) are the most common vaccines with live, attenuated viruses and should be avoided during pregnancy, although retrospective assessment of risks to the fetus has not documented a significant risk. Vaccines made of viral coat and not the complete virus are safe to administer in pregnancy for example, influenza vaccinations are recommended. However, the pregnant woman should receive the injected vaccine and not the nasal spray, which is the live, attenuated virus.

Clostridium Spiroforme

Definitive diagnosis is by demonstration of i-like toxin by a lethality assay in mice or a cytotoxicity assay in Vero cells.181-183 A change in diet can be an effective therapy, as can use of antibiotics such as metronidazole and penicillin q 178,184 protectjon 0f Weanling rabbits against intraperitoneal challenge with i-toxin can be achieved by vaccination with a toxoid.185

Growth and Development

Vaccine Administration Poliovirus Vaccine Measles, Mumps, and Rubella Vaccine Haemophilus Influenzae Type b Conjugate Vaccine Acellular Pertussis Vaccine Rotavirus Vaccine Varicella Vaccine Hepatitis A Vaccine Hepatitis B Vaccine Conjugate Pneumococcal Vaccine Influenza Vaccine Conjugate Meningococcal Vaccine Human Papillomavirus Vaccine National Childhood Vaccine Injury Act

Care of Children in Family Medicine

Initial history for a new infant or child includes the birth history, nutritional history (e.g., breastfed vs. bottle-fed), developmental milestones achieved, immunization record, and environmental history (e.g., do parents smoke ) Later, the physician or staff will also perform anticipatory guidance, including injury prevention and the need to immunize against vaccine-preventable diseases.

Recommended reading

Feline Advisory Bureau 2004 Sheet 6 - Feline vaccines. Available on line at http fab is23.html The Feline Advisory Bureau publish about 50 fact sheets accessible via their web site. They are well written and cover many feline disorders. This particular sheet outlines the nature and regime of vaccinations for cats.

Cytotoxic T Cell Antigen

Finally, the CTLA-4 tetrameric aptamer was evaluated in conjunction with dendritic cell-based vaccination strategies. The polypeptide component of telomerase (TERT) elicits modest protective tumor immunity against several tumors (Nair et al., 2000). In melanoma tumor-bearing mice, 50pmol injection of the CTLA-4 tetrameric aptamer enhanced the efficacy of immunotherapy engendered by TERTmRNA-transfected dendritic cells. Therefore, an aptamer also can act as an adjuvant to enhance the potency of vaccines (Santulli-Marotto et al., 2003).

Schedule of Immunizations

The recommended schedule for childhood and adolescent immunizations are given online in eTables 23-3 to 23-5. A lapse in the immunization schedule does not require starting over the entire series. Doses of any vaccine should not be divided or reduced, because this can result in an inadequate response. Premature infants should receive the same vaccine dose, usually at the same chronologic age as full-term infants. Most vaccines can be administered simultaneously using separate syringes at separate sites (AAP Red Book, 2009, 33).

Clostridium Tetani

Some species are naturally resistant to tetanus, although antitoxic antibodies are usually not demonstrated in their tissues.287 Acquired resistance to tetanus is based upon circulating antitoxin, and among susceptible species, widespread vaccination has dramatically lessened the impact of tetanus on animal production. Passive immunity acquired by neonates from the dam (especially in the case of foals and mares) protects for 2-3 months, after which active immunization with toxoid can begin. Boosters, given at 1-5-year intervals, are commonly recommended.

Nursing considerations

Neonatal and juvenile patients have an undeveloped immune system so, as with any other hospitalized patient, a high level of cleanliness and hygiene must be maintained. This is even more significant in sick neonates and juveniles, especially if the primary vaccination has not yet been given and levels of maternally derived antibody levels are waning, which usually occurs around 8-12 weeks of age. All feeding bowls and litter trays should be disinfected and sterilized. Barrier nursing should be implemented in the case of a contagious disease.

Evidence Based Screening Guidelines

Immunizations are an important part of well-woman care. All patients benefit from disease prevention, and women are often caregivers for children or elderly persons, who are at higher risk from vaccine-preventable illnesses. Vaccines recommended by the U.S. Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) include tetanus diphtheria pertussis (Tdap), herpes zoster, and influenza for adults over age 50 and human papillomavirus vaccine for women 26 and younger.

Adjuvant Interferon Clinical Trials

In light of the discordant survival results in E1684 and E1690, the initial results of another Intergroup trial, E1694, have received intense scrutiny. This trial compared one year of highdose interferon not to an observation control as in the two earlier studies, but rather to two years of a ganglioside vaccine called GMK. This was the largest of the three trials, with 774 eligible patients between two study arms. For the first time, staging of the lymph nodes by sentinel node biopsy was performed in a significant fraction of patients. Gangliosides are carbohydrate antigens found on the surface of melanoma cells, as well as normal cells of neural crest origin and tumour cells of other types. A pilot randomised trial suggested a relapse-free survival benefit in patients who were treated with purified ganglioside GM2 (the specific ganglioside in the GMK vaccine) plus BCG compared to those treated with BCG alone.14 In May 2000, the E1694 trial's independent Data Safety Monitoring...

Clinical Considerations

Two of the three randomised Phase III trials of high-dose interferon, E1684 and E1690, demonstrate a relapse-free survival advantage. The third trial, E1694, also shows a relapse-free survival benefit but with GMK vaccine and not observation as the control treatment. The implication of this design difference is discussed in detail below. Nevertheless, many consider there is uniformity of evidence that high-dose interferon has biologic activity in at least delaying relapse after surgical therapy. This fact alone, combined with the lack of proven alternatives, is enough for many patients to choose interferon therapy in the absence of consensus regarding the overall survival benefit.

Statistical Considerations

E1694 was designed to detect a GMK vaccine benefit over interferon as the contemporary treatment standard. As is often practiced with superiority designs, the trial would be stopped at planned interim analyses if the hypothesised vaccine benefit could be definitively ruled out. This provision was incorporated in the study design in the following manner. Instead of the typical, highly stringent interim p-value requirements, the GMK vaccine needed only to be inferior to interferon at a fixed, onesided p-value of 0.05 for relapse-free survival in order to consider study termination at interim analyses. Such evidence might not establish the vaccine inferiority but would certainly rule out its superiority. Considering the substantially more favourable vaccine toxicity profile, a more appropriate trial design might have sought to demonstrate the equivalence of the two agents in their efficacy rather than the superiority of the vaccine. In fact the Data and Safety Monitoring Committee in...

How Does Immunization with Mature Tumor Cells Induce an Antitumor StemCell Response

We immunize patients with the bulk tumor cell population, only 0.5 percent or less of which are SP cells. Why, then, is the most effective immune response observed against such a minority cell population As mentioned in the preceding section, SP tumor cells express more primitive antigens than the mature non-SP population. In B-CLL these antigens include proteins associated with highly proliferative cells in general, such as hTERT and survivin, and the sternness associated proteins P21cip waf1 and BMI-1. We have found that when transgenic CD40 ligand in the tumor vaccine activates B-CLL through their CD40 receptor, there is subsequent up-regulation of expression of many genes in the bulk population that are normally only expressed by B-CLL SP cells. For example, both hTERT and survivin are increased once non-SP cells have encountered CD40L. In other words, CD40L tumor vaccines make mature B-CLL cells more SP-like, allowing them to act as an immunogen which produces a response...

Pathogenic Factors A The organism

Poor hygiene and the close association of people with their pigs increases the opportunities for food contamination with C. perfringens type C in PNG. In the case of darmbrand there was also environmental contamination. The German organism was extremely heat resistant, the spores withstanding boiling for over 4 h. This made isolation of the organism easy, but also contributed significantly to the contamination of the environment, and particularly of cooked food with C. perfringens type C. Kloos reported the spread of cases of EN along railways and roads, perhaps reflecting the spread of the heat-resistant strain.18 Enterotoxaemia in piglets is often associated with heavy contamination of farrowing pens with C. perfringens type C. Control strategies reduce or eliminate the contact of sows with areas of high C. perfringens type C concentration. Vaccination is also effective.

Iontophoresis with microneedles

Evolving microneedle systems will be well positioned to address a significant segment of the large-molecule biological drugs expected to emerge from the convergence of automated discovery and genome mapping. However, before microneedles find widespread use, researchers still need to find ways ofperfecting the techniques for optimally inserting them into the skin, and complete the integration ofmicroneedles into a full diagnostic, monitoring, or drug delivery system. 3M and Alza Corp are two pioneering companies in designing microneedle systems to deliver vaccines, proteins, and peptide-based drugs. Studies at 3M have achieved successful delivery of water-soluble, polar, ionic, and large molecules (19 500 Da). The combination of iontophoresis and microneedles was used to enhance trandermal drug delivery for certain compounds, including peptides. Lin et al. (2001) designed a Macroflux and iontophoresis combined transdermal delivery system for the delivery of an...

Antibodydependent Enhancement Of Viral Infections

The possible biological significance of the ADE was raised first by the vaccine failures and other findings observed with two viruses, the respiratory syntitial virus (RSV) and the dengue virus. Sixty percent of children immunized with a formalin-inactivated RSV vaccine still became infected and the course of the disease was markedly more serious in the vaccinated than in the non-vaccinated children (4). Similar exacerbation of the disease

Incubation period 47 days

Prevention Vaccination of dam before mating and puppy from 8 weeks of age. In high-risk areas the dam can be given a killed vaccine during gestation and puppies can receive antiserum or start early vaccination at 6 weeks of age, followed by the usual primary vaccine course. Puppies who survive the disease will develop very good immunity, which may last a number of years.

Trials Of Devices And Surgical Procedures

Another feature of device and surgical trials is that unlike most drugs (vaccines being an exception) that need to be administered regularly, devices are implanted and expected to work for a long time, and surgery, unless reversed, can be life-long. Batteries and other components may need to be replaced, but unless there are problems, they last for years. This is generally a strength of such trials. There is less problem with compliance to protocol and long-term follow-up is not only feasible, but desirable. The several coronary artery bypass graft surgery trials assessed outcome 10, and in some cases more than 20 years after the initial procedure.41

Viral haemorrhagic disease VHD

Prevention There is a vaccine for use in countries where the disease is already widespread and eradication efforts are difficult to employ. Quarantine measures must be applied to rabbits entering from countries where VHD is present. There is documented evidence to suggest increased resistance among young rabbits, which may be due to passive immunity acquired from ingesting colostral antibodies against the apathogenic strain of lapine parvovirus.

Modified live attenuated

Rupted and harmless version of the pathogen into the body to stimulate the defence system to produce an immune response in the absence of clinical disease. Although it has not been proved that vaccination will completely protect the animal, it will protect the animal from expressing all clinical symptoms when naturally exposed to the disease. Vaccines are available against most of the common infectious diseases of companion animals and horses (Table 21.3).

Intervention Strategies

The introduction of anti-idiotypic antibodies mimicing mCRP are considered another interesting option in cancer immunotherapy. The human anti-idiotypic antibody 105AD7, originally isolated from a colorectal cancer patient, not only recognises the binding site of 791T 36 (an antibody directed to an osteosarcoma cell line) but also mimics CD55 (Austin et al. 1989). Immunisation of both mice and rats with 105AD7 resulted in the generation of antibodies that bind to CD55 (Austin et al., 1991). This human anti-idiotypic antibody that mimics CD55 has been used successfully in over 200 colorectal cancer and osteosarcoma patients. 70 of the patients showed CD55-specific immune responses with no associated toxicity (Durrant and Spendlove, 2001). In patients who received 105AD7 at diagnosis and prior to tumor resection, increased infiltration of CD4, CD8 and CD56 cells and increased tumor cell apoptosis was observed relative to unimmunised control patients (Spendlove at al., 2000 Amin et al.,...

Current Challenges And Trends

Low-frequency sonophoresis may also have considerable potential for facilitating needle-free vaccinations and immunizations. Transcutaneous immunization provides contact with the skin's immune system via densely concentrated antigen-presenting Langerhans cells. These cells induce T-cell-mediated immune reactions against numerous antigens. In order for this technique to be practical, the vaccine, which is usually a large molecule, must penetrate the stratum corneum. Low-frequency ultrasound could be used to permeabilize the stratum corneum to a vaccine as well as a complementary adjuvant. Promising work in this context has already been published (Tezel at al., 2005).

Upon completion of the chapter the reader will be able to

Design appropriate empirical antimicrobial regimens for patients suspected of having CNS infections caused by each of the following pathogens (taking age, vaccine history, and other patient-specific information into account), and analyze the impact of antimicrobial resistance on both empirical and definitive therapy Neisseria meningitidis meningitis, meningitis, Haemophilus influenzae meningitis, Listeria meningitis, group B Streptococcus meningitis, gram-negative bacillary meningitis, postneurosurgical infection, CNS shunt infection, herpes simplex encephalitis. 8. Identify candidates for vaccines and other prophylactic therapies to prevent CNS infections.

Summary and future considerations

In relation to cancer, the identification of novel antigens not only plays a crucial role in the biology and pathology of different types of cancers but also activate both cell-mediated and antibody-mediated immune responses, a more effective immunotherapeutic strategy (i.e. cancer vaccines) for educating our immune system could be developed. In this way, persistent tumour antigens would be recognized and remembered by memory B and T cells already present in the immune system, leading to the prevention of most human cancers (Lollini and Forni, 2003). However, as discussed above, immunization against such persistent tumour antigens should be performed in young people when the immune system is most efficient at recognizing and destroying foreign antigens (Miller, 1996 Abgrall et al., 2002 Davidson et al., 2002 Costello et al., 2003 Lollini and Forni, 2003 Waldman, 2003). Recent advances in this direction may be imminent thanks to advances in tumour immunology, cell and molecular biology...

Epidemiology and etiology

Bacterial meningitis is the most common cause of CNS infections. Streptococcus pneumoniae (pneumococcus) was the most common pathogen for bacterial meningitis (47 ), followed by Neisseria meningitidis (meningococcus, 25 ), group B Streptococcus (12 ), Listeria monocytogenes (8 ), and Haemophilus influenzae (7 ).5 Vaccines directed against bacteria causing meningitis and related infections (such as pneumonia and ear infections) have reduced the risk of infections due to S. pneumo-niae, N. meningitidis, and H. influenzae type b (HIb) dramatically. Prior to the availability of Hib conjugate vaccines, Hib meningitis or other invasive disease was documented in one in 200 children by the age of 5 years.5 Widespread use of the Hib vaccine has reduced the incidence of invasive Hib disease by 99 and has shifted the age distribution of bacterial meningitis to older age groups (from 15 months in 1986 to 25 years in 1995).1,6 The routine use of the 7-valent conjugate pneumococcal vaccine (PCV7)...

Prevention and Control

Vaccines have been available for many years for immunization of humans and of livestock. Live attenuated vaccines have been available in Japan since 1972, and in China more recently, and their effectiveness is shown by seroconversion rates of up to 96 percent. Vaccines are prepared by purification of viral suspensions from mouse brains, or from hamster kidney cultures, but several newer technologies are presently under active investigation. Widespread immunization campaigns have been successful in Japan, Taiwan, and China. At present, the vaccines are composed principally of the prototype Nakayama strain, and reasonable control of the disease has taken place. It is therefore unclear how necessary or desirable the addition of the newer iso Currently used vaccines require primary immunization with two injections at 7- to 14-day intervals, a booster within 1 year, and further boosters at 3- to 4-year intervals. Fortunately, the vaccine produces relatively few side reactions, and...

Patient Encounter 2 Part 2

Close contacts of patients with H. influenzae type B meningitis should be evaluatedfor antimicrobial prophylaxis. The risk of Hib meningitis in close contacts may be up to 200- to 1,000-fold higher than in the general population.10 Invasive Hib disease, including meningitis, should be reported to the local health department and the CDC. Prophylaxis to eliminate nasal and oropharyngeal carriage of Hib in exposed individuals should be initiated after consultation with local health officials. Rifampin (600 mg day for adults 20 mg kg day for children, maximum of 600 mg day) is administered for 4 days.16 Rifampin prophylaxis is not necessary for individuals who have received the full Hib vaccine series. Exposed, unvaccinated children between 12 and 48 months of age should receive one dose of vaccine, and unvaccinated children 2 to 11 months of age should receive three doses of vaccine, as well as rifampin prophylaxis.16 Because of prior vaccine shortages, it cannot be assumed that all...

Patient Encounter 2 Part 3

Further results reveal BB had confirmed bacterial meningitis secondary to S. pneumoniae, serotype 6B. It was noted that BB had not received any vaccinations since birth. The parents are concerned and inquire about the need for antibiotic prophylaxis for the family and vaccination for BB. Who should receive vaccination against pneumococcal disease How is vaccination important in the prevention of invasive pneumococcal disease, specifically noting BB

Using evidence and logic in everyday clinical reasoning communication and legal and scientific argumentation

Good medicine relies not only on good evidence, but also on the ways evidence is used. Besides evidence itself, the second key factor then, is how evidence is integrated within our reasoning and how we convey our conclusions to their intended recipients. Any good evidence, such as a valid diagnostic test or the effectiveness of a new vaccine demonstrated in an impeccable clinical trial, is useful and beneficial only when applied critically. In other terms, it can be used well or poorly depending on how we introduce it in our reasoning about the health problem under scrutiny. Did we properly assess the risks and benefits of an intervention Did we properly choose the individuals who would benefit the most from a new treatment And so on. Critical thinking can be defined as the process of evaluating a claim for the purpose of deciding whether to accept, reject, or perhaps suspend judgment about it or as reasonable reflective thinking that is focused on deciding what to believe or do 1 . A...

Effects on morbidity and mortality

Pharmacological androgen therapy has also been evaluated for maintenance therapy for acute non-lymphocytic leukemia (ANLL) on the basis that enhanced proliferation of residual normal hematopoietic precursors would suppress competitively the growth of the leukemic clones. Among 114 212 patients with newly diagnosed ANLL who obtained complete remission after standard induction chemotherapy, 82 agreed to be randomised to undergo standard maintenance chemotherapy alone or in combination with BCG vaccination, stanozolol (0.1 mg kg d) or BCG vaccination plus stanozolol. After three years follow-up, all four arms had similar rates of remission and adverse events (Mandelli etal. 1981).

Identical methods for beneficial and adverse effects

Urgent direct current cardioversion in patients with new atrial fibrillation who are cardiovascularly stable risk of stroke from cardioversion. Aspirin for patient with a stroke, but who has a past history of gastrointestinal haemorrhage Carotid endarterectomy in older patients with ischaemic heart disease who present with stroke. Improving uptake of a vaccine to promote herd immunity, while trying to assuage fears about early serious neurological adverse effects.

Salmonella and HIV Infection

Three typhoid vaccines are available currently for use in the United States (a) an oral live-attenuated vaccine (Vivotif Berna-TM vaccine, Swiss Serum and Vaccine Institute), (b) a parenteral heat-phenol-inactivated vaccine (Typhoid Vaccine, Wyeth-Ayerst), and (c) a parenteral capsular polysaccharide vaccine (Typhim Vi, Pasteur Merieux). Immunization is recommended only for travelers going to endemic areas such as Latin America, Asia, and Africa household contacts of a chronic carrier and laboratory personnel who frequently work with S. typhi9

Treatment and Monitoring

A live oral rotavirus vaccine is approved by the FDA for use in infants aged 6 weeks to 32 weeks and provides protection against rotavirus infection for at least 24 months.4 The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices recommends vaccination at 2, 4, and 6 months.

Ongoing Studies And Novel Therapies

A fourth therapeutic paradigm that is being explored for children with supratentorial high-grade gliomas involves applications of local therapies, which builds upon single-institution pilot studies and promising results in adults with malignant gliomas. These approaches include convection-enhanced delivery of immunotoxins into the tumor bed,26 administration of interstitial chemotherapy (i.e., Gliadel)7 in conjunction with O6-benzylguanine to potentially reverse alkyltransferase-mediated drug resistance,56 and tumor-targeted immunotherapy using cytokine gene transduction-based and dendritic cell-based vaccine strategies.47 It is anticipated that one or more of these approaches will be translated to the PBTC setting within the next year.

Clinical Features and Associated Findings

The Advisory Committee on Immunization Practices (ACIP) of the United States Public Health Service has recommended that the United States adopt a sequential poliomyelitis immunization schedule--two doses of inactivated polio vaccine (IPV) followed by two doses of live oral polio vaccine (OPV). y , y At the present time, the World Health Organization recommends only OPV for both routine immunization and to achieve polio eradication. y , y Although OPV is among the safest of vaccines, one case of vaccine-associated polio occurs for every 2.5 million doses of OPV administered. The proposed sequential schedule recommended by the ACIP is a compromise that seeks to retain the advantages of OPV while preventing half of the 8 to 10 vaccine-related cases that occur every year in the United States. y

Other Diseases of the Spotted Fever Group

Inapparent infection is common, occurring in as many as half the cases. Rubella has special significance when a woman contracts it in early pregnancy because fetal infection can ensue and result in congenital rubella syndrome (CRS). Rubella is a vaccine-preventable disease, but the vaccine is not yet widely used on a global basis.

Clusterrandomized trials 1631 Introduction

In cluster-randomized trials, groups of individuals rather than individuals are randomized to different interventions. Cluster-randomized trials are also known as group-randomized trials. We say the 'unit of allocation' is the cluster, or the group. The groups may be, for example, schools, villages, medical practices or families. Such trials may be done for one of several reasons. It may be to evaluate the group effect of an intervention, for example herd-immunity of a vaccine. It may be to avoid 'contamination' across interventions when trial participants are managed within the same setting, for example in a trial evaluating a dietary intervention, families rather than individuals may be randomized. A cluster-randomized design may be used simply for convenience.

Assessing risk of bias in clusterrandomized trials

(v) In a meta-analysis including both cluster and individually randomized trials, or including cluster-randomized trials with different types of clusters, possible differences between the intervention effects being estimated need to be considered. For example, in a vaccine trial of infectious diseases, a vaccine applied to all individuals in a community would be expected to be more effective than if the vaccine was applied to only half of the people. Another example is provided by Hahn et al., who discussed a Cochrane review of hip protectors (Hahn 2005). The cluster trials showed large positive effect whereas individually randomized trials did not show any clear benefit. One possibility is that there was a 'herd effect' in the cluster-randomized trials (which were often performed in nursing homes, where compliance with using the protectors may have been enhanced). In general, such 'contamination' would lead to underestimates of effect. Thus, if an intervention effect is still...

Distribution and Incidence

When a nonimmune person who is infected with a virulent poliovirus receives an injection of an inflammatory substance into a muscle, the chance of paralysis occurring 7 to 18 days later is much increased. In many cases, the muscle receiving the injection is the first paralyzed and the extent and severity of paralysis may also be increased. The phenomenon, called provocation, was recognized in 1950, when mass immunization with diphtheria-pertussis-tetanus vaccine (DPT) began. Risk of provocation was much reduced by giving DPT in winter when circulation of poliovirus was minimal. Sterile saline and human gammaglobulin did not provoke. Provocation had first been described, but not named, in 1914 when nearly a quarter of 22 babies with congenital syphilis were paralyzed with polio after treatment with multiple injections of Salvarsan. Further epidemics with 25 percent case-rates were noted in Rome between 1936 and 1947 among similar children given multiple injections of Salvarsan...

History and Geography

After 1955, with the widespread use of the IPV in the United States, Canada, South Africa, Australia, and some countries in Europe, the number of cases fell dramatically. As not all children were immunized, small epidemics still occurred among the poor living in substandard conditions. But soon almost all the countries in temperate climates were using polio vaccine, and the potency of the vaccine was improved. Nonetheless, by 1960 in the United States in particular, there were doubts that IPV would eliminate polio. With these exceptions, beginning in 1961, OPV was increasingly used in countries with the most temperate climate, and the number of polio cases fell to even lower levels, although there were still small epidemics where wild virus struck communities that refused immunization or were not receiving primary health care. In the United States there are now about 10 cases a year, roughly half of which are vaccine-associated in vaccines or their contacts, or in...

Patient Encounter 1

A 1-year-old child is brought to the pediatrician's office for a routine 1-year checkup. The child is healthy and meeting all growth and developmental targets. The child has received all vaccinations to date. The pediatrician discusses with the mother the need for more vaccinations during this visit. Which vaccine should the child receive during this visit Herd immunity refers to high levels of immunization in one population resulting in protection of another unvaccin-ated population. For example, concentrated vaccination of children with the 7-valent pneumococcal conjugate vaccine resulted in decreased invasive Streptococcus pneumoniae infection not only in the vaccinated children, but also in elderly persons within the same community.

Patient Encounter 2

An 18-year-old male is having a routine physical before leaving for college. He will be a freshman and is looking forward to dormitory life. The health care provider recommends some vaccinations be given at this visit. Which vaccines should be administered What is the risk of not receiving the vaccines A meningococcal polysaccharide vaccine containing serogroups A, C, Y, and W-135 has been available in the United States for a number of years. Meningococcal polysaccharide vaccine is similar to other polysaccharide vaccines, in that it is poorly immunogenic in infants and children less than 2 years of age, and does not produce lasting immunity. Meningococcal polysaccharide vaccine produces a T-cell-independent response and fails to induce a memory response. Repeated vaccination results in hyporesponsiveness to serogroups A and C the clinical implication of this finding is unknown. In January 2005, a new meningococcal polysaccharide diphtheria toxoid conjugate vaccine was approved by the...

Other Safety Concerns

A clear cause-and-effect relationship between vaccine administration and chronic diseases, such as diabetes mellitus, multiple sclerosis, and chronic arthritis, has never been scientifically proven. Thimerosal is a preservative used in vaccines that has been purported to cause autism in children. The assumption is that thimerosal, also known as ethyl mercury, causes similar effects as methyl mercury, which has neurotoxic and nephrotoxic effects at high-doses. Several epidemiologic studies have not shown a higher rate of autism among children receiving thimerosal-containing vaccines when compared to the normal background rate of autism. Additionally, the mercury exposure with vaccination is much lower than through many other environmental exposures. Despite the lack of evidence of thimerosal causing neurologic disorders, vaccine manufacturers are producing vaccines that are thimerosal-free or only contain trace amounts of 21

Special populations Immunocompromised Host

The number of immunocompromised persons is continually increasing as advances are made in medicine. The life expectancy for persons with cancer, HIV infection, and solid organ or bone marrow transplantation is increasing. Vaccination provides one tool to prevent infection in the immunocompromised host however, the individual's immunosuppressed state will alter the response to the vaccine. In general all vaccinations should be updated prior to the person becoming immunosuppressed, if possible. Once a person becomes significantly immunosuppressed, live virus vaccines should be avoided.

The winter months Health Care Workers

Most health care workers are at risk for exposure to many diseases in the normal course of their work. Additionally, health care workers may transmit vaccine-preventable diseases to their patients. At the time of employment and on a regular basis, health care workers should be screened for immunity to measles, mumps, rubella, and varicella if found to be nonimmune, the measles, mumps, and rubella, and varicella vaccines should be administered. The hepatitis B series should be given if not already completed. Tetanus should be updated and given every 10 years. Health care personnel in hospitals and ambulatory settings with direct patient contact should receive Tdap if not already received an interval as short as 2 years from the last tetanus-containing vaccine should be used. All health care personnel should be strongly encouraged to receive the influenza vaccine yearly in order to prevent transmission of influenza within the health care fa cility and to decrease employee absenteeism...

Pathology and Clinical Manifestations

There have been a handful of reports of survivors, but even the most intensive supportive care is generally futile, and there are no specific drugs or other therapies. Prevention is the only solution. Vaccinating dogs and cats, controlling strays, monitoring wildlife populations, and education are all essential. A preexposure human vaccine is available for persons at special risk, such as game wardens, veterinarians, and laboratory workers. Fortunately, persons bitten by a rabid or possibly rabid animal can still be effectively vaccinated before the disease completes its long incubation period. If the biting animal is captured and shown to be rabid, or if it escapes but there are grounds to suspect that it might be rabid, prompt treatment is essential. Careful cleansing of the wound to remove as much virus as possible is followed by a series of injections of a serum (gamma globulin) that contains preformed antibodies to the virus. Human rabies immune globulin (RIG) has replaced an...

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