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Introduction Ever since the physician assistant (PA) profession was developed, one of its defining features has been the relationship between PAs and physicians. When physicians created the PA profession, they envisioned PAs practicing medicine with physician delegation and supervision. Throughout the profession’s more than 50-year history, PAs have consistently embraced the concept of team-based health care. PAs believe that the physician–PA team provides the framework of…
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1 Introduction The fields of vaccinology and adoptive cell transfer (ACT) converge in the shaping of the acquired cellular and humoral responses of the B- and T cells of the immune system toward desired antigens on pathogens or self-targets. However, the approaches differ markedly, with vaccines often requiring immunizations and boosting over a period of months, whereas ex vivo culture of T cells and gene transfer…
1 Introduction In the last decades there has come into being, without either flourish of trumpets or serious controversy, a general current of belief in what I have come to call ‘immunological surveillance’. – One can therefore picture a form of surveillance by which the body is being continuously patrolled, as it were, for the appearance of aberrant protein patterns. — M. Burnet The idea that…
1 Introduction Infectious diseases continue to plague mankind and evolve to keep pace with the efforts to control them. Sir William Osler captured the ongoing fear of infectious pathogens when he said, “Humanity has but three great enemies: fever, famine, and war; of these by far the greatest, by far the most terrible, is fever.” Despite the significant impact of antimicrobials and vaccines on public health,…
Public trust in vaccines and immunization programs is a dynamic and changing phenomenon. Seeming success in an immunization program can be disrupted by a confidence crisis more quickly than it can be rebuilt. Constant care and vigilance are needed to detect and address waning trust and confidence before they become a crisis. Fixing a crisis once does not mean that another one may not erupt—sometimes driven…
1 Introduction Vaccination is recognized as one of the greatest public health achievements of the last century, likely saving more lives in the last 50 years than any other health intervention. For continued success, however, high population vaccination coverage rates need to be attained and sustained. Immunization not only protects the individual, but also, in many instances, provides community protection against vaccine-preventable diseases through herd immunity. Sadly,…
1 Introduction India has the largest birth cohort in the world (27 million children) but lags other countries of similar gross national income per capita on immunization coverage ( Exhibit 25.1 ). A third of the world’s roughly 27 million unimmunized children live in India. The proportion of children under 2 years of age who are fully immunized has increased by 1% a year and is estimated…
1 Introduction The decision for a national government to adopt a population-based health intervention such as vaccines is a complex process involving political, economic, operational/logistics, and governance issues. There are as many variations of decisions as there are the number of countries and vaccines. Three important issues predominate: the financing and costs of the vaccine intervention, existing infrastructures on which to add a vaccine component, and…
In May 2012, the World Health Assembly approved the Global Vaccine Action Plan (GVAP) to achieve the Decade of Vaccines vision by delivering universal access to immunization. One of the ambitious goals set by the GVAP was to unleash vaccines’ future potential with the aim of developing and launching two new major vaccines by the end of this decade. In its assessment report from 2014, the…
1 Introduction This chapter focuses on ethical concerns early in the life cycle of vaccines, namely trials designed to test safety, immunogenicity, and efficacy of vaccines in human participants. Vaccine trials involve many ethical complexities that stem from several features. These include that vaccine trials are frequently international projects involving organizations in high-income countries collaborating with those in low-resource settings; such trials are often implemented in…
1 Introduction Influenza is a communicable acute respiratory disease and one of the major infectious disease threats to the human population. Influenza virus affects individuals of all ages, causes repeated infections throughout life, and is responsible for annual worldwide epidemics of varying severity, commonly referred to as “seasonal influenza.” Influenza also causes periodic pandemics that are characterized by a novel virus strain to which the majority…
1 Introduction In 1984, coincident with the identification of HIV as the cause of AIDS, the US Secretary of Health and Human Services made an announcement indicating that a vaccine should be expected within the next few years. As we enter into the fourth decade of the AIDS epidemic, this has still not come to fruition. Global research efforts have revealed unprecedented obstacles to making a…
1 Introduction Malaria is a major cause of human suffering caused by Plasmodia parasites, transmitted to humans via the bite of anopheline mosquitoes. While five Plasmodia species can infect humans, Plasmodium falciparum and Plasmodium vivax constitute major public health problems. Access to long-lasting insecticide-impregnated bednets, indoor residual insecticide spraying, use of appropriate diagnostic tools and efficacious artemisinin-derivative based combined therapies led to an estimated 50% reduction…
1 Introduction Tuberculosis (TB) usually manifests as a lung disease. Diagnosis is often delayed because of the chronic nature of the disease, while 6 months of treatment is required for a cure. Many diagnostic and antimicrobial tools that are currently used for intervention represent relatively dated technologies. The causative pathogen, Mycobacterium tuberculosis (Mtb), has been remarkably successful in causing and sustaining a global pandemic. One third of…
Infectious diseases caused by parasites are major causes of morbidity and mortality in the poorest countries of Asia, Africa, and Latin America. Among the most prevalent infectious diseases commonly referred to as “neglected,” 11 are caused by helminthic and protozoan parasites, which along with malaria affect more than 1 billion people and cause more than 1 million deaths annually. Unfortunately, there is as yet no safe,…
1 Background Bacteria are still one of the most common causes of infection, associated with a range of different diseases in humans and important veterinary animals. The emergence of antibiotic resistant microbes (ARM) means that the threat bacteria pose to human health is unlikely to diminish in the near future. Thus, the design of new or improved bacterial vaccines remains high on the global health agenda,…
1 Introduction Vaccination is the most effective means of preventing and controlling viral infections. The eradication of smallpox and the significant progress made toward polio eradication are clear examples of the great impact of antiviral vaccines. However, viral infections remain a major public health threat and a significant cause of death. Most of the antiviral vaccines introduced over the past century were empirically developed. Poliomyelitis, measles,…
Rotavirus is the leading cause of severe childhood gastroenteritis worldwide, accounting for about one-third of diarrhea episodes requiring hospitalization. Although rotavirus is equally prevalent worldwide, the vast majority of rotavirus deaths occur in developing countries, because of suboptimal access to health care. Orally administered live attenuated vaccines have been developed to provide protection against rotavirus. Two licensed rotavirus vaccines have been available since 2006 and have…