Stories about: immunization

Effective vaccination of newborns: Getting closer to the dream

 

newborn vaccines global health

In many parts of the world, babies have just one chance to be vaccinated: when they’re born. Unfortunately, newborns’ young immune systems don’t respond well to most vaccines. That’s why, in the U.S., most immunizations start at two months of age.

Currently, only BCG, polio vaccine and hepatitis B vaccines work in newborns, and the last two require multiple doses. But new research raises the possibility of one-shot vaccinations at birth — with huge implications for reducing infant mortality.

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A vaccine of one’s own: Precision medicine comes to immunization

precision vaccines
When it comes to vaccines, one size doesn’t fit all, researchers are finding.

Once upon a time, an English country doctor forged a treatment out of cow pus. Edward Jenner squeezed fluid from a cowpox sore on a milkmaid’s hand, and with it, successfully inoculated an eight-year-old boy, protecting him from the related smallpox virus.

It was the world’s first successful vaccination and laid the foundation for modern vaccinology: researchers formulate vaccines from a dead or disabled microbe — or its virulent components — and people sigh with relief when they don’t succumb to the disease.

But investigators are now finding holes in traditional vaccine dogma. “Vaccines were developed under the assumption that one size fits all,” says Ofer Levy, MD, PhD, a physician-scientist in the Division of Infectious Diseases at Boston Children’s Hospital and director of the collaborative Precision Vaccines Program. “That you develop a vaccine and it will protect the same way whether the patient is young, middle aged or elderly; male or female; living in a city or rural environment; northern or southern hemisphere; whether given day or night; summer or winter.”

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Six emerging trends in vaccine development

boy receiving vaccine-shutterstock

Vaccines to protect against infectious disease are the single most effective medical product, but developing new ones is a challenging and lengthy process, limiting their use in developing countries where they are most needed. Once a new vaccine is developed, it undergoes animal testing, which is time-consuming and does not necessarily reflect human immunity.

“It can take decades from the start of vaccine development to FDA approval at huge cost,” says Ofer Levy, MD, PhD, a physician and researcher in the Division of Infectious Diseases at Boston Children’s Hospital. “We are working on making the process faster and more affordable.”

A variety of new strategies are emerging to facilitate vaccine development and delivery:

1. Modular approaches to vaccine production

The Multiple Antigen Presenting System (MAPS) is one innovative modular method to more efficiently produce vaccines that provide robust immunity.

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Strengthening newborns’ immune systems: A secret in the plasma

Blood cells
The immunosuppressant effect in newborns' blood comes not from blood cells themselves, but from the plasma that surrounds them (smaller.pathological.ca/Flickr)
There’s something different about newborns’ blood. In babies less than 28 days of age, the immune system still hibernates—making newborns more susceptible to life-threatening infections and less responsive to many vaccines. Ofer Levy, MD, PhD, and his colleagues at Boston Children’s Hospital have done extensive work toward understanding the newborn immune system, and now they’ve uncovered a mechanism to help explain why the system is so weak—and how it might be strengthened.

“If we can understand the molecular mechanisms causing the immune system to be different when we’re very young or very old, we can leverage that knowledge to develop new treatments,” says Levy.

Tracking vaccine misconceptions–by mining online data

This 1802 British cartoon skewers the cowpox vacccine, newly introduced against smallpox. Read more at http://en.wikipedia.org/wiki/File:The_cow_pock.jpg#file
This 1802 British cartoon skewers the cowpox vaccine, newly introduced against smallpox. Read more at http://en.wikipedia.org/wiki/File:The_cow_pock.jpg#file

Fifty years after Boston Children’s Hospital faculty developed a vaccine against measles, the United Kingdom is seeing a surge of cases. Last year, it tracked a record 2,000 measles diagnoses—unusual for a country that used to average only a dozen cases every year. With 1,200 cases reported this year so far, that record could be broken.

The cases are the legacy of parents who decided to forgo vaccinating at least 1 million children against measles, based on a 1998 study in The Lancet linking the measles vaccine to autism. That now-retracted study became the origin of its own epidemic, carrying misinformation through a network of parents and media outlets that believed the author had discovered the cause of autism.

Until recently, tracking the spread of vaccine-related rumors was even more difficult than tracking the outbreaks such misinformation engenders. A study in The Lancet Infectious Diseases, involving Boston Children’s Hospital’s HealthMap data collection system and funded by the Bill & Melinda Gates Foundation, has taken a huge step toward turning that around.

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A vaccine that works in newborns?

If we could immunize infants at birth, far more could be protected from infections.(DFID-UK Dept for International Development)

Right now, immunizations against most infections begin at 2 months of age. But that leaves newborns at risk for infections like rotavirus, whooping cough and pneumococcus during a highly vulnerable time.

In resource-poor countries, this is a serious problem: Many children see a health care provider only at birth, so may miss their chance to be protected. Worldwide, each year, more than 2 million infants under 6 months old die from infections, especially pneumonia. If we could immunize infants at birth, it would be a huge win for global health.

Unfortunately, though, newborns don’t respond to most vaccines. Their immune systems are too immature—which is why few vaccines for newborns exist.

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Influenza, MRSA and why flu vaccination can save children’s lives

Influenza A H1N1 model (scherle.com/Wikimedia)

What caused previously healthy children to die during the 2009 H1N1 influenza pandemic?  Yesterday, the journal Pediatrics published the results of a study I conducted with the Pediatric Acute Lung Injury and Sepsis Investigator’s (PALISI) Network. Results have been widely reported, by the New York Times, the Washington Post, USA Today and TIME, among many others, provoking a lot of reader commentary, questions and, I fear, some misconceptions.

Methicillin-resistant S. aureus (MRSA)(CDC)

Our study collected data on 838 children with 2009 H1N1 infection admitted across 35 pediatric intensive care units (ICUs) in the U.S. Most of these children were severely ill, the majority requiring mechanical ventilator support for respiratory failure, and 9 percent died. Many  (70 percent) had underlying illnesses like asthma or neurologic conditions that increased their risk. But among those who were previously healthy, the chief risk factor for death was co-infection with methicillin-resistant Staphylococcus aureus, or MRSA. It increased the risk of mortality 8-fold.

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New universal pneumococcal vaccine advances in early tests

Streptococcus pneumoniae in spinal fluid
Streptococcus pneumoniae in spinal fluid

Serious pneumococcal infections – pneumonia, bacteremia, meningitis – are responsible for up to 11 percent of child deaths on the planet. Vaccines exist, such as Prevnar, but they have two big shortcomings.

First, they’re designed to help people build antibodies against specific strains of pneumococcus. But new strains keep emerging, and most of those circulating in the developing world aren’t covered.

Second, they’re too expensive for most developing countries.

Six years ago, Richard Malley, of the Division of Infectious Diseases at Children’s Hospital Boston, and Marc Lipsitch of the Harvard School of Public Health, showed that there is another defense against pneumococcus that doesn’t care what strain it’s encountering. And, despite what textbooks were saying, it has nothing to do with antibodies.

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Affordable pneumococcal vaccines that work globally

Streptococcus pneumoniae kills over a million young children a year, most of them in the developing world. Yet currently available pneumococcal vaccines are only effective against strains circulating in Europe and the US.  How can we make affordable vaccines that work globally?

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A distant star: a single vaccine at birth

Ofer Levy is nothing if not passionate. Talking about his new project, he starts taking notes on my pad for me, to make sure I catch every detail. When Levy was getting his MD/PhD at NYU, one of his mentors told him, “In pursuing your life’s passion as a researcher, you should set your sights on a distant star.”

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