Vaccine safety in the neonatal period

Prophylaxe der kaninen Parvovirose

Obwohl Impfstoffe gegen das canine Parvovirus (CPV) weltweit eingesetzt werden, tritt die Parvovirose vor allem bei jungen Hunden nach wie vor vergleichsweise häufig auf. Der vorliegende Übersichtsartikel konzentriert sich auf die Ursachen für ein Impfversagen. Hierfür kommen unterschiedlichste Faktoren in Betracht, die den Hund selbst oder seine Umwelt betreffen. So gibt es genetisch bedingt Hunde, die keine Antikörper (Non-Responder) oder nur sehr niedrige Konzentrationen an Antikörpern (Low-Responder) nach einer CPV-Impfung ausbilden. Der Impferfolg kann auch durch andere intrinsische Faktoren (z. B. Gewicht, Alter, Reproduktions- und Ernährungsstatus, Krankheiten) und/oder extrinsische Faktoren (z. B. Stress, Belastung, Medikamente) beeinträchtigt werden. Neben Ursachen, die den individuellen Hund betreffen, kann ein Impfversagen auch durch eine reduzierte immunisierende Eigenschaft des Impfstoffs bedingt sein; hierfür kommt eine Vielzahl verschiedener Faktoren in Betracht (z. B. Herstellung, Lagerung, Applikation).

[Prevention of canine parvovirosis - Part 3: Vaccine-associated adverse events]

Although nowadays vaccines, especially those against canine parvovirus (CPV), are considered to be safe, vaccine-associated adverse events (VAAEs) can occur in rare cases. Some VAAEs are mild and manifest shortly (within a few days) after vaccination (e. g. gastrointestinal signs, fever, reduced general condition, lymphadenopathy). These signs are likely a result of vaccine virus replication and indicate a good immune response. Anaphylactic reactions can also occur promptly following vaccine administration and might be life threatening. Affected dogs show clinical signs such as edema, salivation, vomiting, diarrhea, hypotension, and/or shock. Since it is often unclear which component of the vaccine carries responsibility for the anaphylactic reaction it is important to limit future vaccinations of these dogs to indispensable components only. When revaccination is unavoidable, e. g. because antibodies against CPV cannot be detected, combined vaccines should not be used and CPV (and other components, if needed) should preferably be vaccinated separately. Changing the vaccine manufacturer might also prevent further anaphylactic reactions. Finally, there are VAAEs occurring after a prolonged period of time. In dogs, it is discussed that autoimmune diseases, such as immune-mediated hemolytic anemia (IMHA), can be a consequence of excessive vaccination or in the least be triggered by vaccination. Numerous dogs with IMHA are reported to have a history of receiving a vaccination within a few weeks before the onset of clinical sings. In such dogs, further vaccinations should generally be avoided.

[Prevention of canine parvovirosis - Part 1: Humoral and cellular immunity]

Canine parvovirosis remains a common and highly infectious disease. Thus, adequate protection is essential for all dogs at any time. In this, humoral immunity plays an essential role. The presence of antibodies in adult dogs suggests immunity against the disease, and nearly all adult dogs possess antibodies (either due to previous vaccination or infection). Meanwhile, worldwide vaccination guidelines recommend measurement of pre-vaccination antibodies instead of regular triennial re-vaccinations in adult dogs. Studies have demonstrated a long lasting duration of immunity against canine parvovirus. Re-vaccination therefore possesses no beneficial effect when dogs already have pre-vaccination antibodies. Thus, when antibodies are present, unnecessary re-vaccinations that potentially cause vaccine-associated adverse events should be avoided. Hemagglutination inhibition and virus neutralization can be performed in specialized laboratories for quantitative antibody titer measurement. Semiquantitative point-of-care (POC) tests for detection of CPV antibodies are available. Since the presence of CPV antibodies in adult dogs that have been vaccinated or previously infected suggests adequate immunity against disease, these POC tests can be a useful tool in practice. They identify dogs that might potentially be unprotected and require re-vaccination during preventive health care appointments. Concerning the POC tests' quality assessment, a high specificity (low number of false positive test results) is considered the most important feature.

From the bluetongue vaccination campaigns in sheep to overimmunization and ovine ASIA syndrome

The use of vaccines has proven to be very effective in controlling and eradicating infectious diseases, both in veterinary and human medicine; however, vaccines can be also the source of an array of problems caused by procedures such as overimmunization. Bluetongue, an orbiviral disease that affects ruminants, is best controlled by the use of inactivated vaccines. During the last years of the past decade, these vaccines were applied all over Europe to control the spreading of the disease, a goal that was accomplished; however, at the same time, several adverse effects related to the vaccination were reported. Especially in sheep, this vaccination campaign brought out a new cachectic and neurologic disease with harmful consequences for the ovine industry. This disease is now recognized as the ovine version of the autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome) and poses an immense challenge in veterinary medicine, immunology, and vaccinology.

Vaccine responses in newborns

Immunisation of the newborn represents a key global strategy in overcoming morbidity and mortality due to infection in early life. Potential limitations, however, include poor immunogenicity, safety concerns and the development of tolerogenicity or hypo-responsiveness to either the same antigen and/or concomitant antigens administered at birth or in the subsequent months. Furthermore, the neonatal immunological milieu is polarised towards Th2-type immunity with dampening of Th1-type responses and impaired humoral immunity, resulting in qualitatively and quantitatively poorer antibody responses compared to older infants. Innate immunity also shows functional deficiency in antigen-presenting cells: the expression and signalling of Toll-like receptors undergo maturational changes associated with distinct functional responses. Nevertheless, the effectiveness of BCG, hepatitis B and oral polio vaccines, the only immunisations currently in use in the neonatal period, is proof of concept that vaccines can be successfully administered to the newborn via different routes of delivery to induce a range of protective mechanisms for three different diseases. In this review paper, we discuss the rationale for and challenges to neonatal immunisation, summarising progress made in the field, including lessons learnt from newborn vaccines in the pipeline. Furthermore, we explore important maternal, infant and environmental co-factors that may impede the success of current and future neonatal immunisation strategies. A variety of approaches have been proposed to overcome the inherent regulatory constraints of the newborn innate and adaptive immune system, including alternative routes of delivery, novel vaccine configurations, improved innate receptor agonists and optimised antigen-adjuvant combinations. Crucially, a dual strategy may be employed whereby immunisation at birth is used to prime the immune system in order to improve immunogenicity to subsequent homologous or heterologous boosters in later infancy. Similarly, potent non-specific immunomodulatory effects may be elicited when challenged with unrelated antigens, with the potential to reduce the overall risk of infection and allergic disease in early life.

Immunization

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Active immunization can partially or completely protect dogs and cats from severe consequences of infection with a variety of different pathogens, and in some cases it reduces shedding of these pathogens.

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Vaccines contain attenuated live microorganisms, inactivated microorganisms, or portions of these organisms. They also contain preservatives and adjuvants.

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Failure of immunization can occur with improper storage or administration of vaccines, a large challenge dose, host factors such as concurrent infections or disease, and interference by maternal antibody.

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Other adverse effects of vaccine administration are uncommon to rare but include hypersensitivity reactions, disease induced by live attenuated vaccine organisms, and injection-site sarcomas in cats.

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The decision to administer a vaccine should be based on discussion of risks and benefits between the veterinarian and pet owner. This should be documented in the medical record.

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Guidelines for vaccine selection and administration have been published by a number of veterinary bodies, such as the AAFP, AAHA, AVMA, and WSAVA; suggestions can also be found in Appendix I.

Origins of injection-site sarcomas in cats: the possible role of chronic inflammation-a review

The etiology of feline injection-site sarcomas remains obscure. Sarcomas and other tumors are known to be associated with viral infections in humans and other animals, including cats. However, the available evidence suggests that this is not the case with feline injection-site sarcomas. These tumors have more in common with sarcomas noted in experimental studies with laboratory animals where foreign materials such as glass, plastics, and metal are the causal agent. Tumors arising with these agents are associated with chronic inflammation at the injection or implantation sites. Similar tumors have been observed, albeit infrequently, at microchip implantation sites, and these also are associated with chronic inflammation. It is suggested that injection-site sarcomas in cats may arise at the administration site as a result of chronic inflammation, possibly provoked by adjuvant materials, with subsequent DNA damage, cellular transformation, and clonal expansion. However, more fundamental research is required to elucidate the mechanisms involved.

Safety and efficacy of neonatal vaccination

Newborns have an immature immune system that renders them at high risk for infection while simultaneously reducing responses to most vaccines, thereby posing challenges in protecting this vulnerable population. Nevertheless, certain vaccines, such as BCG and Hepatitis B vaccine, do demonstrate safety and some efficacy at birth, providing proof of principal that certain antigen-adjuvant combinations are able to elicit protective neonatal responses. Moreover, birth is a major point of healthcare contact globally meaning that effective neonatal vaccines achieve high population penetration. Given the potentially significant benefit of vaccinating at birth, availability of a broader range of more effective neonatal vaccines is an unmet medical need and a public health priority. This review focuses on safety and efficacy of neonatal vaccination in humans as well as recent research employing novel approaches to enhance the efficacy of neonatal vaccination.