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Peptide Vaccine
Published in Mesut Karahan, Synthetic Peptide Vaccine Models, 2021
Joel Lim Whye Ern, Tan Shen Leng, Tee Yi Na, Palaniarajan Vijayaraj Kumar
In vaccine formulation, emulsions protect antigens from rapid degradation, increase antigen uptake by antigen-presenting cells, and activate the non-specific immune response locally, thereby improving the immune response (Koh et al. 2006). MF59 is the first oil-in-water emulsion of squalene adjuvant, developed in the 1990s by Novartis, composed of squalene oil and surfactant (Span 85 and Tween 80) (O’Hagan et al. 2013). Squalene is a naturally occurring organic compound which offers the potential of a low level of toxicity. Studies showed that MF-59 adjuvanted influenza vaccines had superior immunogenicity than alum adjuvant for influenza vaccine with a high safety profile (O’Hagan 2007; Black 2015). However, MF59 may induce inflammatory arthritis and reactogenicity (Sanina 2019). Another squalene-based adjuvant is GSK’s AS03 used in Pandemrix, a A/H1N1 pandemic flu vaccine.
Sleep–Wake Disorders
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Margaret Kay-Stacey, Eunice Torres-Rivera, Phyllis C. Zee
The discovery of the hypocretin/orexin in neurons in the lateral hypothalamus was crucial to the understanding of the pathogenesis of narcolepsy. In particular, ‘NT1 is caused by deficiencies in hypocretin signaling, which is most likely due to a selective loss of hypothalamic hypocretin-producing neurons'.2 Orexin neurons innervate tuberomammillary nucleus (TMN), basal forebrain, periaqueductal gray (PAG), dorsal raphe, and locus ceruleus (LC), which are areas that promote arousal and suppress REM.38 Orexin neurons also suppress REM sleep. Narcoleptics have dysregulated REM sleep which leads to poor circadian timing of REM sleep, rapid transitions into REM sleep, and disruption of REM sleep physiology.38 The etiology of the loss of the orexin neurons is not totally clear, but it is thought to be a T-cell–mediated autoimmune disease. In 2009–2010, there was a striking increase in the number of patients who developed NT1 after flu vaccination, Pandemrix. There was an 8- to 12-fold increase in NTI in children and adolescents as well as a 3- to 5-fold increase in adults.38, 39
Knowledge and evidence
Published in Jane Wilcock, Grace Mutton, General Practice Today, 2017
In 2008, there was an influenza H1N1 pandemic and unfortunately a few pregnant women developed severe symptoms, illness and some died. GPs and midwives were instructed to immunise pregnant women with the influenza vaccine and this is now standard practice. At the time, some GPs and many midwives were reluctant to take on this work as they had been trained not to immunise in pregnancy (they were risk averse). There were no long-term data on outcomes for mothers and babies before the programme was instituted. Due to the speed of the pandemic spread, there was no training and little explanation given for the change in practice but plenty of weekly guidance produced by PHE and RCGP. Some GPs had not given influenza injections for years as this had been delegated to practice nurses, which also complicated clinician attitudes and behaviour. Since the pandemic there has been concern that a small number of children may have developed narcolepsy from the Pandemrix vaccine, which is no longer used in pregnancy. However, the vaccination programme was very safe in general and influenza vaccination is now routinely given at any stage of pregnancy to protect the pregnant mother from flu.
Emerging therapeutic targets for narcolepsy
Published in Expert Opinion on Therapeutic Targets, 2021
Marieke Vringer, Birgitte Rahbek Kornum
It is hypothesized that an autoimmune reaction is involved in the specific loss of Hcrt neurons in NT1. Narcolepsy is genetically associated with the human leukocyte antigen (HLA) class II allele DQB1*06:02. About 95% of NT1 patients are HLA-DQB1*06:02 positive, compared to 12–38% of the healthy population [112]. Moreover, HLA-DQB1*06:02 homozygosity increases the susceptibility for narcolepsy even further [113,114]. A strong HLA association is a common theme in autoimmune disorders. Also, in favor of an immune related pathogenesis is the observation of an elevated incidence of narcolepsy after the H1N1 influenza A vaccination campaign in 2009–2010 in Northern Europe [115,116]. The Pandemrix vaccine was related to an increased relative risk of 5–14-fold in children, and 2–4-fold in adults [116].
Understanding modern-day vaccines: what you need to know
Published in Annals of Medicine, 2018
Volker Vetter, Gülhan Denizer, Leonard R. Friedland, Jyothsna Krishnan, Marla Shapiro
Like all medicines, vaccines can have adverse events. However, because vaccines are given as preventive measures mostly to healthy individuals, especially infants and children, a highly positive benefit–risk profile is essential. Vaccine safety is evaluated in the preclinical and clinical phases of development but is also continuously monitored after licensure. Surveillance of vaccination programs and reporting by healthcare providers are essential to detecting rare or serious adverse events linked to vaccination, such as intussusception with the first rotavirus vaccine Rotashield (Wyeth) or narcolepsy with the adjuvanted H1N1 influenza vaccine Pandemrix (GSK) [23,65]. However, further research is needed to confirm what role Pandemrix may have played in the development of narcolepsy among those affected. Indeed, narcolepsy is a complex disease whose causes are not yet fully understood but it may be associated with genetic and environmental factors, including infections [66].
Oculofacial plastic surgery-related online search trends including the impact of the COVID-19 pandemic
Published in Orbit, 2021
Daniel B. Azzam, Sanja G. Cypen, Jeremiah P. Tao
Interestingly, searches for eyelid malpositions decreased slightly. While the reasons for this shift are unclear, the authors postulate that searches for “Bell’s palsy” – the driver of most searches in this category – may be decreasing. Following the influenza A(H1N1) pandemic in 2009 and 2010, media coverage of a potential association of the Pandemrix (GlaxoSmithKline, Brentford, UK) vaccine and Bell’s palsy may have spurred the spike in interest. Plausibly, interest regressed following the 2013 release of evidence against the link.15–17