Different Types of Vaccine

Whole virus vaccines. either live or killed, constitute the vast majority of vaccines in use at
present. However, recent advances in molecular biology had provided alternative methods
for producing vaccines. Listed below are the possibilities;1. Live whole virus vaccines
2. Killed whole virus vaccines
3. Subunit vaccines;- purified or recombinant viral antigen
4. Recombinant virus vaccines
5. Anti-idiotype antibodies
6. DNA vaccines
1. Live Vaccines
Live virus vaccines are prepared from attenuated strains that are almost or completely
devoid of pathogenicity but are capable of inducing a protective immune response. They
multiply in the human host and provide continuous antigenic stimulation over a period of
time, Primary vaccine failures are uncommon and are usually the result of inadequate
storage or administration. Another possibility is interference by related viruses as is
suspected in the case of oral polio vaccine in developing countries. Several methods have
been used to attenuate viruses for vaccine production.
Use of a related virus from another animal - the earliest example was the use of cowpox
to prevent smallpox. The origin of the vaccinia viruses used for production is uncertain.
Administration of pathogenic or partially attenuated virus by an unnatural route - the
virulence of the virus is often reduced when administered by an unnatural route. This
principle is used in the immunization of military recruits against adult respiratory distress
syndrome using enterically coated live adenovirus type 4, 7 and (21).
Passage of the virus in an "unnatural host" or host cell - the major vaccines used in man
and animals have all been derived this way. After repeated passages, the virus is
administered to the natural host. The initial passages are made in healthy animals or in
primary cell cultures. There are several examples of this approach: the 17D strain of yellow
fever was developed by passage in mice and then in chick embryos. Polioviruses were
passaged in monkey kidney cells and measles in chick embryo fibroblasts. Human diploid
cells are now widely used such as the WI-38 and MRC-5. The molecular basis for host
range mutation is now beginning to be understood.

Development of temperature sensitive mutants - this method may be used in conjunction

with the above method.
2. Inactivated whole virus vaccines
These were the easiest preparations to use. The preparation was simply inactivated. The
outer virion coat should be left intact but the replicative function should be destroyed. To be
effective, non-replicating virus vaccines must contain much more antigen than live vaccines
that are able to replicate in the host. Preparation of killed vaccines may take the route of
heat or chemicals. The chemicals used include formaldehyde or beta- propiolactone. The
traditional agent for inactivation of the virus is formalin. Excessive treatment can destroy
immunogenicity whereas insufficient treatment can leave infectious virus capable of
causing disease. Soon after the introduction of inactivated polio vaccine, there was an
outbreak of paralytic poliomyelitis in the USA use to the distribution of inadequately
inactivated polio vaccine. This incident led to a review of the formalin inactivation
procedure and other inactivating agents are now available, such as Beta-propiolactone.
Another problem was that SV40 was occasionally found as a contaminant and there were
fears of the potential oncogenic nature of the virus.

LivevsDeadvaccines
Feature

Live

Dead

no.ofdoses

Single

Multiple

needforadjuvant

No

Yes

Durationofimmunity

manyyears

Less

antibodyresponse

IgG,IgA

IgG

CMI(CellMediatedImmunity)

Good

Poor

Reversiontovirulence

possible

notpossible

Doselowhigh

Because live vaccines replicate inside host cells, bits of virus antigen are presented to the
cell surface and recognized by cytotoxic cells

Potential safety problems

Live vaccines
1. Underattenuation
2. Mutation leading to reversion to virulence
3. Preparation instability
4. Contaminating viruses in cultured cells
5. Heat lability
6. Should not be given to immunocompromized or pregnant patients
Killed vaccines
1. Incomplete inactivation
2. Increased risk of allergic reactions due to large amounts of antigen involved
Present problems with vaccine development include
1. Failure to grow large amounts of organisms in laboratory
2. Crude antigen preparations often give poor protection. eg. Key antigen not
identified, ignorance of the nature of the protective or the protective immune
response.
3. Live vaccines of certain viruses can (1). induce reactivation, (2) be oncogenic in
nature
3._Subunit Vaccines
Originally, non-replicating vaccines were derived from crude preparations of virus from
animal tissues. As the technology for growing viruses to high titres in cell cultures
advanced, it became practicable to purify virus and viral antigens. It is now possible to
identify the peptide sites encompassing the major antigenic sites of viral antigens, from
which highly purified subunit vaccines can be produced. Increasing purification may lead
to loss of immunogenicity, and this may necessitate coupling to an immunogenic carrier
protein or adjuvant, such as an aluminum salt. Examples of purified subunit vaccines
include the HA vaccines for influenza A and B, and HBsAg derived from the plasma of
carriers.
4. Recombinant viral proteins

Virus proteins have been expressed in bacteria, yeast, mammalian cells, and viruses. E. Coli
cells were first to be used for this purpose but the expressed proteins were not glycosylated,
which was a major drawback since many of the immunogenic proteins of viruses such as
the envelope glycoproteins, were glycosylated. Nevertheless, in many instances, it was
demonstrated that the non-glycosylated protein backbone was just as immunogenic.
Recombinant hepatitis B vaccine is the only recombinant vaccine licensed at present.
An alternative application of recombinant DNA technology is the production of hybrid
virus vaccines. The best known example is vaccinia; the DNA sequence coding for the
foreign gene is inserted into the plasmid vector along with a vaccinia virus promoter and
vaccinia thymidine kinase sequences. The resultant recombination vector is then introduced
into cells infected with vaccinia virus to generate a virus that expresses the foreign gene.
The recombinant virus vaccine can then multiply in infected cells and produce the antigens
of a wide range of viruses. The genes of several viruses can be inserted, so the potential
exists for producing polyvalent live vaccines. HBsAg, rabies, HSV and other viruses have
been expressed in vaccinia.
Hybrid virus vaccines are stable and stimulate both cellular and humoral immunity. They
are relatively cheap and simple to produce. Being live vaccines, smaller quantities are
required for immunization. As yet, there are no accepted laboratory markers of attenuation
or virulence of vaccinia virus for man. Alterations in the genome of vaccinia virus during
the selection of recombinant may alter the virulence of the virus. The use of vaccinia also
carries the risk of adverse reactions associated with the vaccine and the virus may spread to
susceptible contacts. At present, efforts are being made to attenuate vaccinia virus further
and the possibility of using other recombinant vectors is being explored, such as attenuated
poliovirus and adenovirus.
5. Synthetic Peptides
The development of synthetic peptides that might be useful as vaccines depends on the
identification of immunogenic sites. Several methods have been used. The best known
example is foot and mouth disease, where protection was achieved by immunizing animals
with a linear sequence of 20 aminoacids. Synthetic peptide vaccines would have many
advantages. Their antigens are precisely defined and free from unnecessary components
which may be associated with side effects. They are stable and relatively cheap to
manufacture. Furthermore, less quality assurance is required. Changes due to natural
variation of the virus can be readily accommodated, which would be a great advantage for
unstable viruses such as influenza.
Synthetic peptides do not readily stimulate T cells. It was generally assumed that, because
of their small size, peptides would behave like haptens and would therefore require
coupling to a protein carrier which is recognized by T-cells. It is now known that synthetic
peptides can be highly immunogenic in their free form provided they contain, in addition to
the B cell epitope, T- cell epitopes recognized by T-helper cells. Such T-cell epitopes can be
provided by carrier protein molecules, foreign antigens. or within the synthetic peptide
molecule itself.

Synthetic peptides are not applicable to all viruses. This approach did not work in the case
of polioviruses because the important antigenic sites were made up of 2 or more different
viral capsid proteins so that it was in a concise 3-D conformation.
Advantages of defined viral antigens or peptides include:
1. Production and quality control simpler
2. No NA or other viral or external proteins, therefore less toxic.
3. Safer in cases where viruses are oncogenic or establish a persistent infection
4. Feasible even if virus cannot be cultivated
Disadvantages:
1. May be less immunogenic than conventional inactivated whole-virus vaccines
2. Requires adjuvant
3. Requires primary course of injections followed by boosters
4. Fails to elicit CMI.
6. Anti-idiotype antibodies
The ability of anti-idiotype antibodies to mimic foreign antigens has led to their
development as vaccines to induce immunity against viruses, bacteria and protozoa in
experimental animals. Anti-idiotypes have many potential uses as viral vaccines,
particularly when the antigen is difficult to grow or hazardous. They have been used to
induce immunity against a wide range of viruses, including HBV, rabies, Newcastle disease
virus and FeLV, reoviruses and polioviruses.
7. DNA vaccines
Recently, encouraging results were reported for DNA vaccines whereby DNA coding for
the foreign antigen is directly injected into the animal so that the foreign antigen is directly
produced by the host cells. In theory these vaccines would be extremely safe and devoid of
side effects since the foreign antigens would be directly produced by the host animal. In
addition, DNA is relatively inexpensive and easier to produce than conventional vaccines
and thus this technology may one day increase the availability of vaccines to developing
countries. Moreover, the time for development is relatively short which may enable timely
immunization against emerging infectious diseases. In addition, DNA vaccines can
theoretically result in more long-term production of an antigenic protein when introduced
into a relatively nondividing tissue, such as muscle.

Indeed some observers have already dubbed the new technology the "third revolution" in
vaccine developmenton par with Pasteur's ground-breaking work with whole organisms
and the development of subunit vaccines. The first clinical trials using injections of DNA to
stimulate an immune response against a foreign protein began for HIV in 1995. Four other
clinical trials using DNA vaccines against influenza, herpes simplex virus, T-cell
lymphoma, and an additional trial for HIV were started in 1996.
The technique that is being tested in humans involves the direct injection of plasmids loops of DNA that contain genes for proteins produced by the organism being targeted for
immunity. Once injected into the host's muscle tissue, the DNA is taken up by host cells,
which then start expressing the foreign protein. The protein serves as an antigen that
stimulate an immune responses and protective immunological memory.
Enthusiasm for DNA vaccination in humans is tempered by the fact that delivery of the
DNA to cells is still not optimal, particularly in larger animals. Another concern is the
possibility, which exists with all gene therapy, that the vaccine's DNA will be integrated
into host chromosomes and will turn on oncogenes or turn off tumor suppressor genes.
Another potential downside is that extended immunostimulation by the foreign antigen
could in theory provoke chronic inflammation or autoantibody production
Presentation of immunogenic proteins and peptides
Proteins separated from virus particles are generally much less immunogenic than the intact
particles. This difference in activity is usually attributed to the change in configuration of a
protein when it is released from the structural requirements of the virus particle. Many
attempts have been made to enhance the immunogenic activity of separated proteins.
Adjuvants
Used to potentiate the immune response
1. Functions to localize and slowly release antigen at or near the site of administration.
2. Functions to activate APCs to achieve effective antigen processing or presentation
Materials that have been used include;1. Aluminum salts
2. Mineral oils
3. Mycobacterial products, eg. Freud's adjuvants
Immunostimulating complexes (ISCOMS)
1. An alternative vaccine vehicle

2. The antigen is presented in an accessible, multimeric, physically well defined

complex
3. Composed of adjuvant (Quil A) and antigen held in a cage like structure
4. Adjuvant is held to the antigen by lipids
5. Can stimulate CMI
6. Mean diameter 35nm
In the most successful procedure, a mixture of the plant glycoside saponin, cholesterol and
phosphatidylcholine provides a vehicle for presentation of several copies of the protein on a
cage-like structure. Such a multimeric presentation mimics the natural situation of antigens
on microorganisms. These immunostimulating complexes have activities equivalent to
those of the virus particles from which the proteins are derived, thus holding out great
promise for the presentation of genetically engineered proteins.
Similar considerations apply to the presentation of peptides. It has been shown that by
building the peptide into a framework of lysine residues so that 8 copies instead of 1 copy
are present, the immune response induced was of a much greater magnitude. A novel
approach involves the presentation of the peptide in a polymeric form combined with T cell
epitopes. The sequence coding for the foot and mouth disease virus peptide was expressed
as part of a fusion protein with the gene coding for the Hepatitis B core protein. The hybrid
protein, which forms spherical particles 22nm in diameter, elicited levels of neutralizing
antibodies against foot and mouth disease virus that were at least a hundred times greater
than those produced by the monomeric peptide.
Immunization and Herd Immunity
The following questions should be asked when a vaccination policy against a particular
virus is being developed.
1. What proportion of the population should be immunized to achieve eradication.
2. What is the best age to immunize?
3. How is this affected by birth rates and other factors
4. How does immunization affect the age distribution of susceptible individuals,
particularly those in age-classes most at risk of serious disease?
5. How significant are genetic, social, or spatial heterogeneities in susceptibility to
infection?
6. How does this affect herd immunity?

A basic concept is that of the basic rate of the infection R0. for most viral infections, R0 is
the average number of secondary cases produced by a primary case in a wholly susceptible
population. Clearly, an infection cannot maintain itself or spread if R0 is less than 1. R0 can
be estimated from as B/(A-D);B = life expectancy, A = average age at which infection is
acquired, D = the characteristic duration of maternal antibodies.
The larger the value of R0, the harder it is to eradicate the infection from the community in
question. A rough estimate of the level of immunization coverage required can be estimated
in the following manner: eradication will be achieved if the proportion immunized exceeds
a critical value pinc = 1-1/R0. Thus the larger the R0, the higher the coverage is required to
eliminate the infection. Thus the global eradication of measles, with its R0 of 10 to 20 or
more, is almost sure to be more difficult to eradicate than smallpox, with its estimated R0 of
2 to 4. Another example is rubella and measles immunization in the US. Rubella (A = 9
years) has an Ro roughly half that of measles (A = 5 years) and indeed rubella has been
effectively eradicated in the US while the incidence of measles have declined more slowly.
Why do we not require 100% coverage to eradicate an infection? Immunization has both a
direct and indirect effect. The susceptible host population is reduced by mass immunization
so that the transmission of infection has become correspondingly less efficient and
eventually, the infection will be unable to maintain itself.

Measles
Pertussis
Mumps
Rubella
Diptheria
Polio

Averageage
ofinfection
4-5
4-5
6-7
9-10
11-14
12-15

Epidemic
period
2
3-4
3
3-5
4-6
3-5

R0
15-17
15-17
10-12
7-8
5-6
5-6

Critical
coverage
92-95
92-95
90-92
85-87
80-85
80-85