Vaccine
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Measles vaccination via the aerosol route has proven effective under field conditions, using vaccine reconstituted prior to nebulization. Inhalation of a dry powder aerosol vaccine would have additional benefits, including easier logistics of administration, reduced cold chain dependence and the potential of single dose administration. ⋯ Specific immune responses were demonstrated, but levels of immunity were lower than in animals vaccinated by injection or by nebulized aerosol. These studies provide proof of principle that dry powder inhalation is a possible route for measles vaccination, but suggest that either the vaccine formulation or the method of delivery need to be improved for a better immune response.
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We previously developed a dengue tetravalent DNA vaccine that can induce neutralizing antibodies against four dengue viruses in mice. Here, we demonstrated that immunogenicity of our tetravalent vaccine is synergistically increased in mice by co-immunization with dengue type 2 virus (DENV2) subviral extracellular particles (D2EPs) or inactivated Japanese encephalitis vaccine (JEVAX). A single immunization with a mixture of 100 microg of the tetravalent vaccine and 150 ng of D2EPs or a 1/10 dose of JEVAX induced moderate levels of neutralizing antibodies in a 90% plaque reduction assay. Immunized mice were protected from "artificial" viremia created by intravenous injection with DENV2.
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Randomized Controlled Trial
Antibody responses after dose-sparing intradermal influenza vaccination.
Reduced-dose intradermal (ID) influenza vaccination is an attractive approach to increase availability of vaccine supply in an event of vaccine shortage. We conducted a randomized open-label study, in which 500 subjects were randomly assigned to receive an ID injection of 0.1 ml dose of inactivated split-virion influenza vaccine or an IM injection of 0.5 ml dose. The subjects who had hemagglutination inhibition (HI) antibody titer of at least 1:40 at day 28 post-vaccination in ID and IM groups were 93.3% versus 98.0% for influenza A(H1N1) virus, 86.3% versus 95.0% for A(H3N2) virus, and 43.5% versus 57.0% for influenza B virus. ⋯ Local reactions were significantly more frequent among subjects in the ID group than those in the IM group, but the reactions were mild and transient. In this study, ID administration of one-fifth dose of influenza vaccine elicited significantly lower levels of antibody response as compared to full-dose IM injection. However, the antibody responses elicited by the ID vaccination were still sufficiently high to meet the requirement guidelines of the European Committee for Proprietary Medicinal Products (CPMP) for the annual relicensure of influenza vaccines.
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We present two cases of shoulder pain and weakness following influenza and pneumococcal vaccine injections provided high into the deltoid muscle. Based on ultrasound measurements, we hypothesize that vaccine injected into the subdeltoid bursa caused a periarticular inflammatory response, subacromial bursitis, bicipital tendonitis and adhesive capsulitis. Resolution of symptoms followed corticosteroid injections to the subacromial space, bicipital tendon sheath and glenohumeral joint, followed by physical therapy. We conclude that the upper third of the deltoid muscle should not be used for vaccine injections, and the diagnosis of vaccination-related shoulder dysfunction should be considered in patients presenting with shoulder pain following a vaccination.
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Although previous studies have shown either no association between immunisation and SIDS or even a decreased risk of SIDS, adverse effects, including death, from immunisations continue to cause concern, especially when a new vaccine is introduced. ⋯ This study provides further support that immunisations may reduce the risk of SIDS.