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1 COMMONWEALTH OF AUSTRALIA Copyright regulations 1969 Warning This material has been reproduced and communicated to you by or on behalf of the University of Melbourne pursuant to part VB of the Copyright Act 1968 (the Act). The material in this communication may be subject to copyright under the act. Any further copying or communication of this material by you may be the subject of copyright protection under the act. Do not remove this notice

2 Vaccines Save Lives Smallpox was eradicated in Before that it killed >300 million people in the 20 th century alone Immunisation has nearly eradicated Hib meningitis, but only from countries that use the vaccine When immunisation stops diseases may reappear, e.g. whooping cough in the UK In the USA, measles has been reduced by >99%. In countries without the vaccine, there are still many cases and deaths.

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4 Applications of Immunisation To prevent infection To treat infection To prevent and/or treat non-infectious conditions, e.g., autoimmune conditions, cancer To modify immune responses To modify physiological processes

5 Types of Immunisation Active Passive: antibodies immune cells

6 Passive Immunisation with Ig Uses: Sources: Types: Features: treatment and/or prevention horse, human, monoclonal, engineered pooled (= standard) hyperimmune short-lived potentially hazardous

7 Some Applications of Passive Immunisation Indication Type Origin Use Agammaglobulinaemia PGG human prevention Measles PGG human prevention, modification Hepatitis B HIG human prevention Varicella HIG human prevention, modification Rabies HIG human prevention Tetanus HIG human prevention, treatment Diphtheria HIG horse prevention, treatment Botulism HIG horse treatment Bites/stings HIG horse prevention, treatment Autoimmunity mab mouse:human treatment Malignancy mab mouse:human treatment PGG = pooled γ-globulin; HIG = hyperimmune globulin; mab = monoclonal antibody

8 Immunizing Agents 1 : Living unattenuated (different host or route) empirically attenuated rationally attenuated reassortants antigen expressed on living vector

9 Living Unattenuated Vaccines respiratory adenovirus (different route) rotavirus (different host) vaccinia (?)

10 Living Empirically Attenuated Vaccines Viruses polio (Sabin OPV); measles; mumps; rubella; varicella-zoster; rotavirus (Rotarix); yellow fever Bacteria BCG; typhoid (Ty21a)

11 Living Rationally Attenuated Vaccines Cholera (CVD 103-Hg R ) Others under development

12 Reassortant Vaccines Rotavirus (RotaTeq) Influenza (not in Australia)

13 Antigen Expressed on Living Vector For example: rvsv-zebov

14 Immunizing Agents 2 : Non-replicating inactivated virion, bacterium purified product, component (+/- modification) product of cloned gene synthetic immunogen (experimental only) DNA vaccine (experimental only)

15 Viruses Inactivated Vaccines polio (Salk IPV); influenza; hepatitis A; Japanese encephalitis; rabies Bacteria cholera; pertussis (whole cell); Q fever

16 Component Vaccines Viruses Hepatitis B HPV (virus-like particles)

17 Component Vaccines Bacteria acellular pertussis (3 or 5 components, incl. pertussis toxin, filamentous haemagglutinin and pertactin) toxoids: diphtheria; tetanus; cholera (with whole cells) capsular polysaccharide: unmodified: 23vPPV; Vi conjugated: Hib; 10vPCV; 13vPCV; MenCCV; 4vMenCV

18 Living Vaccines : Advantages broader, longer-lived immune response local immunity (sometimes) ease of administration (sometimes)

19 Living Vaccines : Disadvantages Disease back mutation spread contamination Failure dead (may need cold chain ) pre-existing immunity interference

20 Killed Vaccines : Advantages stable contamination unlikely can t spread safe for immune deficient

21 Killed Vaccines : Disadvantages weaker immune response high dose need adjuvants expensive

22 Immunisation Schedule Victoria 2016 Age Birth 2, 4 and 6 months 12 months 18 months 4 years years pregnant women 50 years 65 years Vaccine(s) HepB HepB + DTPa + Hib + IPV; 13vPCV; rotavirus Hib + MenC; MMR MMR DTPa + IPV; MMR (if not given at 18 mo.) VZV; HPV; dtpa; flu*; 23vPPV* flu 23vPPV* (5 yearly??) 23vPPV (5 yearly??); flu (yearly) * Aboriginals, Torres Strait Islanders only

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