There are real or potential difficulties with all vaccines. There may be problems with attenuation of live vaccines, with possible risks for vaccinees or their contacts. With non-infectious vaccines, there may be problems in identifying and preserving the immunogenic components and of ensuring correct presentation of the antigens so that the appropriate immune response is stimulated. With all vaccines, there are potential problems of delivery and storage, particularly in tropical climates. In this respect, the WHO Programme of Expanded Immunization is building on experience gained during the Smallpox Eradication Campaign to facilitate widespread use of vaccines. There are still problems caused by, for example, influenza virus, human immunodeficiency virus (HIV), and various respiratory and enteric pathogens which have variable and/or multiple serotypes, and also by malaria, but progress is being made. Various vaccines are being tested against typhoid, cholera and rotavirus gastroenteritis [[1]xPlotkin, S and Fantini, B eds. See all References, [8]xThe legacy of Jenner. Levine, MM. Brit Med J. 1996; 312: 1177–1178Crossref | PubMedSee all References], and considerable attention is being paid to a synthetic subunit vaccine for malaria [9xMalaria – advances in vaccines. Targett, GAT. Curr Opin Infect Dis. 1995; 8: 322–327Crossref | Scopus (6)See all References[9]. Various HIV vaccines are being developed, and the recent isolation of apparently naturally attenuated mutants of HIV which lack the nef gene suggests they may be developed into attenuated vaccines [10xReconsidering an attenuated vaccine for AIDS. Beale, AJ. Lancet. 1996; 347: 344–345Abstract | PubMed | Scopus (3)See all References[10].Recombinant DNA technology has already made a considerable impact through the successful yeast recombinant hepatitis B vaccine [[1]xPlotkin, S and Fantini, B eds. See all References, [11]xProgress on the control of hepatitis B infection through immunization. Kane, MA. Gut. 1993; 34 (suppl): 10–12Crossref | Scopus (40)See all References], and it is appropriate that smallpox vaccine still has a role to play. Infectious vaccinia recombinant vaccines which express the immunogenic glycoprotein of rabies virus are proving very successful in Europe for oral immunization of foxes, the principal wildlife reservoir of rabies [12xThe development and use of a vaccinia–rabies recombinant oral vaccine for the control of wildlife rabies. Pastoret, PP and Brochier, B. Epidemiol Infect. 1996; 116: 235–240Crossref | PubMedSee all References[12]. Although there are reservations about the widespread use of recombinant vaccinia vaccines, particularly in humans, the technology is being transferred to other poxviruses. Candidate mammalian vaccines are being developed using recombinant canarypox vectors which induce good immune responses although they do not replicate in mammalian cells [[1]xPlotkin, S and Fantini, B eds. See all References, [13]xNon-replicating expression vectors : applications in vaccine development and gene therapy. Limbach, K and Paoletti, E. Epidemiol Infect. 1996; 116: 241–256Crossref | PubMedSee all References].Considerable interest is also being shown in ‘DNA vaccines’ [14xDNA vaccines. McDonnell, WM and Askari, FK. New Eng J Med. 1996; 334: 42–45Crossref | PubMed | Scopus (155)See all References[14]. These comprise the appropriate gene inserted into a plasmid carrier which, when injected into the body, is taken up by host cells. The viral gene is expressed and the antigen preferentially stimulates cell-mediated immunity. By appropriate use of reverse transcriptase, recombinant DNA vaccines are being developed for RNA virus infections, particularly influenza.Jenner's pioneer work on smallpox vaccine was not immediately extended to the control of other infections. However, vaccines have made a significant impact in developed countries, through the control of, for example, measles, diphtheria, tetanus and polio, and the widespread use of these and other vaccines in developing countries should have similar effects. There are still problems with infectious diseases, however, and current vaccine research may help to solve these. Increasing concern about antibiotic-resistant bacteria and the slow rate of development of antiviral drugs emphasizes the ‘truism’ that prevention is better than cure; the ultimate goal should be eradication. This has been achieved for smallpox [5xFenner, F, Henderson, DA, Arita, I, Jezek, Z, and Ladnyi, ID. See all References[5], and is achievable for polio by the year 2000 by mass vaccination [15xMass polio vaccination; eradication by 2000 is a realistic goal. Chander, J and Subrahmanyan, S. Brit Med J. 1996; 312: 1178–1179Crossref | PubMedSee all References[15].
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