The History Of Vaccines And Immunization: Familiar Patterns, New Challenges

Confidence in government and vaccination willingness in the USA

The most recent internationally widespread disease outbreak occurred during the flu season of 2009 and 2010. On April 2009, the first cases of influenza A (H1N1) (Popularly called, Swine Flu) were confirmed in the USA and UK following a novel virus that was first identified in Mexico. As the virus spread rapidly, the risk of morbidity and mortality increased in several countries. In this paper, we rely on the social cognitive theory of risk to assess the willingness of the US public to comply with vaccination and reduce the risk of sickness and death from the flu. We conduct a secondary data analysis of the Pew Research for the People and Press October 2009 and investigate the factors associated with willingness to take the swine flu vaccine (n = 1000). The findings indicate that the decision to take the swine flu vaccination was highly polarized across partisan lines. Controlling for education, income and demographic factors, the likelihood of taking the vaccine was associated with party identification. Individuals that identified themselves as Democrats were more likely to be willing to take the swine vaccine than individuals that identify themselves as Republicans and Independents. Confidence in the ability of the government to deal with the swine flu crisis seems to explain party identification differences in the willingness to take the vaccine. The implications of the findings are discussed.

An education in contrast: state-by-state assessment of school immunization records requirements

OBJECTIVES

We reviewed the complexities of school-related immunization policies, their relation to immunization information systems (IIS) and immunization registries, and the historical context to better understand this convoluted policy system.

METHODS

We used legal databases (Lexis-Nexis and Westlaw) to identify school immunization records policies for 50 states, 5 cities, and the District of Columbia (Centers for Disease Control and Prevention "grantees"). The original search took place from May to September 2010 (cross-referenced in July 2013 with the list on http://www.immunize.org/laws ). We describe the requirements, agreement with IIS policies, and penalties for policy violations.

RESULTS

We found a complex web of public health, medical, and education-directed policies, which complicates immunization data sharing. Most (79%) require records of immunizations for children to attend school or for a child-care institution licensure, but only a few (11%) require coordination between IIS and schools or child-care facilities.

CONCLUSIONS

To realize the full benefit of IIS investment, including improved immunization and school health program efficiencies, IIS and school immunization records policies must be better coordinated. States with well-integrated policies may serve as models for effective harmonization.

Peering into the crystal ball: influenza pandemics and vaccine efficacy

The looming threat of a new influenza virus pandemic has fueled ambitious efforts to devise more predictive parameters for assessing the risks associated with emergent virus strains. At the same time, a comprehensive understanding of critical factors that can accurately predict the outcome of vaccination is sorely needed in order to improve the effectiveness of influenza virus vaccines. Will new studies aimed at identifying adaptations required for virus transmissibility and systems-level analyses of influenza virus vaccine responses provide an improved framework for predictive models of viral adaptation and vaccine efficacy?

The impact of search engine selection and sorting criteria on vaccination beliefs and attitudes: two experiments manipulating Google output

Background

During the past 2 decades, the Internet has evolved to become a necessity in our daily lives. The selection and sorting algorithms of search engines exert tremendous influence over the global spread of information and other communication processes.

Objective

This study is concerned with demonstrating the influence of selection and sorting/ranking criteria operating in search engines on users’ knowledge, beliefs, and attitudes of websites about vaccination. In particular, it is to compare the effects of search engines that deliver websites emphasizing on the pro side of vaccination with those focusing on the con side and with normal Google as a control group.

Method

We conducted 2 online experiments using manipulated search engines. A pilot study was to verify the existence of dangerous health literacy in connection with searching and using health information on the Internet by exploring the effect of 2 manipulated search engines that yielded either pro or con vaccination sites only, with a group receiving normal Google as control. A pre-post test design was used; participants were American marketing students enrolled in a study-abroad program in Lugano, Switzerland. The second experiment manipulated the search engine by applying different ratios of con versus pro vaccination webpages displayed in the search results. Participants were recruited from Amazon’s Mechanical Turk platform where it was published as a human intelligence task (HIT).

Results

Both experiments showed knowledge highest in the group offered only pro vaccination sites (Z=–2.088, P=.03; Kruskal-Wallis H test [H₅]=11.30, P=.04). They acknowledged the importance/benefits (Z=–2.326, P=.02; H₅=11.34, P=.04) and effectiveness (Z=–2.230, P=.03) of vaccination more, whereas groups offered antivaccination sites only showed increased concern about effects (Z=–2.582, P=.01; H₅=16.88, P=.005) and harmful health outcomes (Z=–2.200, P=.02) of vaccination. Normal Google users perceived information quality to be positive despite a small effect on knowledge and a negative effect on their beliefs and attitudes toward vaccination and willingness to recommend the information (χ²₅=14.1, P=.01). More exposure to antivaccination websites lowered participants’ knowledge (J=4783.5, z=−2.142, P=.03) increased their fear of side effects (J=6496, z=2.724, P=.006), and lowered their acknowledgment of benefits (J=4805, z=–2.067, P=.03).

Conclusion

The selection and sorting/ranking criteria of search engines play a vital role in online health information seeking. Search engines delivering websites containing credible and evidence-based medical information impact positively Internet users seeking health information. Whereas sites retrieved by biased search engines create some opinion change in users. These effects are apparently independent of users’ site credibility and evaluation judgments. Users are affected beneficially or detrimentally but are unaware, suggesting they are not consciously perceptive of indicators that steer them toward the credible sources or away from the dangerous ones. In this sense, the online health information seeker is flying blind.

Listeria monocytogenes: a promising vehicle for neonatal vaccination

Vaccination as a medical intervention has proven capable of greatly reducing the suffering from childhood infectious disease. However, newborns and infants in particular are age groups for whom adequate vaccine-mediated protection is still largely lacking. With the challenges that the neonatal immune system faces and the required highest level of stringency for safety, designing vaccines for early life in general and the newborn in particular poses great difficulty. Nevertheless, recent advances in our understanding of neonatal immunity and its responses to vaccines and adjuvants suggest that neonatal vaccination is a task fully within reach. Among the most promising developments in neonatal vaccination is the use of Listeria monocytogenes (Lm) as a delivery platform. In this review, we will outline key properties of Lm that make it such an ideal neonatal and early life vaccine vehicle, and also discuss potential constraints of Lm as a vaccine delivery platform.

Human papillomavirus (HPV), HPV-associated oropharyngeal cancer, and HPV vaccine in the United States--do we need a broader vaccine policy?

BACKGROUND

Human papillomavirus (HPV) is a sexually transmitted infection (STI) of global importance; it is the most prevalent STI in the United States, with strains causally linked to oropharyngeal and other cancers. Efforts to prevent HPV have been made to varying degrees by policies implemented by different state governments; however, HPV and associated oropharyngeal cancer continue to show increasing incidence rates in the US.

DESIGN

A narrative review based on search on SciVerse, PubMed/Medline, Google Scholar, and EMBASE databases, as well as literature/documents from the World Health Organization, Centers for Disease Control and Prevention, American Cancer Society, National Conference of State legislatures, and the U.S. Department of Health and Human Services relevant to HPV and HPV vaccine policy in the US.

RESULTS

Vaccination has proved to be a successful policy in the US, and an extant recommendation aimed at preventing HPV and associated cervical and other anogenital cancers is the routine use of HPV vaccines for males and females. However, HPV vaccines are presently not recommended for preventing oropharyngeal cancer, although they have been shown to be highly effective against the HPV strains that are most commonly found in the oropharynx. And while there is a history of successful vaccine mandate in the US with resulting decrease in occurrence of infectious diseases, implementing HPV vaccine mandate has proved to be very unpopular.

CONCLUSIONS

With emerging evidence of the efficacy of the use of the HPV vaccine in preventing oral-HPV, more focus should be put on extending HPV vaccine to present oral HPV infection and oropharyngeal cancer. Also, implementing a broader HPV vaccine policy that include mandating HPV vaccines as a school-entry requirement for both sexes may increase vaccine use in the US for the greater good of the public.

Vaccine refusal and the endgame: walking the last mile first

As multiple papers within this special issue illustrate, the dynamics of disease eradication are different from disease control. When it comes to disease eradication, 'the last mile is longest'. For social and ecological reasons such as vaccine refusal, further ending incidence of a disease when it has reached low levels is frequently complex. Issues of non-compliance within a target population often influence the outcome of disease eradication efforts. Past eradication efforts confronted such obstacles towards the tail end of the campaign, when disease incidence was lowest. This article provides a comparison of non-compliance within polio, measles and smallpox campaigns, demonstrating the tendency of vaccine refusal to rise as disease incidence falls. In order to overcome one of the most intractable challenges to eradication, future disease eradication efforts must prioritize vaccine refusal from the start, i.e. 'walk the last mile first'.

THE FRAGILITY OF THE FUTURE AND THE TUG OF THE PAST: LONGEVITY IN LATIN AMERICA AND THE CARIBBEAN

BACKGROUND

Cohorts that will attain age 60 after 2010 in the Latin American and Caribbean region (LAC) are beneficiaries of a massive mortality decline that began as early as 1930. The bulk of this decline is due to diffusion of low-cost medical technology that improved recovery rates from infectious diseases. This changes the composition of elderly cohorts in a distinct way: more among those who could experience the deleterious impact of adverse early conditions as adults survive to attain old ages.

OBJECTIVE

To compute bounds for the size of effects on old age mortality of changes in cohorts' composition by exposure to early conditions. We calculate estimates for countries in the LAC region that span the entire range of post-1950 mortality decline.

METHODS

We use counterfactual population projections to estimate bounds of changes in the composition of cohorts by exposure to early conditions. These are combined with empirical effects of adverse early conditions on adult mortality to generate estimates of foregone gains in life expectancy at age 60.

RESULTS

under somewhat conservative assumptions life expectancy at age 60 will at best increase much more slowly than in the past and at worst reach a steady state or decline. Foregone gains may be as high as 20% of projected values over a period of 30 to 50 years, the time it takes for cohorts that reaped the benefits of the secular mortality decline to become extinct.

CONCLUSIONS

Changing composition of cohorts by early exposures constitutes a powerful force that could drag down or halt short-run progress of life expectancy at older ages.

The long-term potential of biodegradable poly(lactide-co-glycolide) microparticles as the next-generation vaccine adjuvant

Biodegradable polymeric microparticles of poly(lactide-co-glycolide) (PLG) have been extensively evaluated for drug delivery and vaccine applications over the last three decades. Despite a wealth of studies on the use of PLG microparticles in vaccines through controlled release of antigens, there is no commercial PLG-based vaccine as yet. The key challenge that prevented the development of PLG microparticles as commercial vaccines was the instability of encapsulated antigen. Over the years, advancements were made towards maintaining antigen integrity during PLG microparticle preparation and sterilization. In parallel and independently, development of PLG microparticles as therapeutic commercial products established PLG with an excellent safety record in humans, and as a suitable candidate for next-generation vaccines. Through the combination of Toll-like receptor agonist encapsulation and surface adsorption of antigen, PLG microparticles can be used as a vaccine adjuvant to address unmet medical needs, such as vaccines against HIV, malaria and TB. With strategic development of PLG-based vaccines, PLG microparticles can offer advantages over the conventional vaccine adjuvants allowing commercial development of this adjuvant.

Bridging the Gap Between Validation and Implementation of Non-Animal Veterinary Vaccine Potency Testing Methods

Simple Summary

Many vaccines are tested for quality in experiments that require the use of large numbers of animals in procedures that often cause significant pain and distress. Newer technologies have fostered the development of vaccine quality control tests that reduce or eliminate the use of animals, but the availability of these newer methods has not guaranteed their acceptance by regulators or use by manufacturers. We discuss a strategic approach that has been used to assess and ultimately increase the use of non-animal vaccine quality tests in the U.S. and U.K.

Abstract

In recent years, technologically advanced high-throughput techniques have been developed that replace, reduce or refine animal use in vaccine quality control tests. Following validation, these tests are slowly being accepted for use by international regulatory authorities. Because regulatory acceptance itself has not guaranteed that approved humane methods are adopted by manufacturers, various organizations have sought to foster the preferential use of validated non-animal methods by interfacing with industry and regulatory authorities. After noticing this gap between regulation and uptake by industry, we began developing a paradigm that seeks to narrow the gap and quicken implementation of new replacement, refinement or reduction guidance. A systematic analysis of our experience in promoting the transparent implementation of validated non-animal vaccine potency assays has led to the refinement of our paradigmatic process, presented here, by which interested parties can assess the local regulatory acceptance of methods that reduce animal use and integrate them into quality control testing protocols, or ensure the elimination of peripheral barriers to their use, particularly for potency and other tests carried out on production batches.

Encapsulation of antigen in poly(D,L-lactide-co-glycolide) microspheres protects from harmful effects of γ-irradiation as assessed in mice

During the last two decades, synthetic polymers such as poly(lactide-co-glycolide) (PLGA) have been investigated for the development of nano- or microparticles as adjuvants or antigen vehicles. To enable transfer of this technology to human settings, the issue of sterilisation is of central importance. Since most polymers are heat-sensitive, sterilisation of polymeric microspheres for parenteral administration is assured either by costly and laborious aseptical preparation or the more preferred γ-irradiation. Many studies have investigated the effect of γ-irradiation on various physiochemical properties of the microspheres, but investigations on immunological effects are rare. We prepared poly(lactide-co-glycolide) (PLGA) microspheres containing ovalbumin (OVA) and tested the effect of γ-irradiation on the various immunological properties in mice. For reference, OVA was γ-irradiated and tested equivalently. The ability of encapsulated or non-encapsulated OVA to trigger activation of dendritic cells (DCs) was not affected by irradiation. However, while γ-irradiation of free OVA strongly influenced the antigen presentation, encapsulated OVA was not affected by irradiation. γ-Irradiation of OVA also reduced the immunogenicity in mice with regard to OVA-specific IgG1 production. In contrast, the antibody and the T-cell responses in mice immunised with PLGA-encapsulated OVA were similar irrespective of the γ-irradiation status. Hence, encapsulation of antigen into PLGA microspheres protects antigen from the potential detrimental effect of γ-irradiation leading to inactivation or altered immunogenicity. Sterilisation by γ-irradiation therefore enables a cost-effective production of PLGA-based antigen-delivery systems as compared to the more laborious and expensive aseptical production of such vaccines.

Confidence about vaccines in the United States: understanding parents' perceptions

The United States has made tremendous progress in using vaccines to prevent serious, often infectious, diseases. But concerns about such issues as vaccines' safety and the increasing complexity of immunization schedules have fostered doubts about the necessity of vaccinations. We investigated parents' confidence in childhood vaccines by reviewing recent survey data. We found that most parents--even those whose children receive all of the recommended vaccines--have questions, concerns, or misperceptions about them. We suggest ways to give parents the information they need and to keep the US national vaccination program a success.

A brief review of vaccination coverage in immunization registries

Immunization registries are effective electronic tools for assessing vaccination coverage, but are only as good as the information reported to them. This review summarizes studies through August 2010 on vaccination coverage in registries and identifies key characteristics of successful registries. Based on the current state of registries, paper-based charts combined with electronic registry reporting provide the most cohesive picture of coverage. To ultimately supplant paper charts, registries must exhibit increased coverage and participation.

Stressor-induced alterations of adaptive immunity to vaccination and viral pathogens

The stress response influences the immune system, and studies in laboratory animals indicate that the response to stress significantly reduces resistance to infectious challenge. Only a few studies, however, have determined the impact of the stress response on human susceptibility to infectious challenge due, in part, to the difficulties of using live, replicating pathogens in human research. As a result, many studies have assessed the immune response to vaccination as a surrogate for the immune response to an infectious challenge. Thus, much is known about how the stress response influences adaptive immunity, and memory responses, to vaccination. These studies have yielded data concerning the interactions of the nervous and immune systems and have provided important information for clinicians administering vaccines to susceptible populations. This review provides a brief overview of the immune response to commonly used vaccines and the impact that stress can have on vaccine-specific immunity.

Two distinct chimeric potexviruses share antigenic cross-presentation properties of MHC class I epitopes

Chimeric VLPs made of papaya mosaic virus (PapMV) trigger a CTL response through antigenic presentation of epitopes on MHC class I. Here, a chimeric VLP composed of malva mosaic virus (MaMV) was shown to share similar properties. We demonstrated the capacity of both VLPs to enter human APCs. The chimeric constructions were cross-presented in CD40-activated B lymphocytes leading to in vitro expansion of antigen-specific T lymphocytes. We showed that high concentrations of chimeric MaMV induced cell death, suggesting that some modifications can trigger collateral effects in vitro. Results suggest that potexvirus VLPs are an attractive vaccine platform for inducing a CTL response.

The need for new vaccines

Advances in biotechnology and immunology are yielding exciting progress in the development of new biologics and vaccines. Yet in both the developed and developing world, we see a backlog of new vaccines that are licensed but not yet used, an "innovation pile-up", which may prevent individuals and societies from benefiting from protection against preventable infectious diseases. What is the "need for new vaccines"? Reviewing the vaccines environment and the place of vaccination in public health, we present our business model that we use to sustainably deliver the benefits of vaccination and review potential solutions to accelerating the introduction and adoption of under-utilised and future vaccines.

The immunization status of home-schooled children in America

The immunization of children against a vast number of life-threatening infectious agents has been hailed as one of the greatest public health interventions of the twentieth century. In America, the morbidity and mortality associated with many common childhood infectious diseases has all but vanished. State-based school entry vaccination laws play a significant role in achieving high immunization rates among children and adolescents. Alarmingly, there is no consistent regulation in place to monitor the immunization status of the ever-growing home-schooled population. It is widely unknown whether the nearly 2 million home-schooled children are adequately immunized. As the home schooling movement continues to gain ground in the United States, pediatric nurse practitioners in the primary care setting will play an important role in protecting the health of these children, as well as the public's health.

A postmodern Pandora's box: anti-vaccination misinformation on the Internet

The Internet plays a large role in disseminating anti-vaccination information. This paper builds upon previous research by analyzing the arguments proffered on anti-vaccination websites, determining the extent of misinformation present, and examining discourses used to support vaccine objections. Arguments around the themes of safety and effectiveness, alternative medicine, civil liberties, conspiracy theories, and morality were found on the majority of websites analyzed; misinformation was also prevalent. The most commonly proposed method of combating this misinformation is through better education, although this has proven ineffective. Education does not consider the discourses supporting vaccine rejection, such as those involving alternative explanatory models of health, interpretations of parental responsibility, and distrust of expertise. Anti-vaccination protestors make postmodern arguments that reject biomedical and scientific "facts" in favour of their own interpretations. Pro-vaccination advocates who focus on correcting misinformation reduce the controversy to merely an "educational" problem; rather, these postmodern discourses must be acknowledged in order to begin a dialogue.

Portrait of a lengthy vaccination trajectory in Burkina Faso: from cultural acceptance of vaccines to actual immunization

BACKGROUND

The global recognition of vaccination is strongly related to the fact that it has proved in the past able to dramatically reduce the incidence of certain diseases. Nevertheless, reactions regarding the practice of vaccination still vary among communities, affecting the worldwide vaccination coverage. Numerous studies, conducted from varying perspectives, have focused on explaining this active refusal or resistance to vaccination. Although in some cases low immunization coverage has been well explained by active refusal or resistance to vaccination, little is known about the reasons for low coverage where those reactions are absent or play a minor role, especially outside an epidemic context. This study attempts to explain this situation, which is found in the health district of Nouna in Burkina Faso.

METHODS

An in-depth ethnographic study was undertaken in the health district of Nouna in an effort to understand, from an anthropological point of view, the logic behind the parental decision-making process regarding the vaccination or non-vaccination of children, in a context where rejection of, and reservations concerning vaccination are not major obstacles.

RESULTS

Three elements emerged from the analysis: the empirical conceptions of childhood diseases, the perceived efficacy of vaccine and the knowledge of appropriate age for vaccination uptake; the gap between the decision-making process and the actual achievement of vaccination; and the vaccination procedure leading to vaccination uptake in the particular context of the health district of Nouna.

CONCLUSION

The procedures parents must follow in order to obtain vaccination for their children appear complex and constraining, and on certain points discord with the traditional systems of meaning and idioms of distress related to pregnancy, the prevention of childhood diseases and with the cultural matrix shaping decision-making and behaviour. Attention needs to be directed at certain promotional, logistical and structural elements, and at the procedure that must currently be followed to obtain vaccination for a child during routine vaccination sessions, which are currently limiting the active demand for vaccination. ABSTRACT IN FRENCH : See the full article online for a translation of this abstract in French.

Smallpox vaccines for biodefense: need and feasibility

Smallpox, eradicated as a cause of natural disease through an intensive global effort in the later part of the 20th Century, has resurfaced as a possible agent of bioterrorism. For this reason, there is renewed interest in smallpox vaccines. Live vaccinia virus, an orthopoxvirus related to smallpox, has a long and successful clinical track record as an effective smallpox vaccine; however, its use is associated with uncommon yet serious adverse events. This has led to a surge of recent research into newer-generation smallpox vaccines with improved safety profiles and retained efficacy. This article will review the history of smallpox vaccines, assess the status of newer-generation vaccines and examine the overall risk-versus-benefit profile of smallpox vaccination.