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TM: Immunisations - Past & Future (i) (Intro (Control of meningitis…
TM: Immunisations - Past & Future (i)
Intro
Prevention NB
individual patient level
community
national (larger prevention programmes cheaper + more effective)
Control of meningitis
Hib has decreased no. of cases in Ire
S pneumoniae PCV7+13 decreased prevalence of invasive pneumococcal disease in US
N meningitides subtype C has decreasedmno. of cases in Ire + UK, esp in children
polysacc conjugated vaccines
Control of neonatal tetanus
vaccinate mother, antibodies cross placenta
tetanus toxoid @ NMJ
increased tone
excess stimulation
flexor posturing (as flexors are stronger than extensors)
baby feels v rigid
hard abdomen
natural hx = resp muscle paralysis (needs ventilator or will die)
Cancer prevention using hep B vaccine
had decreased mortality from acute hep + hep carc
a lot of vaccines (+ other medicines) are Irish exports
supply vs demand (financial incentives) driven
Biosimilar drugs bypass patents
For hep B + HPV person must get vaccine before they are infected
hence vaccinate before onset of sexual activity
HPV in men: penile, head, neck cancers
HPV vaccine = bivalent (16+18)
ebola = filovirus
viruses have a v diverse constantly changing genome compared to humans (esp HIV - hence no vaccine)
can be a problem for vaccine making unless there's conserved sequences
How vaccines were made historically
live attenuated
BCG
tx + prevents spread of early stage bladder cancer
oral polio
causes immunity not disease
contraindication = immunocompromised
Killed
rabies
adjunvanted
e.g. with alum
2nd chemical product to improve immune response
makes carb antigens more immunogenic when covalently bound to a protein
Subunits
Hep B surface protein
Conjugated
Hib covalently linked to tetanus toxoid (Men B OMP - outer membrane protein)
Pneumococcus CHO linked to CRM197 (non-toxic mutant of diphtheria toxin, currently used as a carrier protein for polysaccs + happens to make them more immunogenic)
Men C linked to tetanus
Future
DNA vaccines
work in mice, not as well in humans
vectors
2 viruses
effective - strongly immunogenic
prime boost - same antigen, different vectors
Prime boost (immunisation strategy involving priming with DNA)
Polyvalency
6 in 1
23-valent pneumovax
H1N1 influenza A vaccine with AS03 (adjuvant system 03)
squalene-based immunologic adjuvant
AS03 associated with narcolepsy (1 in 10000, destruction of some brain cells that keep you awake)
Immunotherapy
individualised APCs primed against cancers
taking out patient's cells, priming them (stimulating) + reinfusing them into patient