Abstract
Infectious pathogens are responsible for high utilisation of healthcare resources globally. Attributable morbidity and mortality remains exceptionally high. Vaccines offer the potential to prime a pathogen-specific immune response and subsequently reduce disease burden. Routine vaccination has fundamentally altered the natural history of many frequently observed and serious infections. Vaccination is also recommended for persons at increased risk of severe vaccine-preventable disease. Many current nonadjuvanted vaccines are poorly effective in the elderly and immunocompromised populations, resulting in nonprotective postvaccine antibody titres, which serve as surrogate markers for protection. The vaccine-induced immune response is influenced by: (i.) vaccine factors i.e., type and composition of the antigen(s), (ii.) host factors i.e., genetic differences in immune-signalling or senescence, and (iii.) external factors such as immunosuppressive drugs or diseases. Adjuvanted vaccines offer the potential to compensate for a lack of stimulation and improve pathogen-specific protection. In this review we use influenza vaccine as a model in a discussion of the different mechanisms of action of the available adjuvants. In addition, we will appraise new approaches using "vaccine-omics" to discover novel types of adjuvants.
Highlights
Adjuvants should be added on the basis of the type of immune response desired; for influenza vaccines, for example, cytotoxic and Th1 responses against haemagglutinin might be of less clinical importance to prevent infection
These studies showed that MF59-adjuvanted influenza vaccines induce a more potent immune response with higher rates of seroconversion compared with nonadjuvanted vaccines [86,87,88,89,90,91]
For an adjuvant to act as a modulator of the immune response, it must be specific for one of the receptors involved in this process and regulate its activity
Summary
Infectious pathogens are responsible for high utilisation of healthcare resources globally. Vaccines offer the potential to prime a pathogen-specific immune response and subsequently reduce disease burden. Adjuvanted vaccines offer the potential to compensate for a lack of stimulation and improve pathogen-specific protection. A century later, Emil von Behring and Shibasaburo Kitasato discovered that sera from animals immune to diphtheria contained an antitoxin activity, later called antibodies [2]. These key findings of an inducible immune response resulted in the development of vaccines at the beginning of the last century. Vaccination induces two important immune phenotypes: (i.) a virus-specific B-cell response with production of neutralising antibodies [15]
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