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Introduction to Vaccines

Introduction to Vaccines. MedCh 401 Spring 2006 Kirsten L. Vadheim, Ph.D. Why study vaccines?. Patient education Pharmacists are often the most accessible medical professional too many choices! Flu: yes or no? live or inactivated? Pneumococcal? Meningococcal? TD booster?.

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Introduction to Vaccines

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  1. Introduction to Vaccines • MedCh 401 Spring 2006 • Kirsten L. Vadheim, Ph.D. KL Vadheim Lecture 1

  2. Why study vaccines? • Patient education • Pharmacists are often the most accessible medical professional • too many choices! • Flu: yes or no? • live or inactivated? • Pneumococcal? • Meningococcal? • TD booster? KL Vadheim Lecture 1

  3. Why study vaccines? II • Misinformation • Only children get pertussis - no • MMR vaccination causes autism - no • HepB vaccination is linked to development of autoimmune disorders - no • Childhood vaccinations increase the risk of SIDS - no • SV40-contaminated polio vaccine caused cancer - inadequate data KL Vadheim Lecture 1

  4. More reasons to study vaccines • Vaccine administration • you may have to give them! • New vaccines, changing recommendations • Rotavirus • Lyme disease • OPV to IPV • Pertussis • Public health KL Vadheim Lecture 1

  5. History • Variolation • c. 16th centure China • 1721 - Lady Mary Montagu brought it to England • 1774 - cattle breeder Benjamin Jesty inoculated his wife and children with cowpox to protect them from a smallpox epidemic KL Vadheim Lecture 1

  6. History II • Edward Jenner • 1798 Variolae Vaccinae • demonstrated that cowpox could be passed directly from one infected person to another, providing large-scale, effective inoculation against smallpox • 1840: variolation made a felony in England KL Vadheim Lecture 1

  7. History III • Louis Pasteur • 1880: attenuation of Pasteurella multocida to protect against chicken cholera • 1881: developed animal vaccine for anthrax, demonstrating that one could create standardized, reproducible vaccines at will • 1885: successful vaccination of first human (Joseph Meister, rabies) KL Vadheim Lecture 1

  8. History III • Killed vaccines • Salmon and Smith, 1886; killed hog cholera virus vaccine (actually a bacterial vaccine against salmonellosis) • 1896-7: Human typhoid, cholera, plague vaccines KL Vadheim Lecture 1

  9. History IV • Paul Ehrlich • 1897: receptor theory of immunity explained toxin-antitoxin interactions • active and passive immunity • ‘magic bullets’ • Emil von Behring • 1890: Development of diphtheria antitoxin as protection during diphtheria epidemics KL Vadheim Lecture 1

  10. History V • Early 1900s • 23 U.S. children died from diphtheria antitoxin derived from horse infected with tetanus • post-WWII progress on viral vaccines • virus propagation in stationary cell culture • CPE KL Vadheim Lecture 1

  11. History VI • Polio • Salk et al.: formalin-inactivated vaccine • Sabin: live attenuated vaccine • Cutter incident • inadequately inactivated vaccine • 204 cases of type I polio KL Vadheim Lecture 1

  12. Immune Globulins • Immediate transfer of passive immunity • Homologous pooled human antibody • Homologous human hyperimmune globulines • Heterologous hyperimmune serum (antitoxin) • Tetanus, Rabies • Polyclonal (RSV-IGIV) • Monoclonal (Palivizumab) KL Vadheim Lecture 1

  13. Comparison of Maximum and Current Morbidity KL Vadheim Lecture 1

  14. Licensed Vaccines I • FDA/CBER • BLA • IND • Clinical trials • Extensive agency review • Inspection • Approval KL Vadheim Lecture 1

  15. Licensed Vaccines II • Post-approval • Lot release • Biennial inspections • Annual reports • Pharmacovigilence • 21CFR601.12 KL Vadheim Lecture 1

  16. Anthrax BCG DTaP Haemophilus influenzae b Meningococcal Plague Pneumococcal Typhoid - Ty21a and Vi Licensed Bacterial Vaccines KL Vadheim Lecture 1

  17. Hep A Hep B Flu JEV Measles Mumps Polio Rabies Rotavirus Rubella Rotavirus Smallpox Varicella Yellow Fever Licensed Viral Vaccines KL Vadheim Lecture 1

  18. Types of Vaccines I • Prophylactic • Therapeutic KL Vadheim Lecture 1

  19. Types of Vaccines II KL Vadheim Lecture 1

  20. Types of Vaccines III KL Vadheim Lecture 1

  21. The Perfect Vaccine • 100% effective • Oral dosage form • No adverse effects • Highly immunogenic • life-long immunity • no boosters required • Cheap • Stable at room temperature • no cold chain required KL Vadheim Lecture 1

  22. Combination vaccines • DT • DTaP • DTaP-HepB-IPV • HepA-HepB • MM • MMR • MMRV KL Vadheim Lecture 1

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