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Lyme Disease Vaccines—The Journey Continues

INTRODUCTION Lyme disease was described as a separate entity in 1976 because of the geographic clustering of a group of children with arthritis in Lyme, Connecticut, who originally were diagnosed as having juvenile rheumatoid arthritis. The rural setting of the case clusters and the identification of an expanding skin lesion, erythema migrans, as a feature of the illness suggested that the disorder was transmitted by an…

Japanese Encephalitis Vaccines

INTRODUCTION Japanese encephalitis virus (JEV), a mosquito-borne flavivirus, is the leading recognized cause of childhood encephalitis in Asia. Although safe and effective vaccines are available, several thousand cases of Japanese encephalitis (JE) are reported annually. Because JE is not under comprehensive surveillance while diagnostic capacity is limited, official reports from many JE-endemic countries undoubtedly underestimate the true number of cases. , Substantial progress has been made…

Influenza Vaccine—Live

Influenza viruses cause recurrent and widespread disease in humans. Vaccination is the most effective means of preventing influenza infection. The use of inactivated influenza virus vaccine (IIV) in humans has been the subject of numerous studies, with an emphasis on providing an effective vaccine with minimal reactogenicity. An alternative approach to influenza immunization using live attenuated virus administered by nasal spray has also been successful. This…

Inactivated and Recombinant Influenza Vaccines

HISTORY AND IMPORTANCE History of the Disease and Vaccines Influenza is a leading cause of morbidity and mortality worldwide, occurring in annual epidemics and occasional global pandemics. Five global pandemics of influenza with high attack rates have been well described, the first beginning in 1889, with subsequent pandemics occurring in 1918, 1957, 1968, and 2009. However, influenza pandemics and epidemics have likely occurred for millennia, with…

Human Papillomavirus Vaccines

Human papillomavirus (HPV) infections, which are very common, produce epithelial lesions of the nongenital and genital skin and mucous membranes. Although most infections are benign and self-limited, persistent infection by a subset of the more than 200 HPV genotypes (types) can lead to a variety of epithelial malignancies. , The oncogenic potential of HPVs was shown first in the 1970s by Orth and colleagues for epidermodysplasia…

Human Immunodeficiency Virus Vaccines

In 1981, the acquired immunodeficiency syndrome (AIDS) was first recognized in humans as an outbreak of Pneumocystis carinii pneumonia among gay men in the United States, , having spread from Africa to Haiti to the United States, and then globally. , The disease is caused by the human immunodeficiency virus type 1 (HIV-1), a lentivirus that is transmitted through varied routes of transmission including cervicovaginal, penile,…

Herpes Simplex Virus Vaccines

“O'er ladies' lips, who straight on kisses dream, Which oft the angry Mab with blisters plagues….” William Shakespeare, Romeo and Juliet , Act 1, Scene 4, p. 4 More than 2500 years ago Hippocrates used the Greek term herpes , meaning “to creep or crawl,” to describe spreading cutaneous lesions, but it was not until the 19th century that Vidal first described person-to-person transmission of “herpes.”…

Hepatitis E Vaccines

Hepatitis E was not recognized as a distinct disease until 1980, when waterborne epidemics of hepatitis in India, previously thought to have been caused by hepatitis A virus (HAV), were shown to have occurred in persons who were already immune to HAV. , Three years later, the etiologic agent (tentatively designated as “epidemic non-A non-B hepatitis,” or “enterically transmitted non-A non-B hepatitis”) was transmitted to a…

Hepatitis C Vaccines

Hepatitis C virus (HCV) is a leading cause of chronic liver disease worldwide. According to the World Health Organization, 58 million people are chronically infected with HCV worldwide, and approximately 400,000 people die each year from HCV-related liver diseases. Importantly, around 2 million more individuals are newly infected with HCV each year. A significant number of those newly infected will develop progressive liver disease, ultimately leading…

Hepatitis B Vaccines

Hepatitis has been recognized as a clinical entity since antiquity, but the diversity of viruses causing the infectious form of the disease has only recently been recognized. The first evidence that a form of hepatitis was transmitted by direct inoculation of blood or blood products was discovered when an outbreak of hepatitis occurred after a smallpox immunization campaign in Germany in 1883. Jaundice developed in 15%…

Hepatitis A Vaccines

INTRODUCTION History of Hepatitis A Disease Contagious jaundice was initially recognized independently in Europe—by the Greeks at the time of Hippocrates—and in Asia, by the Chinese ; however, the earliest recorded outbreaks of jaundice that appear epidemiologically to have been hepatitis A occurred in Europe in the 17th and 18th centuries. Early in the 20th century, Cockayne concluded that sporadic and epidemic forms of jaundice were…

Haemophilus influenzae Type b Vaccines

INTRODUCTION Prior to use of vaccination, Haemophilus influenzae type b (Hib) was responsible for significant morbidity and mortality worldwide, largely due to its role in causing pneumonia and meningitis in those younger than 2 years of age. In 2000 alone, an era when Haemophilus influenzae type b conjugate vaccines (Hib-CV) was in routine use in nearly all high-income countries, Hib was estimated to still cause 8.13…

Epstein–Barr Virus Vaccines

Epstein–Barr virus (EBV) is a ubiquitous human pathogen that infects at least 90% of the world’s population. EBV causes infectious mononucleosis, which can result in significant loss of time from school or work in developed countries. In addition, EBV is responsible for a number of cancers including endemic Burkitt lymphoma, nasopharyngeal carcinoma (NPC), a subset of Hodgkin lymphomas, lymphomas in HIV-infected individuals, aggressive NK cell leukemia/lymphoma,…

Nonpolio Enteroviruses

## Enteroviruses (EVs), which have been classified into four species (A, B, C, and D), are positive-sense, single-stranded RNA viruses within the Picornaviridae family. They cause a wide spectrum of clinical manifestations, including common childhood illnesses (e.g., acute febrile illness, herpangina, and hand-foot-mouth disease [HFMD]), neurological diseases (e.g., aseptic meningitis, encephalitis, acute flaccid myelitis [AFM]), severe infections in special hosts (e.g., neonatal viral sepsis, severe or…

Ebola Vaccines

INTRODUCTION Named for the site of the first outbreak in the Ebola River valley in 1977, Ebola virus and the closely related filovirus, Marburg virus, represent a family of pathogens that cause hemorrhagic fever with an associated high mortality. The potential significance of these viruses was first appreciated with the occurrence of a series of outbreaks in the 1970s. After a hiatus in the 1980s, the…

Diphtheria Toxoid

Respiratory diphtheria is an acute communicable upper respiratory illness caused by toxigenic strains of Corynebacterium diphtheriae , a Gram-positive bacillus. The illness is characterized by a membranous inflammation of the upper respiratory tract, usually of the pharynx but sometimes of the posterior nasal passages, larynx, or trachea, and by widespread damage to other organs, primarily the myocardium and peripheral nerves. Extensive membrane production and organ damage…

Vaccines Against Diarrhea Caused by Noncholera Bacteria

Diarrheal infections are estimated to cause 1.7 billion disease episodes and 700,000 deaths globally each year, mainly in children in low- and middle-income countries. In addition to these direct consequences, infectious diarrhea is a major cause of malnutrition leading to stunting and also, even independently of malnutrition, to significant intellectual and other cognitive disturbances. Travelers to endemic areas are also at high risk for being infected…

Dengue Vaccines

INTRODUCTION History of Disease Early in the 20th century, investigators studying dengue fever outbreaks successfully transmitted infection from person to person through the bite of Aedes aegypti mosquitoes. The epidemiology and clinical descriptions of this disease made it possible to identify outbreaks of dengue fever from historical records. A well-characterized outbreak of “break-bone fever” occurred in late summer of 1780 on the Philadelphia waterfront. Benjamin Rush…

Cytomegalovirus Vaccines

Cytomegalovirus (CMV) is a ubiquitous β-herpesvirus that only replicates in human cells and hence is only transmitted by person-to-person spread. CMV infections are generally asymptomatic in immunocompetent individuals but may produce a heterophile-negative mononucleosis syndrome in approximately 10% of primary infections in older children and adults. Like other herpesviruses, it becomes latent after primary infection but may reactivate from latency, particularly in the setting of immune…

Coronavirus Vaccines

INTRODUCTION: CORONAVIRUSES IN GENERAL Coronaviruses (CoVs) are a family of single-stranded positive (plus, +) RNA viruses with the largest RNA genomes of any human pathogenic viruses, ranging from 26 to 32 kb in length. Pathogenic CoVs of humans and domestic and companion animals were identified over many years. With the enhanced surveillance and identification of CoVs that has occurred since the SARS epidemic 2003, it has…