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; More here...

The Revised Authoritative Guide To Vaccine Legal Exemptions Summary


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Table 230 Key steps in the planning of an vaccination campaign

Plan vaccination strategies mass vaccination campaigns vs. routine vaccination selective vs. non-selective vaccination. 4. Define needs number of vaccine doses cold chain equipment other supplies (auto-destruct syringes, safety boxes, monitoring forms, vaccination cards, tally sheets) staff. 5. Implement vaccination campaign safety of injection safe disposal of injection material record keeping individual vaccination cards other activities (e.g. nutritional supplementation and vitamin A, treatment of complications) health education and social promotion materials. 6. Evaluate coverage percentage vaccinated among estimated target population) incidence of side-effects (post-vaccination surveillance).

Mass vaccination strategies

To implement a mass vaccination campaign in emergencies, there are two main strategies. 1. Vaccination can be carried out at the screening centre on arrival at a camp. This is possible when the screening facility has been set up and the influx of refugees is steady and moderate. 2. Vaccination sites can be set up in different sections of the target area and mass vaccination carried out by outreach teams. This is necessary when the population has already settled at a site or the influx has been too rapid to organize a screening facility.

Routine vaccination strategies

In the case of measles, once the target population has been immunized in the mass campaign, measles vaccination must become part of health care activities. Ongoing vaccination is required to cover children who might have missed the initial vaccination campaign, children vaccinated at the age of 6-9 months who must receive a second dose of the vaccine at 9 months, Vaccination may be selective, whereby the vaccination status of the child is checked on the basis of a vaccination card and the vaccine is given if there is no evidence of previous vaccination. In non-selective vaccination, vaccination status is not checked and all children are immunized regardless of their immune status. A second dose of measles vaccine has no adverse effect. Non- selective vaccination is preferred in a mass campaign, as it is quicker and leaves little chance for error. The first activity is to assess the need for an vaccination campaign by Data on background vaccination coverage in the emergency-affected...

Oral cholera vaccines

New generation orally administered cholera vaccines (OCV) have passed the stage of research and development and two formulas are commercially available. Currently, the main users of marketed OCV have been individual travelers from industrialized countries who expect to be exposed temporarily to the risk of cholera while traveling in endemic areas. Recently, there has been renewed interest in using oral cholera vaccines in mass vaccination campaigns, in conjunction with traditionally recommended control measures such as provision of safe water and improved sanitation. Several mass-vaccination campaigns using OCV have been performed with the support of WHO. In 2000, the Federated States of Micronesia exposed to an ongoing outbreak in Pohnpei Island decided on using the live-attenuated oral cholera vaccine CVD 103-HgR to limit the spread of the outbreak. A retrospective analysis suggested that mass vaccination with OCVs can be a useful adjunct tool for controlling outbreaks, particularly...

Therapeutic Vaccines and Toleragens

While vaccines have traditionally been used as prophylactics, they are increasingly being used as therapies for already established chronic disease.31 For autoimmune disease therapy, a peptide similar to that causing the disease is administered to the patient in theory, the vaccine then stimulates an immune response to the T cells reacting in the disease. This presumes that the autoantigen(s) is known, and that the disease is caused by one or a few antigens. An advantage to this hypothetical mechanism is that the anti-Tcell response should, in theory, be specific for the T cells contributing to disease pathogenesis. Glatiramer acetate is the first vaccine that has been used to treat an autoimmune disease - in this case RRMS32 it was approved by the US FDA in 1996. It is a mixture of many synthetic peptides - random polymers - that mimic the antigenic portion of MBP. It reduces the relapse rate in RRMS, impacts MRI markers of disease activity, is well tolerated, and does not appear to...

Nutrients antibodies secondary metabolites and vaccines

A gene encoding the enzyme phytoene synthase, which condenses two molecules of geranyl geranyl diphosphate to get -carotene (provitamin A) synthesis, was expressed in rice endosperm (Burkhardt et al. 1997). The biosynthetic pathway for regulating Vitamin C content has been investigated by Wheeler et al. (1998). Plants could also produce antibodies (Ma and Hein 1995) and vaccines (Arntzen 1998). Antibodies against bacteria associated with dental caries (Ma et al. 1998), antigens for certain forms of diabete (Ma et al. 1997), and some new vaccines (Arakawa et al. 1998) can be produced in fruits particularly banana.

Bioinformatics And Vaccine Discovery

Immunoinformatics is a newly emergent subdiscipline within the informatic sciences that deals specifically with the unique problems of the immune system. Like bioinformatics, immunoinformatics complements, but never replaces, laboratory experimentation. It allows researchers to address, in a systematic manner, the most important questions in the still highly empirical world of immunology and vaccine discovery. The first vaccine was discovered by Edward Jenner in 1796, when he used cowpox, a related virus, to build protective immunity against viral smallpox in his gardener's son. Later, Pasteur adopted vaccination the word coined by Jenner for his treatment (from the Latin vacca cow) for immunization against any disease. In 1980, the World Health Organisation declared that worldwide vaccination had freed the world of smallpox. A vaccine is a molecular or supramolecular agent that induces specific, protective immunity (an enhanced adaptive immune response to subsequent infection)...

Cloning Of Lymphomaderived Ig Variable Region Genes Vh AND Vl And Construction Of Singlechain Fv Fusions For Use As

Lymphoma is clonally restricted to express a unique Ig, and its idiotype is considered a tumor marker and potential immunogen to elicit anti-idiotypic anti-tumor responses. Heavy and light chain variable region genes of Ig can be expressed as a genetically linked protein, designated single chain Fv (scFv), which usually retains the conformation of the parental idiotype. However, syngeneic mice immunized with lymphoma-derived Ig or scFv alone from 38C-13 and A20 do not elicit anti-Id responses. Rather, chemical or genetic fusion of Ig or scFv with carriers or cytokines is required for immunogenicity (Campbell et al., 1990). Previously, the authors of this unit reported that scFv can also be rendered immunogenic by targeting them to APC and DC using chemokine carriers (Biragyn et al., 1999). Herein, we describe a novel and simple approach which produces immunogenic lymphoma-derived scFv and can be used for both protein- and DNA-based vaccinations. Specifically, a complete protocol is...

Tumor Protection Using Gmcsftransduced Wholecell Vaccine B16gmcsf

It is difficult to induce reliable protection against B16 challenge by vaccination with irradiated B16, even when admixed with Corynebacterium parvum. However, robust protection can be obtained by vaccinating with B16 that is retrovirally transduced to secrete high levels of GM-CSF (Dranoff et al., 1993). Although B16.GM-CSF will still grow upon injection, vaccination with irradiated cells will induce a T cell-dependent protection against wild-type B16. It is unknown what antigens are targets of this immune protection, and the involvement of eosinophils and macrophages has been implicated (Hung et al., 1998). The following protocol describes the use of B16.GM-CSF for protection against B16 challenge in the authors ' laboratory. Recent results suggest it may also be possible to impact on growth of established tumors by vaccinations with irradiated B16.GM-CSF, especially in conjunction with anti-CTLA-4 antibody (van Elsas et al., 1999). The addition of this antibody, which presumably...

Induction Of B16 Melanoma Protection By Recombinant Vaccinia Virus rVv Vaccine

Currently, the two tumor vaccines that induce the most reliable protection of mice from lethal B16 challenge are rVV encoding the MDA, mTRP-1 and irradiated B16 expressing GM-CSF (Hung et al., 1998 Overwijk et al., 1999). Although immunization with rVVhgp100 induces high levels of gp100-specific CTL, this regimen is completely ineffective in preventing B16 growth upon intravenous or subcutaneous challenge. However, adoptive transfer of in vitro cultured, gp100-reactive CTL can greatly reduce the number of lung metastases upon subsequent intravenous B16 challenge (Overwijk et al., 1998).

Tumor Protection Using Genetically Modified Whole Tumor Cell Vaccines Granulocytemacrophage Colonystimulating

Additional lymphoma antigens have not been defined. Therefore, one general approach to active immunotherapy is to utilize genetically modified autologous tumor cells as a source of Ag. Expression of various cytokine genes in tumor cells may enhance the immunogenicity and potency of cell-based vaccines. Tumor cells are modified transduced in vitro to express immuno- modulatory molecules such as cytokines (GM-CSF, IL-2, and IL-4), chemokines (IP-10), or costimulatory molecules (B7.1 and B7.2). Although transiently transfected cells can be used, stable transfectant tumor cells are selected using selective markers, such as the neomycin analog G418 or hygromycin. Stable transfectants are characterized by flow cytometry (unit5.4) and ELISA (unit 10.17). Herein we describe a brief strategy for producing and testing stably transduced A20 lymphoma cells expressing murine GM-CSF which can elicit T cell-dependent protective and therapeutic immunity against early pre-established tumors (Levitsky...

Vaccine Clinical Trials

Similar to clinical development of drug products, there are four phases of clinical trials in vaccine development. Phase I trials are referred to early studies with human subjects. The purpose of phase I trials is to explore the safety and immunogenicity of multiple dose levels of the vaccine under investigation. Phase I trials are usually of a small scale. Phase II trials are to assess the safety, immunogenicity, early efficacy of selected doses of the vaccine, and generate hypotheses for later testing. Phase III trials, which are usually large in scale, are to confirm the efficacy of the vaccine in the target population and or proving consistency of manufacturing processes. Phase IV trials are usually conducted for collecting additional information regarding long-term safety, immunogenicity, or efficacy of the vaccine to fulfill with regulatory requirement and or marketing objectives after regulatory approval of the vaccine. In this section, we provide some design considerations,...


The major vaccines used in emergency situations are those against measles, meningococcal meningitis and yellow fever. Measles vaccination is one of the highest priorities in the acute phase of an emergency if vaccine coverage rates in the affected population are below 90 . The main objective of a measles vaccination programme is to prevent an outbreak of measles with the high mortality rates often associated with this disease in emergency situations. In this way, the measles vaccine provides one of the most cost-effective public health tools. The use of cholera vaccine is recommended only in stable post-emergency situations. Once the acute phase of the emergency is over, plans should also begin to re-establish the Expanded Programme on Immunization (EPI) to routinely immunize children against tetanus, diphtheria, polio and tuberculosis. This should be integrated with the national EPI programme using national vaccination policies, and it is important to involve the national EPI...

Meningitis vaccine

Meningococcal meningitis A and C can be prevented by vaccination. The vaccine is effective within 8-14 days. Some 90 of recipients over 18-24 months of age seroconvert and are protected against the disease. Vaccine-induced immunity lasts about 5 years in adults and older children, while younger children are protected for approximately 2 years. A quadrivalent vaccine is also available for combined vaccination against serogroups A, C, Y and W135. Vaccination recommendations for meningococcal meningitis are summarized in Table 2.32. Table 2.32 Meningococcal meningitis vaccination recommendations Table 2.32 Meningococcal meningitis vaccination recommendations The group at highest risk of meningococcal meningitis is children aged 2-10 years this should be the priority group during vaccination campaigns Deep subcutaneous or deep intramuscular, using a new sterile disposable needle and syringe for each individual mixing the meningitis vaccine in the same vial or syringe as live virus...

Vaccination Therapy

Vaccination for the treatment of CTCL has the aim to achieve a tumor antigen-specific immune response against malignant T-cells. The specific targeting of tumor cells with activated cytolytic effector cells should ideally destroy tumor cells in the absence of significant side effects. Dendritic cell vaccination is a powerful vaccination approach which has been mainly used in melanoma (53). Recent evidence supports the notion that this approach might also be applicable to CTCL (54). Extracorporeal photopheresis, a well-established therapeutic approach in CTCL, has recently been proposed to be a form of DC vaccination (55). There are few available data regarding DC vaccination for CTCL. Early pilot data suggest that DC vaccination induces immune responses as well as clinical responses in selected CTCL patients (54). Patients with lower tumor burden seem to respond better. Proof of principle studies in CTCL patients suggests that vaccination approaches might be successful in this...

Yellow fever vaccine

Vaccination is the primary means of preventing yellow fever. The yellow fever vaccine offers a high level of protection, with seroconversion rates of 95 or higher for both adults and children. The duration of immunity is at least 10 years and probably lifelong. The serological response to yellow fever vaccine is not inhibited by simultaneous administration of BCG, diphtheria, pertussis, tetanus, measles and poliomyelitis vaccines. Reactions to yellow fever vaccine are generally mild. It can be given to asymptomatic patients infected with HIV but should not be given to symptomatic HIV-infected persons or other immuno-suppressed individuals. For theoretical reasons, yellow fever vaccine is not routinely recommended for pregnant women however, there is no evidence that vaccination of a pregnant woman is associated with abnormal effects on the fetus. In an outbreak, the risk of disease would outweigh the small theoretical risk to the fetus from vaccination. Recommendations regarding...

Measles vaccination

Prevention of measles in emergency situations has two major components routine vaccination and measles outbreak response. The disease can be prevented by the administration of measles vaccine. Some 95 of individuals vaccinated when over 9 months old gain lifelong immunity. Mass vaccination is a priority in emergency situations where people are displaced, there is disruption of normal services, there are crowded or insanitary conditions and or where there is widespread malnutrition, regardless of whether a single case of measles has been reported or not. A measles vaccination campaign should begin as soon as the necessary human resources, vaccine, cold chain equipment and other supplies are available. Measles vaccination should not be delayed until other vaccines become available or until cases of measles have been reported (if cases are reported the campaign should begin within 72 hours of the first report). Vaccination is also a priority in refugee populations from countries with...

Sagar A Vaidya Mary Klotman and Viviana Simon

Acquired immunodeficiency syndrome (AIDS) appeared 25 years ago and mystified doctors and scientists alike as it became one of the worst plagues in human history. Now an estimated 38.6 million children, women, and men are living worldwide with human immunodeficiency virus (HIV) infection (UNAIDS, 2006). While prevention options have expanded substantially, a cure or protective vaccine remain elusive. Antiretroviral combination treatments slow disease progression and have transformed AIDS from an inevitably fatal condition to a manageable, chronic illness.

Gender Ethnicracial And Life Span Considerations

Anaphylactic shock can occur at any age and in both men and women, but women seem a little more susceptible than men. Individuals with food allergies (particularly shellfish, peanuts, and tree nuts) and asthma may be at increased risk for having a life-threatening anaphylactic reaction. People at the ends of the lifespan are most at risk. To prevent infants and children from experiencing severe allergic reactions, pediatricians carefully plan vaccines and diet to limit the risk of allergic reaction until a child's immune system is more mature. Severe food allergy is more common in children than in adults, but diagnostic contrast, insect stings, and anesthetics are more common in adults than in children. Teenagers with food allergies and asthma may be at high risk for an allergic reaction because they are more likely to eat outside the home and less likely to carry their medications. Older people also have a great risk of anaphylaxis, and their risk of death is high owing to the...

So What Exactly Is Bioinformatics

How then is this seeming dilemma to be addressed What is required is more than just new algorithms and software it requires the confidence of experimentalists to exploit the methodology and to commit laboratory experimentation. Despite the best efforts of programmers and software engineers, the use of many bioinformatics tools remains daunting for laboratory-based bioscientists. Use of these methods must become routine. It is not only a matter of training and education, however. These methods must be made accessible and robust. We have come to a turning point, where a number of technologies have obtained the necessary level of maturity postgenomic strategies on the one hand and predictive computational methods on the other. Progress will occur in two ways. One will involve closer connections between bioinformaticians and experimentalists seeking to discover new drugs. In such a situation, work would progress through a cyclical process of using and refining models and experiments, at...

Discussion And Conclusion

One of the tasks of modern drug research is to evaluate this embarrassment of riches. Can we reduce incoherent data into usable and comprehensible information Can we extract knowledge from this information How much useful data is locked away in the literature Can we ultimately draw out understanding from the accumulation of knowledge One way that we can attack this problem is through computer-based informatics techniques, including bioinformatics. This is not meant, of course, to replace human involvement in the process. It is merely a powerful supplement compensating for an area where the human mind is relatively weak the fast, accurate processing of huge data sets. Bioinformatics has already made significant contributions to drug discovery and has begun to do the same for vaccines.

Types of Freeze Dried Products

These comprise the major area of application and include enzymes, hormones, antibiotics, vitamins, blood products, antibiotics, inactivated or attenuated vaccines, and so on. This subgroup includes pharmaceuticals, which may be used diagnostically or therapeutically. 4. Living organisms for vaccine or seed culture use, which must grow and multiply to produce new progeny after drying and reconstitution.

Processing Principles

Products should be formulated to ensure batch product uniformity, whereas there may be particular requirements relating to product use. In this context, vaccines freeze-dried for oral or aerosol delivery may require the inclusion of excipients that minimize damage when the dried product is exposed to moist air (11). A wide range of containers can be used to freeze-dry vaccines, microorganisms, and others, including all glass ampoules, rubber stoppered vials, double chambered vials, and prefilled syringes that hold both dried vaccine and diluent, bifurcated needles, and so on. Alternatively, vaccines can be dried in bulk in stainless steel or plastic trays and the resultant powder tableted, capsulated, sachet filled, or dispensed into aerosol devices for lung or nasal delivery.

Safety Precautions For Using Vaccinia

Vaccinia virus is not to be confused either with variola virus, another member of the Orthopoxvirus genus that caused smallpox prior to its eradication, or with varicella virus, a herpes virus that causes chicken pox. Until 1972, vaccinia virus was routinely used in the United States as a live vaccine to prevent smallpox, and a residual scar, commonly on the upper arm, is evidence of that vaccination. To prevent laboratory infections, the Centers for Disease Control (CDC) and the National Institutes of Health (NIH) recommend that individuals who come into contact with vaccinia virus receive vaccinations at 10-year intervals (Richmond and McKinney, 1993). The CDC has supplied vaccine for such purposes when requested by qualified health workers. Eczema or an immunodeficiency disorder in the laboratory worker or a close contact, however, may be a contraindication to vaccination, which should only be given under medical supervision. The benefits of routine vaccination for healthy...

Freeze Dryer Design 6223840

The need to operate the freeze-dryer under low-pressure conditions to convert ice directly into water vapor (a process termed sublimation) adds to the complexity and cost of dryer because the chamber holding the sample must withstand the differential pressure from vacuum to atmosphere. Although a suitable vacuum pump is essential for initially evacuating the chamber and eliminating air that may leak into the dryer during operation, vacuum pumps are not capable of continuously removing water vapor subliming from the sample and a refrigerated trap (termed the process condenser) must be placed between the sample and the pump to condense the moisture migrating from the drying sample. In reality, it is the condenser that comprises the pumping force of the system. Process condensers may be incorporated into the drying chamber (referred as an internal condenser) or located in a separate chamber between the sample chamber and pump (external condenser). Each geometry has advantages and...

Critical Control Points

This foundation of good working practices can be combined with specific controls at particular points in livestock production which can be identified as CCPs. In livestock production there are a number of points where such controls can be applied. The first is at the birth of the animal, or at hatching in the case of poultry, and extends through all stages of animal production and includes the foodstuffs fed to the animals. The aim should be to have the young born fit and healthy with good levels of maternal immunity. In addition to their appropriate use in the neonate, vaccines can be given to the pregnant dam, such as the bovine combined rotavirus and K99 E. coli vaccine for calf scours, to help to protect the young in the first weeks of life.

Factors Effecting Dried Products

Freeze-dried vaccines should be formulated to minimize storage decay and should tolerate storage at ambient temperatures for distribution purposes. However, it is a fallacy to suppose that a freeze-dried product remains immune to damage during storage and factors which damage freeze-dried products include

Influence of Suspending Medium Composition on Survival of Live Cells to Freeze Drying

Attempts to freeze-dry cells in water or a simple salt solution typically result in poor survival. A wide range of protective media has been developed for preserving freeze-dried vaccines, including augmented growth media or sugar solutions. Carbohydrates are widely used as freeze-drying protectants either individually or in combination with other solutes. They should be chosen on the basis of experimentally determining their freeze-drying characteristics rather than on a pragmatic basis. Monosaccharides, such as glucose, provide good bioprotection during freezing and freeze-drying but exhibit low glass transition (Tg') or collapse temperatures (Tc) and dry with collapse when orthodox freeze-drying cycles are used. Disaccharides are effective freeze-drying protectants, and because they display higher collapse than monosaccharides, freeze-dry successfully when conventional drying cycles are used. Reducing sugars may induce damaging Maillard reactions, thereby compromising stability,...

Viral Expression Systems

The most popular viral systems include the already mentioned monkey tumor virus SV40,175 the baculovirus insect cells system,181 and the Semliki Forest virus (SFV) that is used with a wide range of mammalian host cells.182 Further less prevalent systems use the Epstein-Barr virus,183 the cytomegalovirus (CMV), RSV, or the SFV-related Sindbis virus.184 Besides their application in expression systems viral vectors are widely used for vaccines and gene therapies.185

Basic Induction Of In Vivo Antibody Responses To Protein Protocol Polysaccharide Antigens

(see reagents and solutions) Polyvalent pneumococcal vaccine (see reagents and solutions) Sterile hypodermic syringes and alcohol swabs Inject 0.5 ml polyvalent pneumococcal vaccine into an appropriately prepared subcutaneous site, taking care not to inject material intravenously. Polyvalent pneumococcal vaccine contains 23 capsular types of polysaccharide. Phenol is added as preservative. Adverse reactions are similar to those obtained with diphtheria and tetanus toxoids. Adults having received vaccine previously are at increased risk of adverse reaction.

Measurement Of In Vivo Antibody Response Using Elisa

The ELISA offers a rapid, sensitive, reproducible, nonradioactive method for measuring in vivo antibody responses to a variety of antigens, including protein and polysaccharide antigens in sera obtained from individuals vaccinated with tetanus and diphtheria boosters and the polyvalent pneumococcal polysaccharide vaccine. Assays specific for tetanus, diphtheria, and pneumococcal polysaccharide types I, II, and III are detailed below. The description given here is a general approach and must be adapted by each laboratory, particularly regarding the optimum concentration of reagents used.

PAmyloid aggregation blockers

Alternate strategies to reduce the Ab plaque load include (1) inhibition of the formation of Ab dimers and their aggregation into b-pleated sheets and (2) clearing of Ab deposits by immune surveillance. Only small molecule-based strategies will be reviewed here however, both passive and active immunization strategies to facilitate brain Ab clearance, e.g., AN-1792, have shown success in animal models. Clinical exposure with AN-1792 resulted in significant adverse events with second-generation vaccines, e.g., AAB001, under evaluation.

Reagents And Solutions

Diphtheria and tetanus toxoids are available from the State Laboratory Institute of Massachusetts. Tetanus toxoid may also be obtained from Connaught Laboratories. Pneumococcal polysaccharide vaccines are available as Pneumovax 23 (Merck) and Pnu-Immune 23 (Lederle). See appendix 5 for addresses and phone numbers of suppliers.

Diagnostic Assays For Evaluation Of Infant And Mother

Live attenuated varicella vaccine. Annu Rev Microbiol 1996 50 59-100. 3. Seward J, Peterson C, Mascola L, et al. Decline of Varicella Disease Evidence of Vaccine Impact, Vol. 1629. Boston Society for Pediatric Research, Boston, 2000. 5. Krause P, Klinman DM. Efficacy, immunogenicity, safety, and use of live attenuated chickenpox vaccine. J Pediatr 1995 127 518-525. 6. Sharrar RG, LaRussa P, Galea S, et al. The postmarketing safety profile of varicella vaccine. Vaccine 2000 19 916-923.

Background Information

Induction of in vivo antibody responses provides an approach to the evaluation of the overall integrity of the immune system. In the protocols presented here, diphtheria and tetanus toxoids are used as representative protein antigens and pneumococcal polysaccharides are used as representative polysaccharide antigens because of their safety and availability. It should be noted, however, that the responses elicited by these antigens are likely to be secondary responses because of past vaccination or natural exposure. To obtain a primary response, an unusual antigen such as keyhole limpet hemocyanin should be used (Burke et al., 1977).

Public health importance

In stable populations, the epidemic threshold is generally an incidence of 15 cases per 100 000 inhabitants per week, in 1 week if the population is greater than 30 000, and 5 cases in 1 week or doubling of the number of cases over a 3-week period if the population is less than 30 000. When the epidemic threshold is reached, a mass vaccination campaign should be implemented in the at-risk population (for more details see Section 4.2.2). In emergency-affected populations, however, particularly in overcrowded situations, the threshold for action is lower and the decision to implement a vaccination campaign must be taken locally in consultation with the relevant authorities, such as WHO or the Ministry of Health. Microbiological confirmation should be sought as a matter of urgency, but this should not delay the start of a vaccination campaign.

Primary Nursing Diagnosis

Other Drug Therapy Bronchodilators, which are used for prevention and maintenance therapy, can be administered as aerosols or oral medications. Generally, inhaled anticholinergic agents are the first-line therapy for emphysema, with the addition of beta-adrenergic agonists added in a stepwise fashion. Antibiotics are ordered if a secondary infection develops. As a preventive measure, influenza and pneumonia vaccines are administered.

EncephalitisDRG cew 020

Encephalitis has two forms primary and postinfectious (or parainfectious). The primary form of the disease occurs when a virus invades and replicates within the brain. Postinfectious encephalitis describes brain inflammation that develops in combination with other viral illnesses or following the administration of vaccines such as measles, mumps, and rubella. In that case, encephalitis occurs because of a hypersensitivity reaction that leads to demyelination of nerves.

Disease Specific Animal Models

Experimental autoimmune neuritis (EAN) is an animal model for both acute and chronic inflammatory demyelinating polyneuropathy (i.e., GBS and CIDP, respectively). EAN can be generated in rats, mice, or rabbits, and is typically induced by injection of myelin proteins (P0, P2, PMP22, and MAG). Two other vaccination protocols have been used to develop models for GBS in Japanese white rabbits a ganglioside vaccination protocol that elicits

DSPC Duffy Blood Group System

DTP Vaccine Abbreviation for vaccine against diphtheria, tetanus, and pertussis. DTPV Abbreviation for diphtheria-tetanus- pertussis vaccine. DTTP A trade name for diphtheria and tetanus toxoids and pertussis vaccine. Duck Embryo Vaccine A killed rabies virus vaccine prepared from duck embryo.

Minimum data elements

- programme activities (including vaccination). Malnutrition and compromised access to basic needs are frequently seen in emergencies and have a major impact on disease susceptibility. Available data (preferably from household surveys) on malnutrition, basic household needs and vaccination coverage should be collected as well, and included in the periodical analysis of surveillance data, together with communicable diseases. Sample household survey forms are included in Annex 2.

Epidemiology And Transmission

Rubella occurs throughout the world, but the epidemiology varies globally. In temperate climates, the peak incidence for infection is the late winter and spring. Rubella remains prevalent in many areas of the world in which the rubella vaccine is not used. In the United States and other countries where the vaccine has been given routinely since the early 1970s, the epidemiology of rubella has changed dramatically. Epidemics of rubella, which occurred in 6- to 9-year cycles prior to vaccine use, have been disrupted, and endemic rubella has been almost eradicated in the United States (3). A 99 reduction in reported cases of rubella and the congenital rubella syndrome (CRS) occurred in the United States between 1965, when the last epidemic occurred, and

Identification of B Cell and T Cell Epitopes Using Synthetic Peptide Combinatorial Libraries

Synthetic combinatorial libraries have been found to be valuable tools for the study of protein-protein interactions. Of the many different combinatorial library methods developed, the one described in this unit consists of the synthesis and screening of mixture-based synthetic combinatorial libraries (SCL) of peptide molecules. These libraries are systematically arranged into mixtures containing a total of hundreds of thousands to trillions of individual peptides. The understanding of B cell and T cell specificity has been advanced significantly by the development and use of SCL composed of millions of synthetic peptides. The use of peptide SCL has led to the identification of high-affinity ligands for both T cells and mAbs with known and unknown specificities. These peptides can result from the combinations of the amino acids that do not necessarily correspond to sequences in known proteins. In addition, the native ligand and potential cross-reactive sequences can be identified from...

Purification Of Map System By Dialysis

The chemistry of solid-phase peptide synthesis has been significantly improved since it was first introduced in 1963. Now synthesis of peptides of 100 or more residues with satisfactory yield and purity is possible. In general, crude synthetic MAP systems (after the cleavage step) are pure enough for many purposes (e.g., for production of antisera). When highly purified MAP systems are required (e.g., for vaccines for humans), the crude synthetic product must be purified to near homogeneity. MAP systems can be purified by dialysis, gel-filtration chromatography, RP-HPLC (unit 9.2), and high-performance gelfiltration chromatography (see Support Protocol 3). This protocol details the special procedure required for the sequential dialysis of MAP systems.

Mendelian susceptibility to mycobaterial disease

Mendelian susceptibility to mycobaterial disease (MSMD) was probably first clinically described in 1951 (Casanova & Abel 2002). Patients with MSMD are highly susceptible to weakly virulent mycobacteria (environmental mycobacteria and BCG vaccines), but are apparently resistant to most other infectious agents, with the exception of Salmonella (Fieschi et al 2003, Dorman et al 2004). Since 1996, disease-causing mutations have been found in five autosomal genes (IFNGR1, IFNGR2, STAT1, IL12B and IL12RB1), involved in interleukin (IL)12 23-dependent, interferon (IFN)y-mediated immunity (Casanova & Abel 2002, Casanova et al 2005). Extensive allelic heterogeneity at these loci accounts for the existence of 12 distinct genetic disorders, which have been diagnosed in more 300 patients worldwide (Fieschi et al 2003, Dorman et al 2004, Vogt et al 2005, Filipe Santos et al 2006) (Chapgier et al 2006). Recent discoveries include the description of the first IFNGR2 mutation associated with the...

Summary and Conclusion

During the past decade, the most exciting and important finding in SLE-prone mice has been the discovery of Fas Fas ligand systems in the pathogenesis of autoimmune phenomena. A human model for murine lpr gld disease has also been reported (Sneller et al. 1992). Furthermore, as shown in Table 16.2, studies on immunoglobu-lin variable region genes, TCR genes, and MHC class II genes have given us much information concerning human and murine SLE. With respect to cytokines, IL-2 deficiency (Dauphinee et al. 1981) and the key role of IL-6 (Finck et al. 1994, Tang et al. 1991) have been found in SLE-prone mouse strains, and Th2 cytokine production has been demonstrated to play a more pathogenic role than Th1 cytokine production in human and murine SLE (Klinman and Steinberg 1995), except in MRL lpr mice (Takahashi et al. 1996.). Transforming growth factor is also intriguing because transforming growth factor p-knockout mice show SLE-like autoantibodies and Sjogren's syndrome-like...

Discharge And Home Healthcare Guidelines

Explain that there is no means for eliminating the varicella virus from the nerve ganglia. (A varicella vaccine, however, is currently under development and may help with prevention of primary chickenpox and therefore might help with decreasing the incidences of herpes zoster.)

Clinical Manifestations

Primary prevention Three typhoidal vaccines (1) oral live vaccine, (2) IM, vaccines approximately 70 efficacy boil-it, bottle-it, peel-it, or forget-it no amphibian reptile pets (especially with children and elderly in household). Secondary prevention Blood (50 ) urine rose spot (70 ) bone marrow (90 ) C&S Widal H O antibodies.

Risk Of Fetal And Neonatal Infection

Although direct fetal infection by polioviruses in early gestation is uncommon, almost half of pregnancies complicated by maternal poliomyelitis in the first trimester ended with fetal loss (8). Fetal loss was greatest with severe maternal illness, although spontaneous abortion also occurred with mild, nonparalytic maternal disease (6). Pathologic evidence of direct fetal infection was lacking in most cases. Neonatal infection was also relatively uncommon compared with the incidence of poliomyelitis in later childhood. However, among mothers with poliomyelitis near the time of delivery, almost 40 of their neonates developed clinical poliomyelitis (7). In the absence of maternal disease at or within the first week after delivery, neonatal poliomyelitis was infrequent (7). Neonatal poliomyelitis is now extremely rare in countries with widespread vaccination but continues to occur in regions with underimmunized populations.

Interpretation Of Diagnostic Evaluations

Herpes simplex virus infection of the newborn can closely mimic findings of neonatal EV infection surface viral cultures and PCR testing of cerebrospinal fluid and serum for herpes simplex virus and EV usually should be done concomitantly when evaluating a sick newborn (33). Co-infection by EVs and bacteria may occur, so bacterial infection should be ruled out by appropriate cultures before ascribing an illness solely to EV infection (33,37,98). Likewise, for meningitis, evaluation may be indicated for other congenital infections such as syphilis, toxoplasmosis, or rubella. It should be remembered that, after the neonatal period, receipt of live attenuated (oral) poliovirus vaccine can result in a positive viral culture or PCR assay of throat or rectum and occasionally of serum or cerebrospinal fluid.

Risk Of Fetalneonatal Infection

Maternal Varicella

It appears that maternal varicella does not increase the incidence of spontaneous abortion (7). It is hoped that one effect of widespread use of varicella vaccine will be the virtual elimination of the congenital varicella syndrome, analogous to that which has occurred with congenital rubella. There is no evidence that the varicella vaccine virus causes the congenital syndrome, but vaccination is contraindicated during pregnancy. As it did for the rubella vaccine, the CDC has established a registry for outcomes of women inadvertently vaccinated during pregnancy (12). To date, only about 50 such women have been followed to term. Before firm conclusions can be made, observation and follow-up of several hundred vaccinated susceptible women will be necessary. At present, there is no evidence of teratogenicity of the vaccine virus.

Raw material control

Once introduced, Salmonella can spread quickly in conditions where animals are reared in close proximity such as poultry in sheds and every effort must be made to prevent the organism entering such sheds through control of the feed, water and environment. Pest control and control of human entry are key to a successful strategy for controlling Salmonella. Proper hand washing and boot changing disinfection are essential to keep the organism out of poultry houses. A strategy that has achieved successful reduction of Salmonella and S. Enteritidis in particular in recent years, has been the introduction of vaccination. While this has been adopted widely for the laying flocks in the UK it has yet to gain a similar application to broiler flocks, which owing to the high cost per bird is unlikely to occur until the introduction of a live vaccine that could be given in the feed rather than the current dead vaccine injected into each bird. survey between 1992 and 1993 of eggshells and contents...

Studies in Experimental Animal Models

The suppressive effect of GA in EAE is a specific one, since GA lacked any suppressive effect on the immune response in several systems - humoral and cellular immune responses to a variety of antigens and vaccination against various induced infections. GA treatment also did not suppress other experimental autoimmune diseases, including myasthenia gravis, thyroiditis, diabetes, and systemic lupus erythematosus.5,17 However, it has been reported to inhibit another autoimmune disorder, namely experimental uveoretinitis,18 a disease interrelated with MBP and EAE. Recently, GA was also shown to be effective in the case of experimental colitis.19 In addition, GA also had an effect on a murine model for graft-versus-host disease, as well as in three systems of graft rejection.20

Diagnostic Evaluation of Suspected Cutaneous Anthrax

Human anthrax vaccine is available as anthrax vaccine adsorbed, a sterile filtrate of cultures of an attenuated unencapsulated, non-proteolytic strain of B. anthracis, containing predominantly protective antigen (2). Doses are given subcutaneously at 0, 2, and 4 weeks, with boosters given at 6, 12, and 18 months. Further boosters are recommended if continued exposure is a possibility. The vaccine has been widely used in military personnel and in some industries that have exposures to at-risk animals from endemic areas. Other immunizations are under investigation, including a transcutaneous system that has recombinant protective antigen of Bacillus anthracis and heat-labile toxin of Escherichia coli delivered by an adhesive patch. In a murine model, maximal immunity with protection against lethal doses of aerosolized anthrax spores was achieved with two doses, holding promise for future use in humans (20). Naturally occurring cutaneous anthrax is a disease that has become almost...

Control procedures for Campylobacter

Chicks dosed with anaerobic preparations of caecal mucus from Campylobacter-free adult hens were shown to be partly protected against C. jejuni (Mead et al., 1996). Vaccination and drug therapy have also been proposed (White et al., 1997) although the use of antibiotics has been a factor in the rapid emergence of antibiotic-resistant Campylobacter strains all over the world (Allos, 2001). This trend has further emphasised the need for appropriate and safe use of antibiotics in animal production (Pedersen et al., 1999).

Induction Of Eau In The Rat By Active Immunization

Susceptibility to experimental autoimmune uveoretinitis (EAU) varies between rat strains. The most popular rat strain for EAU studies is the Lewis rat, which develops characteristically severe uveitis. Both males and females appear to be equally susceptible. In many resistant strains susceptibility can be enhanced by treating with Bordetella pertussis toxin (PTX) or heat-killed B. pertussis vaccine concurrently with immunization. Table 15.6.1 summarizes the susceptibility of some common inbred rat strains to EAU induced with the native retinal soluble antigen (S-Ag). A number of pathogenic epitopes of S-Ag, interphotoreceptor retinoid-binding protein (IRBP), and rhodopsin have been defined for the Lewis rat (RT1B'), but information concerning epitopes pathogenic for other rat haplotypes is sparse. Uveitogenic epitopes of rhodopsin were described by Adamus et al. (1992). Table 15.6.2 lists some of the peptides that have been found to be pathogenic in the Lewis strain additional...

Immunization Schedule For Producing Antipeptide Sera In Rabbits

Rabbits, as described here, are commonly chosen for immunization when the requirement for antiserum is 10 to 200 ml. Whenever possible, choose at least two individuals. This will provide a back-up in case one animal fails to respond, because of premature death or idiosyncrasy. The reagent amounts indicated in this protocol assume that this number is used for vaccination. Scale the reagent amounts as necessary to use other species and or different numbers of animals. Bear in mind that although inbred laboratory strains provide increased reproducibility, outbred animals are more likely to produce a response, since

Induction Of Eam In Rats By Active Immunization With Cardiac Myosin

A T cell response specific for the alpha isoform of cardiac myosin is required to initiate EAM in Lewis rats and is elicited by immunization with purified myosin protein or with specific myosin peptides. To date, Lewis rats are the only known species of rat susceptible to EAM, and females are the preferred gender (see Wegmann, 1994). The sequences of disease-inducing peptides are presented in Table 15.14.3. Note that additional M. tuberculosis (strain H37Ra) is added to the CFA for induction of EAM in rats. Heat-killed Bordetella pertussis vaccine can be administered on days 1 and 3 in rat EAM if additional stimulation is needed to induce EAM. The immunization schedule is shown in Table 15.14.2.

Immunological Properties of Glatiramer Acetate

Recent studies have revealed an additional aspect of GA activity - neuroprotective effects that might also be relevant to MS. It was demonstrated that, similarly to MBP, active immunization with GA as well as adoptive transfer of Tcells reactive to GA can inhibit the progression of secondary degeneration after crush injury of the rat optic nerve.62 The GA-specific T cells secreted significant amounts of BDNF,62 a neurotrophin that plays a major role in neuronal survival. Furthermore, vaccination with GA protected neurons against glutamate cytotoxicity,63 and aggregated beta-amyloid-induced toxicity.64

Introduction to Biopharmaceuticals

Advances in molecular biology, genetic engineering, process purifications, analytical chemistry and related disciplines have led to the production of large quantities of highly purified proteins facilitating drug development efforts. A number of these proteins such as insulin, human growth hormone (HGH), a-interferon, y-interferon, tissue plasminogen activator (TPA), granulocyte colony stimulating factor (G-CSF), granulocyte macrophage colony stimulating factor (GM-CSF), Interleukin-2, erythropoietin, hepatitis B-vaccine and murine monoclonal antibody have already been The marketing of all pharmaceuticals in the United States is regulated by the Code of Federal Regulations for Drugs, 21 CFR, Chapter 1, Sub-chapters C and D. Biological products which include all vaccines, antibiotics, hormones, human blood or blood-derived products, immunoglobulin products, products containing intact cells, fungi, viruses or virus pseudotypes, proteins produced by cell culture or transgenic animals and...

Prevention of dementia I

Disease elimination suits diseases with single known causes (pathogens) that can be specifically targeted in a prevention strategy. This has been the model used in infectious diseases such as smallpox, which was eliminated from the community by population vaccination programs, and in other diseases such as measles, rubella, polio and diphtheria, which can be prevented in most individuals by vaccination. This will also be the model used in proposed gene therapies for genetic disorders where a single gene mutation is responsible for the disease. The gene therapy will target the mutation and correct the abnormality before it has had the opportunity to cause irreparable damage. Another method of disease elimination involves DNA testing of a foetus during early pregnancy where a known genetic risk for a disorder, such as Down syndrome, exists leading to a possible termination of the pregnancy. mouse. Immunisation of young transplanted mice with a protein named AN-1792 prevented the...

Pharmacological Treatment of Chronic Cocaine Addiction

Clinical trials with bupropion, olanzapine, naltrexone, buprenorphine, and other drugs are ongoing. As our understanding of the neurobiological basis of cocaine addiction becomes further refined, new pharmacological strategies are emerging. Potential targets include specific dopamine, serotonin, and other receptor subtypes, neuroendocrine peptides (i.e., CRF), and biogenic amine transporters, including the dopamine reuptake transporter. These pharmaco-therapies and the potential development of a vaccine to prevent cocaine from reaching its CNS site of action are covered in Chapter 26.

Guillainbarre Syndrome Introduction

Guillain-Barre syndrome (infectious polyneuritis) is an acute inflammation of the spinal and cranial nerves manifested by motor dysfunction that predominates over sensory dysfunction. The actual cause is unknown, but it is associated with a previously existing viral infection or vaccine administration. Neurologic symptoms include muscle cramps and paresthesia with weakness progressing to paralysis. The severity of the disease ranges from mild to severe with the course of the disease dependent on the degree of paralysis present at the peak of the condition. Recovery is usually complete and may take weeks or months. The disease most commonly occurs in children between 4 and 10 years of age. Treatment is symptom-dependent with hospitalization required in the acute phase of the disease to observe and intervene for respiratory or swallowing complications.

Emerging Technologies

In addition to recombinant proteins and monoclonal antibodies, recent advances have led to a plethora of new technologies such as antisense oligonucleotides, gene therapy and therapeutic vaccines. The mechanism of action of the drug candidates resulting from these technologies pose unique challenges in drug delivery often requiring novel formulations optimized for penetration of the cell wall and resistance to intracellular components. While many of these challenges are being addressed via conventional drug delivery systems by incorporation of the active drug into structures such as liposomes, a new arena of novel drug delivery systems, such as virus mediated cell penetration agents, have emerged to address some of the unique delivery requirements of these novel biomolecules. As these technologies mature to generate viable candidates for drug development, there will arise a need to characterize these novel therapeutic agents in complicated drug delivery systems. In addition, the...

NOC Knowledge Treatment Regimen

Inform parents as to the benefits of routine immunizations with H. influenzae (type B) vaccine, beginning at 2 months of age for a total of 3 doses. suggests the incidence of this form of meningitis has decreased since the vaccine was introduced may decrease the spread of infection to unvaccinated infants.

Assessment Of In Vivo Cytotoxicity By Flow Cytometry

Mice are immunized with DCs transduced with amplicon carrying the gene for the rabies glycoprotein and boosted with a commercial vaccine 4 days prior to being infused with a mixture of 2.5 x 107 target cells consisting of uninfected targets, DiOC18(3)-labeled at a low concentration, and target cells infected with the rabies virus, labeled at a high concentration. After 24 hr, mice are bled and cells are evaluated by flow cytometry (Fig. 9.17.6). It is expected that the mice primed by DCs transduced with the amplicon rabies can generate a CTL activity that destroys targets infected with the rabies virus while leaving the uninfected targets.

Immunodeficiency Disorders

At present there is no cure for AIDS. Early diagnosis and treatment are vital. Certain medications that are currently available, when used in combination, seem to slow development of the disease. These medications include nucleoside analog reverse transcriptase inhibitors (such as zidovudine, also called AZT), which interrupt an early stage of virus replication, and protease inhibitors (such as indinavir, ritonavir, and saquinavir), which interrupt the same process at a later stage. Although these cocktail drug regimens typically cause unpleasant side effects such as nausea and diarrhea, when started early, they are enabling many people infected with HIV to live longer, more productive lives. Other drugs designed to combat the virus, bolster the immune system, and prevent or treat opportunistic infections that result from HIV infection are now being tested. Research on an AIDS vaccine is also under way. For more information on HIV and AIDS, see page 186.

Allergies to Medications

Medications that typically produce an allergic reaction include antibiotics (such as penicillin), sulfa drugs, insulin that contains pig or ox protein, vaccines, and aspirin. If you are allergic to any medications, be sure to tell your doctor and other healthcare providers who are treating you, such as a nurse or a dentist. Also, in case of emergency, you should always wear a medical identification bracelet or necklace and carry a wallet card that informs people of your allergy. This will help ensure appropriate medical treatment.

Commentary Background Information

Numerous vaccination regimens have been analyzed in the mouse model of CMV infection, and various degrees of protection against lethal and sublethal dose challenges were achieved. These include vaccinations with live attenuated mCMV (Howard and Balfour, 1977), with inactivated virus (Tolpin et al., 1980), with recombinant vaccinia virus expressing an mCMV protein (Jonjic et al., 1988), with peptide, and finally with DNA (Scalzo et al., 1995 Gonzales-Armas et al., 1996). The latter three were based on the identification of an immunodominant, H2-Ld-restricted T cell epitope within the pp89 IE1 protein (del Val et al., 1988).

Helicobacter Animal Models

From immunologic points of view, animal models for H. pylori infection are useful in helping to understand disease processes and in vaccine development. In this unit the protocols for growing Helicobacter organisms on plates (see Basic Protocol 1 see Support Protocol 4 for solid medium preparation) or in liquid cultures (see Basic Protocol 2) are presented first, followed by protocols for infecting mice with Helicobacter felis and H. pylori (see Basic Protocol 3) and for infecting ferrets with H. mustelae (Basic Protocol 5). Also, a procedure is described for adapting an H. pylori isolate (e.g., from a clinical source) to growth in mice (see Basic Protocol 4). Support Protocols 1 and 3 describe methods for quantifying numbers of Helicobacter organisms, and Support Protocol 2 describes how to create a growth curve for Helicobacter cultures. One important technique in investigating Helicobacter infection is assaying the disease processes that occur in the stomach. It is important to...

Orally Infecting Mice With Helicobacter

To ensure that animals are infected, inoculate mice a total of two or three times over a period of 5 days. However, for challenge experiments after vaccination, the authors usually give only a single dose of an isolate that has been well adapted to mice (see Basic Protocol 4).

Otitis Media To Treat or Not to Treat

There have been few true advances in the treatment of otitis media since Armstrong's reintroduction of the tympanostomy tube in 1954.1 Management decisions have revolved around three primary options not to treat, to use antibiotics, or to recommend tympanostomy tubes. Other modalities have been suggested, some shown to be of little benefit (decongestants, antihistamines),2 and others to have a limited degree of efficacy (Xylitol gum, Otovent balloons, steroids).3-7 However, with the millenium, there is the promise of new treatment options (laser myringotomy, vaccination), coexistent with the rapid proliferation of drug resistant Streptococcus pneumoniae.

Biological Warfare Agents

Microbiology Bacillus anthracis is a large, spore-forming Gram-positive bacillus (rod) that grows in lengthening chains and produces three antigens protective antigen that is attenuated for the anthrax vaccine and facilitates endocy-tosis of other two antigens, edema factor (causes massive swelling), and lethal factor (releases TNF and IL-1). Prevention Ciprofloxacin 500 mg or doxycycline mg 100 orally bid for 4-6 weeks and 6-shot vaccine, or every 8 weeks without the anthrax vaccine.

Miscellaneous Biological Warfare QFever

Diagnosis Positive chest x-ray with patchy pneumonic infiltrates, serologic antigen detection by complement fixation, no Weil-Felix (Proteus agglutination) reaction. Treatment Tetracycline 500 mg orally every 6 hours for 1 week, or doxycycline 100 mg orally every 12 hours for 1 week. Prevention Post-exposure tetracycline or dox-ycycline every 1 week within 8-12 days IND vaccine under development avoid domestic livestock aerosols, especially of fecal and gesta-tional products.

Asthma Toward a Molecular Understanding

The purpose of this chapter is to address the influence of maternal fetal immu-notoxicant exposure on the development of asthma. To understand how developmental exposure can lead to postnatal asthma onset or affect the sensitivity to triggers of asthmatic attacks, one must have an awareness of the timeline of immunologic development, as well as an understanding of the cellular and molecular characteristics of asthma. Because developmental timelines were discussed in detail earlier in this textbook, this chapter will examine the relationship between developmental exposures to common allergens and toxicants and the cellular and molecular factors involved in asthmagenesis. The data on common asthma triggers such as dust mites and molds will be explored, and those on less common allergens such as foods and vaccines will be reviewed. In addition, the knowledge base on maternal exposure to environmental immunotoxicants such as heavy metals, pesticides, and industrial chemicals will be...

Safety Concerns Regarding the Use of Recombinant Viruses

Vaccinia virus (VV) and adenovirus have a very broad host range, infecting virtually all mammalian cells, including human. Everyone born before the early to mid-1970s has been vaccinated with the smallpox vaccine, which provides a long-lasting protection against systemic viremia upon VV infection. Most people are continually exposed to adenovirus, which is present in the upper respiratory tract of a large portion of healthy individuals where it ordinarily does not cause pathology. However, it is important to realize that, even in individuals who have been repeatedly boosted, a limited infection does occur upon dermal scarification with VV, as evidenced by a localized pustule and tender draining lymph nodes. Evidence is accumulating that mucosal immunity to vaccinia may be weak, so protection from infection through nose, mouth, and eyes may be particularly poor. In addition, wild-type adenoviruses cause significant numbers of respiratory tract infections and even deaths, especially in...

Generating B16 Melanomaspecific T Cell Cultures

This protocol can be used to test the degree of immunization against specific antigens upon vaccination. It assumes that an MHC Class I restricted peptide epitope has been identified for in vitro restimulation and testing (see Table 20.1.1 for a note on preparing peptide stocks). Alternatively, irradiated B16 tumor cells can be used as stimulators however, in the authors' experience this often results in outgrowth of TRP-2 reactive CTL, even when stimulating splenocytes from naive mice (Bloom et al., 1997 Zeh et al., 1999). This protocol has been used successfully to determine efficacy of immunization with recombinant viruses (i.e., rVV, rFPV, rAd see Support Protocol 6), whole tumor cells (see Basic Protocol 3), recombinant DNA, whole protein, and synthetic peptides. T cell cultures are initiated 2 to 3 weeks after vaccination.

Recurrent Acute Otitis Media

When attacks of acute otitis media are frequent and close together (e.g., three or more episodes in 6 months, or four or more attacks in 12 months, with one being recent), prevention is desirable. The parents caretakers should be advised to avoid placing the child in a day-care center, or if this is not feasible, a facility should be chosen that has the fewest number of children possible. Also, they should be counseled about the increased risk of recurrent acute otitis media associated with smoking in the household. Although not effective in infants, the administration of the currently available pneumococcal vaccine is also recommended for children above the age of 2 years the influenza vaccine is also advocated and can be administered to infants.

Growth Of P815 As An Ascitic Tumor Intraperitoneally

P815 tumor cells can be grown intraperitoneally in syngeneic DBA 2 mice. This is the in vivo equivalent to a liquid culture, and offers the advantage of being able to quantify the viable tumor cells present at various time points after an intervention. Abdominal swelling indicative of ascites is detected 2 to 3 weeks following inoculation. Tumor cell enumeration is done using a soft agar colony assay on cells obtained by peritoneal lavage, and relative numbers are obtained by comparison to control groups. Mice can be immunized prior to tumor inoculation to test for the ability of the vaccine being tested to protect against tumor challenge. Intraperitoneal inoculation is also a rapid method for screening the ability of transfected cDNAs encoding cytokines, costimulator molecules, among others, to increase tumor immunogenicity.

Prepare cells for immunization

Dendritic cells isolated from the spleen by adherence deadherence (unit 3.7) are the most effective on a per cell basis. However, whole splenocytes, purified B cells, and whole PBMC have worked well using this vaccination approach that incorporates IL-12. Splenocytes are the most straightforward to obtain, and thus will be described as the APC population for this protocol. These should be purified using Ficoll-Hypaque or Lymphoprep centrifu-gation (see Alternate Protocol, steps 4 to 8).

Derivation Of Antitumor Ctl Clones

Following spontaneous tumor rejection or vaccination against whole tumor cells or specific tumor antigens, CTL clones can be derived with defined specificities. As the procedure for obtaining T cell clones against tumor antigens is somewhat different from that used to derive alloreactive CTL, the process is described here in detail. As an example, derivation of clones recognizing unique antigens on the tum- variant P198 is shown. Isolation of T cell clones with other specificities will require different stimulator cells.

In Vivo Tumor Protection And Immunotherapy Experiments

In general, vaccine formulations can be tested either for their ability to elicit anti-tumor protection or for eradication of established tumor. Although, the latter is the more challenging task, both assays are feasible using 38c-13 and A20 lymphomas. However, use of the slower-growing lymphoma, A20, is recommended for immunotherapy experiments. Both types of in vivo experiments, tumor protection and therapy of established tumor, are described in this protocol. Moreover, the protocol starts with description of immunization strategies for tumor protection experiments using DNA ( a steps), protein ( b steps), and cytokine-transduced vaccines ( c steps), followed by tumor challenge protocols, including a tumor challenge protocol for protection studies ( d step same as tumor challenge steps in Basic Protocol 1) and a detailed experiment for immunotherapy of established A20 lymphoma ( e steps). All in vivo experiments should be repeated at least three times with 10 mice per experimental...

Elisa To Determine Proper Folding Of scFv Protein

Folding of scFv is assessed by ability of scFv to compete for binding of anti-Id monoclonal antibody (S1C5, anti-38C-13 Id) to intact Ig protein. Sera from mice immunized with prototype Ig-KLH protein vaccines are a good source of polyclonal anti-Id antibodies, if monoclonal antibodies not available. Anti-idiotypic sera are obtained from mice immunized intraperitoneally or subcutaneously with 50 g of lymphoma derived Ig cross-linked with KLH (Campbell et al., 1990 also see Support Protocol 3).

Using Peptidebinding Motifs To Predict Interaction With A Specific Mhc Class I Or Class Ii Allele

Binding to a specific MHC class I or class II allele is a prerequisite for a peptide to be available for T cell recognition. Understanding this interaction at the molecular level is therefore of great interest not only from a structural point of view (Garboczi et al., 1996 Garcia et al., 1996), but even more for designing vaccines and identifying potential T cell epitopes in autoimmune diseases and tumor-specific immune responses. Therefore, based on the known association of autoimmune diseases with particular HLA class I or class II alleles e.g., HLA-DRB1*1501 with multiple sclerosis (Vogt et al., 1994) and HLA-DRB1*0401 with rheumatoid arthritis (Nepom and Erlich, 1991 Hammer et al., 1995) the knowledge of al-lele-specific MHC anchor motifs has been employed to predict T cell epitopes within candidate antigens whenever the respective proteins were not easily available or large sets of overlapping peptides to span such a protein could not be afforded (Margalit et al., 1987 Sette et...

Detection of Borreliacidal Antibodies by Flow Cytometry

Borreliacidal antibodies are lethal to the spirochete Borrelia burgdorferi, the causative agent of Lyme disease. Detection of borreliacidal antibodies is useful for serodiagnosing Lyme disease and monitoring immune status after vaccination. Their detection, however, is dependent on the use of live organisms. Visual assessment of cell viability or monitoring of pH-dependent color changes in growth medium can be used to identify killing by borreliacidal antibodies, but detection by flow cytometry significantly increases sensitivity by allowing evaluation of small numbers of organisms. In addition, data from multiple assays can be rapidly acquired and analyzed objectively.

Genetic resistance to smallpox lessons from mousepox

There is increased interest in understanding protective immunity to smallpox for two principal reasons. First, it is the only disease that has been successfully eradicated using a live virus vaccine and, second, there exists a potential threat of intentional or unintentional release of variola virus, the causative agent of smallpox. Although mortality rates associated with smallpox were as high as 40 , a significant subset of those infected recovered. The basis of susceptibility or resistance, and the immune parameters associated with recovery, are still unknown. Animal models of poxvirus infections are being employed to understand what constitutes an effective host response. Ectromelia virus is closely related to variola virus and it causes a disease similar to smallpox in mice. This model is well established, resistant and susceptible strains of mice are defined and four genetic loci associated with resistance have been identified. Susceptibility to infection and disease...

Host response to viral infection and determinants of disease outcome

Smallpox was one of the biggest human scourges, resulting in mortality rates of up to 40 in some populations. However, a significant subset of the infected population recovered. The basis of susceptibility and resistance, and the immune parameters associated with recovery, is not known as the virus was eradicated more than 25 years ago. Despite the success of the smallpox eradication program, there remains considerable fear that variola virus (VARV), the causative agent of smallpox, or other related pathogenic poxviruses such as monkeypox (MPXV) could re-emerge and spread disease in the human population. The increased interest in understanding protective immunity to smallpox is due not only because of the potential threat of a bioterrorist attack (Henderson et al 1999) but it is the only disease known to humankind that has been successfully eradicated with a live virus vaccine. As such, very useful information on immunity and resistance to disease may be gleaned from the study of...

Modified LDL Antibodies and LDLContaining Immunocomplexes

The inverse correlations between modified LDL antibody levels and atherosclerosis, together with data obtained in laboratory animals suggesting that modified LDL antibodies are predominantly of the noninflammatory immunoglobin (Ig)M isotype (189) and human studies claiming that IgM antibodies to modified LDL may predominate over IgG antibodies (190) and have a protective effect in relation to the development of atherosclerosis (191) have led to considerable speculation, including the possibility of vaccination against atherosclerosis (192). This seems highly unwarranted, because of several other lines of evidence. First, the proposed protective murine IgM antibodies are predominantly reactive with oxidized phospholipids, although human antibodies reacting with modified lysine groups have been extensively characterized (193,194). Second, when the isotype distribution of modified LDL antibodies has been studied under stringent conditions, using affinity chromatography-purified...

Wellness Councils of America WELCOA

Headquartered in Geneva, Switzerland, with regional headquarters in Europe, the eastern Mediterranean, Africa, Southeast Asia, the western Pacific, and the Americas and collaborating centers and offices in many countries, WHO provides services to governments and central technical services such as information on health aspects of travel and commerce, international standardization of vaccines and pharmaceuticals, and literature disseminating knowledge on world health problems. WHO is committed to major policy decisions affecting the health of people globally, training health personnel, providing services to governments as requested, and assisting governments in reviewing and evaluating health needs and resources.

Other Experimental Therapies

Many biologicals have been developed, and, according to preclinical data, some of them seemed to be promising candidates for the treatment of LE. Among several antibodies and fusion proteins that have been effective in first trials, many failed to be of significant clinical benefit and are not being further developed for LE therapy. This includes, for example, anti-CD154, the ligand for CD40 (Dumont 2002), anti-CD4, anti-CD5, ricin, an immunoconjugate, 3E10 monoclonal antibody vaccine, anti-CD40L hu5 c9, and human recombinant DNAse.

Viral hepatitis A virus

Hepatitis A virus is spread through faecal-oral route, primarily person to person. It can also be transmitted through food (e.g. shellfish) and water as a result of sewage contamination or infected food handlers. Measures of prevention include safe disposal of sewage and treatment of water supply, good personal hygiene, in particular prior to handling food, and thorough cooking of shellfish. A vaccine is also available and food handlers as well as travellers are advised to be vaccinated.

Adjunctive Therapies For Neurodegenerative Disorders

DDI ), nonnucleoside reverse transcriptase inhibitors (e.g., nevirapine, delavirdine), protease inhibitors (e.g., indinavir, ritonavir), and combination antiret-roviral therapy (Chang et al., 1999b Ammassari et al., 2000 Gray and Keohane, 2003 Dou et al., 2004). While antiretroviral agents are beneficial in attenuating viral load, complications associated with infection are still prevalent, as the virus is never wholly eliminated. Antiretroviral medicines fail to completely eradicate the virus, in part because of a latent form of the virus that persists in resting memory CD4+ T cells (Finzi etal., 1997 Ho etal., 1998 Silician etal., 2003) and select viral mutations that result in viral resistance to antiretroviral drugs (Johnson et al., 2005). Viral reservoirs represent a potentially lifelong persistence of replication-competent forms ofHIV-1, recovered from resting CD4 T cells (Finzi et al., 1997) and peripheral blood monocytes (Crowe and Sonza, 2000), that cannot be suppressed by...

Prenatal Evaluation Of Mother

Women planning to become pregnant should be questioned about whether (and when) they had varicella. Those with a history of disease need no further evaluation, but those with a negative history should be tested for the presence of VZV antibodies. This is most practically done by enzyme-linked immunosorbent assay (ELISA) tests that are commercially available. Although in general these tests lack sensitivity, they are useful for determining natural immunity (7,12). Women who have no history of varicella and who have no detectable VZV antibodies by ELISA should ideally be vaccinated before becoming pregnant. As has been mentioned, women reared in countries with a tropical climate are highly likely to be susceptible if they have no history of varicella. Immunization of adults requires two doses of vaccine administered 4-8 weeks apart. If the woman is already pregnant, she should not be immunized, but the CDC recommends immunization of close susceptible contacts, such as young children...

B16 as a Mouse Model for Human Melanoma

Since MDA are expressed by most melanoma cells, they are an attractive target for melanoma vaccines. However, from an immunological perspective, MDA are self proteins, to which central and or peripheral tolerance may exist, potentially hampering the induction of powerful, therapeutic anti-melanoma immune responses. Yet clinical observations suggest that some degree of autoreactivity can be induced and may even contribute to prolonged survival of patients. In a prospective study of patients receiving IL-2, vitiligo was seen in 20 of melanoma patients that had objective responses. None of the nonresponding patients developed vitiligo, nor did any of the more than 100 patients receiving IL-2 for the treatment of kidney cancer (Rosenberg and White, 1996). This unit will detail protocols for in vivo models of subcutaneous growth and pulmonary metastases of B16 melanoma (see Basic Protocols 1 and 2). Therapeutic approaches include the use of B16.GM-CSF (see Basic Protocol 3) and rVVmTRP-1...

Syngeneic Trampc1 And C2 Subcutaneous Tumor Model

Previously, two prostate cancer cell lines, TRAMP-C1 and -C2, were established from a tumor harvested from a 32-week-old C57BL 6 TRAMP male (Foster et al., 1997). These lines retain expression of androgen receptor (AR), E-cadherin, and cytokeratin supporting their tissue-specific origin from prostate epithelial cells following malignant transformation. Interestingly, unlike autochthonous TRAMP tumor cells, these lines no longer express TAg (Foster et al., 1997 Kwon et al., 1997). Nevertheless, and perhaps owing to this absence, TRAMP-C1 and -C2 are reliably tumorigenic following subcutaneous injection into the nontransgenic C57BL 6 male mouse. Morphologically, TRAMP-C1 and -C2 form tumors that are histologically similar to advanced tumors in TRAMP mice. These cell lines also provide a convenient reagent for the creation of cell-based vaccines (Kwon et al., 1997 Hurwitz et al., 2000) and facilitate the derivation of potential prostate-specific and nonTAg-related antigens that can be...

Blood Lymphocytes And Demyelination

Unravelling the contribution of T lymphocytes to the demyelinating process has benefited from the study of the animal model of MS experimental allergic encephalomyelitis (EAE).113114 The model is induced by myelin proteins and their immunogenic peptides or by adoptive transfer of sensitized CD4-positive T lymphocytes to naive, syngeneic animals.115 Depending upon the species and strain of the animal, a monophasic, acute or spontaneous relapsing-remitting form of the disease is induced. Disease progression is inhibited by treatment with antibodies to MHC class II molecules,116 to CD4-positive cells,117 and by vaccination with disease-producing T lymphocytes.118 The T-cell receptor (TCR) binds antigen in association with an MHC class II molecule. Extensive heterogenicity exists in the structure of such receptors on different lymphocytes so as to accommodate the vast array of potential antigens that the immune system is capable of recognising. In T lymphocytes that infiltrate the CNS of...

Cancer and immune responses

It is important to note that all proteins of a cell are processed and displayed in this way, not just the ones which are supposed to be recognized by the immune system. With this in mind, how can the immune cells distinguish between self and foreign After all, the vast majority of proteins produced by a cell are normal self proteins. Immune cells usually do not react against self proteins. This is called tolerance. They do, however, react against most pathogens. This is called reactivity. In the context of cancers it appears that the immune response can remain tolerant to mutated cancer proteins during the natural history of progression, but that reactivity can be induced by certain vaccination approaches. What determines whether we observe tolerance or reactivity This question is still debated. Different hypotheses have been put forward. According to one hypothesis, immune cells can distinguish between self and foreign Janeway (2002) . Neg Assuming that the CTL response has failed...

Extracorporeal Photopheresis ECP

The complete mode of action of ECP is not fully understood. There were early suggestions about a vaccine effect against pathogenic circulating T lymphocytes since only 10 of the circulating lymphocytes are irradiated. A simple destruction of malignant lymphocytes would therefore not explain the effects of ECP. Recent data support the notion that antigen presenting dendritic cells are activated in the photo-pheresis chamber, take up pathogenic T cells such as malignant CTCL cells and present them to the immune system after re-infusion (20). The ECP might be therefore considered as some sort of dendritic cell vaccination (21). Further evidence support the notion that ECP induces TNF alpha which has a wide range of antitumorigenic actions as well as apoptosis in malignant T-cell clones (22).

The P815 Mastocytoma Tumor Model

P815 is a mastocytoma cell line derived by methylcholanthrene treatment of a male DBA 2 mouse. It is commonly used as an experimental tumor model not by virtue of its mast cell lineage (mastocytomas are clinically rare tumors) but because it offers several advantages for in vivo experimentation. Wild-type P815 cells grow progressively in the majority of syngeneic DBA 2 mice. They can be implanted either intraperitoneally (see Basic Protocol 1), which allows for colony assays to be performed to quantify numbers of viable cells, or subcutaneously (see Basic Protocol 2), which allows for bidimensional tumor measurements to be taken. Different P815 variants have been used to optimal advantage in each of these settings, and both experimental approaches are outlined in this unit. Immunogenic tum- variants of P815 have been created by in vitro mutagenesis, yielding tumors that are spontaneously rejected by syngeneic mice. This behavior has provided a context in which to study the...

Description Medical Coagulation Disorders

Acute ITP is thought to be a response to a viral infection. Generally, a viral infection, such as rubella or chickenpox, occurs 2 to 21 days before the onset of the disease. Acute ITP may occur after live vaccine immunizations and is most prevalent during the winter and spring months when the incidence of infection is high. It is also associated with human immunodeficiency virus (HIV). Chronic ITP generally has no underlying viral association and is often linked to immuno-logic disorders, such as lupus erythematosus, or to drug reactions. HISTORY. Ask if the patient has recently had rubella or chickenpox or a viral infection with symptoms such as upper respiratory or gastrointestinal (GI) symptoms. Ask if the patient was recently immunized with a live vaccine. Check for a history of systemic lupus erythematosus easy bruising or bleeding from the nose, gums, or GI or urinary tract. Because the symptoms of chronic ITP are usually insidious, patients may not have noticed an increase in...

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