Abstract
The reputation of vaccination rests on a two hundred year old history of success against major infectious diseases. In general, two achievements have been crucial to the success of vaccines: the induction of long-lasting immunological memory in individuals and the stimulation of a herd immunity that enhances control of infectious diseases in populations. However, when one reviews the vaccines now available it is apparent that most successes have been obtained when the microbe has a bacteremic or viremic phase during which it is susceptible to the action of neutralizing antibodies, and before replication in the particular organ to which it is tropic. Success has also been achieved against some agents replicating on respiratory or gastrointestinal mucosae, against which it has been possible to induce immune responses acting locally as well as systemically. Control of intracellular pathogens has not been achieved, except partly with the BCG vaccine against tuberculosis, and modern efforts are directed towards pathogens against which cellular immune responses are critical. Newer approaches in vaccine production such as nucleic acid immunization, vectors, reverse genetics and additional routes of administration may circumvent prior difficulties. The target of vaccination will shift towards adolescents, adults, patients in hospital and those with chronic diseases and possibly will extend to therapy as well as prevention. The major scientific problems to be solved are maintenance of immune memory, immaturity and post-maturity of the immune system, and adjuvants capable of stimulating selective cell types. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive
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