Abstract
In 2019, an ‘influenza pandemic’ and ‘vaccine hesitancy’ were listed as two of the top 10 challenges to global health by the WHO. The skin is a unique vaccination site, due to its immune-rich milieu, which is evolutionarily primed to respond to challenge, and its ability to induce both humoral and cellular immunity. Vaccination into this dermal compartment offers a way of addressing both of the challenges presented by the WHO, as well as opening up avenues for novel vaccine formulation and dose-sparing strategies to enter the clinic. This review will provide an overview of the diverse range of vaccination techniques available to target the dermal compartment, as well as their current state, challenges, and prospects, and touch upon the formulations that have been developed to maximally benefit from these new techniques. These include needle and syringe techniques, microneedles, DNA tattooing, jet and ballistic delivery, and skin permeabilization techniques, including thermal ablation, chemical enhancers, ablation, electroporation, iontophoresis, and sonophoresis.
Highlights
In 2019, the WHO identified an ‘influenza pandemic’ and ‘vaccine hesitancy’ as two of the top ten challenges to global health [1]
By doubling the luciferase plasmid DNA to 4 μg on the killed spores, similar levels of luciferase expression could be achieved. This translated to immune responses where the same level of antibody titres, IgG1/IgG2a ratio, and IFN-γ-producing CD8+ T cells were observed after two vaccinations with 2 μg of pgDE7 h DNA-coated gold particles and 4 μg of pgDE7 h DNA-coated spores [77]
Despite the high hopes raised by preclinical studies, gene guns will need to improve their immunogenicity in humans to be able to progress further in clinical trials and achieve marketing authorisation
Summary
In 2019, the WHO identified an ‘influenza pandemic’ and ‘vaccine hesitancy’ as two of the top ten challenges to global health [1]. A range of new vaccine technologies as well as processes to accelerate their development, testing, and implementation have emerged out of the remarkable global response to coronavirus disease (COVID-19). This impressive reaction will doubtless improve future readiness for, and response to, a wide range of potentially pandemic pathogens. Amidst this fervent vaccine development activity, the second of those global challenges identified by the WHO, i.e., ‘vaccine hesitancy’, should not be forgotten. As many of the means of improving patient acceptance may provide enhancements to both safety and efficacy compared to the current rather outdated paradigm of needle and syringe (N&S)-based vaccine delivery strategies
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