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Chapter 21 : Vaccines and Vaccination

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Abstract:

The impending elimination of paralytic polio emphasizes how effective vaccines can be in preventing infectious diseases. Live, attenuated viral vaccines offer potent immunity, but the fact that these are live pathogens means that some individuals, usually those with underlying immunocompromise, become ill in response to the vaccine strain of the virus. Provoking both cell-mediated and humoral immunity is another advantage of DNA vaccines. are normally enteric pathogens, initiating infection by invading the epithelial layer of the small intestine. Due to this route of infection, salmonellae are natural candidates for the development of vaccines intended to generate mucosal immunity. A factor that inhibits the effectiveness of antibacterial vaccines is the ability of many bacterial species to vary the antigens they express. It has been proposed that cytotoxic T lymphocytes (CTLs) may be needed for resolution of a primary infection while antiantibody is important for preventing the initiation of a subsequent infection. As many of the currently licensed or available vaccines for viral infections use live, attenuated virus particles, safety is of paramount importance in the development of viral vaccines. The development of vaccines has been, and continues to be, one of the greatest accomplishments in modern medicine. Passive therapy also has shown efficacy in prevention and even treatment of some infectious diseases, and newer technologies involved in production of human monoclonal antibodies likely will increase the range of diseases that are amenable to therapy by passive reagents.

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21

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Figures

Image of Figure 21.1
Figure 21.1

Correlation of the immunogenicity of a bacterial polysaccharide antigen with its molecular size. Pools made of the largest polymers, which averaged ~450 kDa in size, were able to induce an IgG immune response, whereas pools made of polymers with an average size of ~100 kDa or ~10 kDa did not.

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Image of Figure 21.2
Figure 21.2

Demonstration of the specificity of protective antibodies to different antigenic epitopes. Patients with cystic fibrosis initially become infected with environmental strains of . Within a year or so the organisms undergo a phenotypic change to become mucoid . This change is due to the overproduction of an extracellular polysaccharide chemically related to seaweed alginate, a polymer of randomly linked mannuronic (or M residues) and guluronic (or G residues) acids . alginate differs from seaweed alginate due to the addition of acetate groups to the mannuronic acid residues by the bacterium. Antibodies that have been found to be protective against infection recognize epitopes with acetate on them, whereas most chronically infected patients produce only antibodies to epitopes lacking acetate and are thus unable to control the infection.

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Image of Figure 21.3
Figure 21.3

Antigenic drift occurs when small changes in protective epitopes render antibody produced from a prior vaccine (antibody 2 [green]) ineffective against new epitopes (dark red), while some preexisting antibodies (antibody 1 [blue]) remain but are not fully effective against the new virus. Antigenic shift occurs when influenza viruses from two different species infect a cell of an animal and exchange genetic information. Again new epitopes (blue) that avoid binding to any of the preexisting antibody induced by a prior vaccine can be produced.

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Image of Figure 21.4
Figure 21.4

Principles of some of the newer vaccination strategies being evaluated for vaccinating against disease. The use of anti-idiotype antibodies as surrogate antigens. Multivalent vaccines that can combine multiple vaccine epitopes in one vaccine. Such vaccines also can incorporate vaccine antigens in a liposomal or micellar structure that can fuse with membranes to deliver antigens to within the cells. DNA vaccines allow activation of both helper and cytotoxic T cells and B cells.

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Image of Figure 21.5
Figure 21.5

Visualization of the essential steps of different concepts of adjuvanticity. Facilitation of antigen transport, uptake, and presentation by antigen-capturing and -processing cells in the lymph node draining the vaccine injection site. Repeated or prolonged release of antigen to lymphoid tissues (depot effect). Signaling via pattern-recognition receptors (PRRs) activates innate immune cells to release cytokines necessary for upregulation of costimulatory molecules. Danger signals from stressed or damaged tissues alert the APCs to upregulate costimulatory molecules. Note that signaling by recombinant cytokines or costimulatory molecules mimics classical adjuvant activity. Steps 3, 4, and 5 allow signal 2 as well as signal 1 from APCs. Reprinted from V. E. Schijns, :456–463, 2000, with permission.

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Image of Figure 21.6
Figure 21.6

Pathways whereby adjuvants activate cells. TLRs transduce signals following recognition of specific microbial structures known to have adjuvant activity. Immune response modifier drugs such as imidazoquinoline can also activate DCs through TLR7. Soluble complement factors can tag antigens with C 3d and improve the response of B cells to the antigen. NK T cells that express an invariant T-cell receptor (Inv TCR) and respond to glycolipid antigens, such as α-Gal-Cer, presented by CD1 MHC-like molecules can secrete cytokines that augment immune cell responses to coexisting antigens. Reproduced from A. Bendelac and R. Medzhitov, :F19–F23, 2002, with permission.

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Image of Figure 21.7
Figure 21.7

Transfection of macrophages with costimulatory molecules and microbial antigen can elicit protective immunity. Mice were vaccinated with cells expressing CD40L and the gp63 antigen from (L-gp63). Mice were injected with irradiated cells expressing both CD40L and gp63 (open squares) or with cells expressing gp63 alone (solid circles). Vaccinated mice were challenged with 5 × 10 promastigotes in the footpad 1 week after the final booster injection. Immunization with L cells expressing CD40L and microbial antigen resulted in reduced immunopathology, as determined by a footpad swelling response. In addition, the mice immunized with cells expressing CD40L and gp63 had lower levels of parasites in the infected tissues . Reprinted from G. Chen et al., 3255–3263, 2001, with permission.

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Image of Figure 21.8
Figure 21.8

Construction of a viral vector vaccine containing DNA encoding a protective antigen from another organism. A DNA plasmid from a poxvirus engineered to contain a viral promoter in the middle of the nonessential thymidine kinase gene is used as a recipient for pathogen DNA. This DNA is inserted into the plasmid under the control of a viral promoter. When the recombinant plasmid is mixed with live virus in cell culture, some of the viral particles will recombine with the plasmid DNA and incorporate the pathogen DNA and the interrupted thymidine enzyme. Exposing cell cultures to bromodeoxyuridine (BUdR) kills the virus particles with intact thymidine kinase genes and selects for the particles with the pathogen antigen DNA interrupting the viral thymidine kinase gene.

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Image of Figure 21.9
Figure 21.9

Comparison of traditional methods used to develop vaccines and reverse vaccinology technology. This new technique relies on computer predictions of surface antigens based on structural characteristics, which can quickly lead to the preparation of a recombinant protein or DNA vaccine for evaluation. Application of this strategy for development of vaccines against group B identified, within an 18-month period, 25 surface-exposed proteins that have vaccine potential. Many of these proteins were different from the conventional outer membrane proteins embedded in the organism's outer layer or secreted, which usually were too variable to be good vaccine candidates. Instead, the newly identified proteins were membrane-anchored lipoproteins or secreted proteins . Reprinted from R. Rappuoli, 2688–2691, 2001, with permission.

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Image of Figure 21.10
Figure 21.10

Major immunologic mechanism mediating protective immunity to bacterial pathogens is antibody to the cell surface capsule. Capsules protect bacterial pathogens from host defenses; to overcome the resistance of the bacteria to phagocytosis, antibodies to the capsule need to be elicited.

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Image of Figure 21.11
Figure 21.11

Replicative cycle of a virus and potential points of possible function of immune effectors. Viruses leaving a cell as either an enveloped particle, via budding, or a nonenveloped particle, via cytolysis, could be neutralized by antibody binding and complement activation or phagocytosis. Antibodies also can block viral receptors from binding to targets, prevent penetration, or prevent uncoating. Once viral replication is initiated in another cell, cell-mediated processes such as cytolytic T cells, antibody-dependent cellular cytotoxicity, and interferons could participate in preventing further production of virus.

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Image of Figure 21.12
Figure 21.12

Structure of the hemagglutinin of influenza virus. The binding cleft anchors the virus to sialic acid residues on host cells. In the areas designated as the tip, the loop, and the hinge, amino acid changes accumulate to produce antigenic drift. Within these regions are amino acids that change with the highest frequency. The crystal structure is from I. Wilson et al., 366–373, 1981, with permission.

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Image of Figure 21.13
Figure 21.13

Survival curves of mice treated with monoclonal antibodies (MAbs) to different cryptococcal antigens. Two different monoclonal antibodies reactive to the capsular polysaccharide prolonged survival, with one antibody clearly better than the other in providing survival from infection. Two different monoclonal antibodies to the melanin antigen also resulted in prolonged survival following infection. Reprinted from J. Mukherjee et al., 4534–4541, 1992 (top), and A. L. Rosas et al., 3410–3412, 2001 (bottom), with permission.

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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References

/content/book/10.1128/9781555816148.chap21
1. Bendelac, A.,, and R. Medzhitov. 2002. Adjuvants of immunity: harnessing innate immunity to promote adaptive immunity. J. Exp. Med. 195:F19F23.
2. Coombes, B. K.,, and J. B. Mahon. 2001. Dendritic cell discoveries provide new insight into the cellular immunobiology of DNA vaccines. Immunol. Lett. 78:103111.
3. Gregersen, J. P. 2001. DNA vaccines. Naturwissenschaften 88:504513.
4. Handman, E. 2001. Leishmaniasis: current status of vaccine development. Clin. Microbiol. Rev. 14:229243.
5. Hull, H. F. 2001. The future of polio eradication. Lancet Infect. Dis. 1:299303.
6. Nalin, D. R. 2002. Evidence based vaccinology. Vaccine 20:16241630.
7. Obaro, S.,, and R. Adegbola. 2002. The pneumococcus: carriage, disease and conjugate vaccines. J. Med. Microbiol. 51:98104.
8. Ogra, P.L.,, H. Fade,, and R. C. Welliver. 2001. Vaccination strategies for mucosal immune responses. Clin. Microbiol. Rev. 14:430445.
9. Orme, I. M. 2001. The search for new vaccines against tuberculosis. J. Leukoc. Biol. 70:110.
10. Pappagianis, D. 2001. Seeking a vaccine against Coccidioides immitis and serologic studies: expectations and realities. Fungal Genet Biol. 32:19.
11. Rappuoli, R. 2001. Conjugates and reverse vaccinology to eliminate bacterial meningitis. Vaccine 19:23192322.
12. Richie, T. L.,, and A. Saul. 2002. Progress and challenges for malaria vaccines. Nature 415:694701.

Tables

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TABLE 21.1

Decrease in cases of vaccine-preventable diseases in the United States through 1998 as reported by the U.S. Centers for Disease Control and Prevention

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Table 21.2

Comparative mechanisms for inducing active or passive immunity

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Table 21.3

Microbial antigens that can be targeted for vaccine development

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Table 21.4

Properties of an effective vaccine

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
Generic image for table
Table 21.5

Types of effector mechanisms known to be involved in immunity to microbial pathogens that would need to be elicited by a vaccine

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Table 21.6

Mechanisms of action of some adjuvants

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Table 21.7

Bacterial vaccines developed to date

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Table 21.8

Viral vaccines developed to date

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Table 21.9

Fungal vaccines under development

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Table 21.10

A selection of antigens as targets for parasite-neutralizing immune response

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21
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Table 21.11

Passive immunotherapeutic reagents available for postexposure prophylaxis

Citation: Pier G. 2004. Vaccines and Vaccination, p 497-528. In Pier G, Lyczak J, Wetzler L (ed), Immunology, Infection, and Immunity. ASM Press, Washington, DC. doi: 10.1128/9781555816148.ch21

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