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Rheumatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Routine childhood vaccines should be administered to all children with JIA, regardless of disease activity. In general, live vaccines should not be given to children who are receiving systemic immunosuppression.
Taming the Enemy
Published in Norman Begg, The Remarkable Story of Vaccines, 2023
These attenuated vaccines (often referred to as live attenuated vaccines or replicating vaccines) have a number of advantages over inactivated vaccines. Because they are alive, they grow and multiply in your body. This means your immune system gets a continuous stimulus over several days or even weeks. Live attenuated vaccines provide stronger, and longer-lasting immunity than killed ones. Yellow fever is a live attenuated vaccine; a single dose will protect you for life. There are some downsides, however. The ability of live vaccines to multiply means that they can produce symptoms of the disease, albeit a much milder version. Measles vaccine is a good example. It’s quite common for a child to develop a rash and mild fever about a week after the vaccine; a “mini measles”. Very rarely, a live vaccine can produce a full-blown version of the disease. Paralysis following live polio vaccination (the version that is given by mouth) occurs at a rate of about one per 2 million doses. This is still much better than the actual disease, where up to one in ten people who are infected will get paralysis, however, it is one of the reasons why most polio vaccines given nowadays are the killed version, which cannot cause paralysis. Another drawback of live vaccines is that they cannot be given to people with severely weakened immune systems, as they may not be able to control the replication of the organism. Examples of live attenuated vaccines include measles, mumps, rubella, yellow fever, BCG (for tuberculosis) and oral polio vaccine.
Immunization
Published in Julius P. Kreier, Infection, Resistance, and Immunity, 2022
Michael F. Para, Susan L. Koletar, Carter L. Diggs
Although the account above is of problems associated with recombinant development methodology for vaccine production, vaccines currently in use for active immunization are mostly produced by other means (Table 19.5). Vaccines may consist of suspensions of live attenuated microbes, of killed, inactivated microbes, of fractions of microbes, or of microbial products. Live vaccines generally evoke a durable immunologic response much like that resulting from natural infection. The currently available measles, mumps, and rubella vaccines are live attenuated agents. Living agents engender good immunogenicity because their growth results in continuous formation of antigen and prolonged antigenic stimulation, in addition, a broad spectrum of microbial antigens is presented to the immune system, if the organisms are intracellular pathogens, the method of presentation favors the development of cell-mediated immunity (see chapter 8). As infection is induced by the attenuated agents, the immunity generated resembles that resulting from natural infection. There is extensive stimulation of the immune system by the antigens produced by the infection; consequently live vaccines usually require just one dose to induce protection.
Respiratory syncytial virus infection and the need for immunization in Korea
Published in Expert Review of Vaccines, 2023
Hye Young Kim, Ki Wook Yun, Hee Jin Cheong, Eun Hwa Choi, Hoan Jong Lee
Nonetheless, there are currently more than 40 vaccines in development, with 19 having entered clinical trials [97,100,101]. They include protein vaccines (particle-based or subunit vaccines) and live vaccines (vector-based or live-attenuated). The majority of protein vaccines target the prefusion conformation of the F membrane protein (pre-F), since antibodies that bind to pre-F are particularly efficient at neutralizing RSV, although some target the G or SH membrane proteins [97]. Live vaccines under development target pre-F, post-fusion F, or other viral antigens such as N, M2 and G proteins [97]. Among the most advanced vaccines, a recombinant adjuvanted pre-F nanoparticle maternal vaccine (ResVax) failed to meet the primary endpoint of a reduction in medically significant RSV LRTI during the first 90 days of life in infants in a phase 3 study, although it did reduce hospitalization and had a favorable safety profile [102]. An adjuvanted vaccine containing the F protein stabilized in its trimeric prefusion conformation (RSVPreF3), which is being developed as a vaccine for adults aged ≥60 years [103], has been submitted for regulatory review in the USA, Europe and Japan [104].
Assessing and mitigating risk of infection in patients with multiple sclerosis on disease modifying treatment
Published in Expert Review of Clinical Immunology, 2021
Susana Otero-Romero, Adrián Sánchez-Montalvá, Angela Vidal-Jordana
Immunization with live vaccines should be completed 4 to 6 weeks before the onset of immunosuppression. In case this approach is not possible, immunosuppressed patients who are candidates to attenuated vaccines (i.e. susceptibility to measles or varicella infection) should be informed that in the event of a risk exposure to these pathogens, post-exposure prophylaxis with specific immunoglobulin should be administered within 5 days following the contact for varicella and 6 days for measles [32]. Additionally, in these patients future immunization should be considered, always after the immunosuppressive medication has been interrupted for a period of time long enough to ensure clearance of the immunosuppressor activity. There are no specific indicators that guarantee immune restoration, but some authors suggest the use of basic immunological parameters (such as subpopulations of CD4, CD8, and CD19 cells), as well as total immunoglobulin count as markers of immune reconstitution [33].
Targeted therapies for autoimmune/idiopathic nonmalignant diseases: risk and management of opportunistic infections
Published in Expert Opinion on Drug Safety, 2020
Davide Fiore Bavaro, Deborah Fiordelisi, Gioacchino Angarano, Laura Monno, Annalisa Saracino
Vaccinations should be considered an essential tool to prevent infectious diseases in patient candidate to immune-suppressant drugs. However, it should be considered that live vaccines could not be safe in this population, and response to vaccinations among patients receiving immune-suppressive therapies is variable and sometimes unsatisfactory [155]. In fact, several studies showed reduced titers of protective post-vaccination response in patients treated with immune-suppressants, along with reduced durability of protection in patients treated with TT, especially in those receiving multiple drugs [156]. For preserving efficacy and ensure safety, recommended vaccinations should ideally be completed before starting TT, although the proper timing depends on vaccine class. Live vaccines should be given at least 1 month before starting immune-suppressive therapy, while non-live vaccine can be administered within 2 weeks before immune-suppression [155]. Hence, all patients who are candidates to immune-suppressants should be tested for viral serology in order to be properly vaccinated. In Table 5, principal recommendations about vaccines in immune-compromised hosts are summarized.