The application of vaccine technology forms a core element of modern medicinal endeavour. It plays a central role in both human and veterinary medicine and represents the only commonly employed prophylactic (i.e. preventative) approach undertaken to control many infectious diseases. The current (annual) global vaccine market stands at in excess of US$3 billion. Immunization programmes, particularly those undertaken on a multinational scale, have served to reduce dramatically the incidence of many killer/disabling diseases, such as smallpox, polio and tuberculosis.
Continued/increased emphasis upon the implementation of such immunization programmes is likely. This is true not only of poorer world regions, but also amongst the most affluent nations. An estimated 500 000 adults die annually in the USA from conditions that could have been prevented by vaccination. These include pneumococcal pneumonia, influenza and hepatitis B.
Vaccination seeks to exploit the natural defence mechanisms conferred upon us by our immune system. A vaccine contains a preparation of antigenic components consisting of, derived from or related to a pathogen. In most instances upon vaccine administration, both the humoral and cell-mediated arms of the immune system are activated. The long-term immunological protection induced will normally prevent subsequent establishment of an infection by the same or antigenically related pathogens. Although some vaccines are active when administered orally, more are administered parenterally. Normally, an initial dose administration is followed by subsequent administration of one or more repeat doses over an appropriate time-scale. Such booster doses serve to maximize the immunological response.
Traditional vaccine preparations have largely been targeted against viral and bacterial pathogens, as well as some bacterial toxins and, to a lesser extent, parasitic agents, such as malaria. However, an increased understanding of the molecular mechanisms underlying additional human diseases suggests several novel applications of vaccines to treat/prevent autoimmune conditions and cancer (discussed later). Despite such potentially exciting future applications, recent scientific surveys indicate that the most urgently required vaccines are those that protect against more mundane pathogens (Table 13.5). Although the needs of the developing world are somewhat different to those of developed regions, an effective AIDS vaccine is equally important to both. Approaches to development of such AIDS vaccines are discussed later in this chapter. Of particular consequence to developing world regions is the current lack of a truly effective malaria vaccine. With an estimated annual incidence of 300-500 million clinical cases (with up to 2.7 million resulting deaths), development of an effective vaccine in this instance is a priority.
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