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The Vaccine Industry

The vaccine industry is composed of companies that are engaged in any of the following activities: research (including that performed in industry and biotech), development, manufacture, sales, marketing, or distribution of vaccines. They receive their revenue chiefly from sales of vaccine products or expectations thereof. The vaccine industry is relatively small compared with the pharmaceutical industry but growing. We estimate that total infectious disease vaccine sales…

Correlates of Protection

Peter Gilbert, PhD Professor Biostatistics Fred Hutchinson Cancer Center, Seattle Washington United States Research Professor Biostatistics University of Washington, Seattle Washington United States The determination of a correlate of protection (CoP) by a vaccine is often critical to its development, as its measurement permits a number of both use Peter B. Gilbert theoretical and practical extrapolations. Aside from the intellectual interest in identifying the immune response…

Non-specific Effects of Vaccines

INTRODUCTION In addition to protecting against their target disease, vaccines can induce changes in the immune system that have broader effects. As early as in the 1800s, it was noted that smallpox vaccination was associated with protection against unrelated infections. In the 1930s, the term “non-specific effects” (NSE) was used to describe the observation that the reduction in all-cause mortality in infants vaccinated with bacille Calmette-Guérin…

Vaccine Immunology

Generating vaccine-mediated protection is a complex challenge. Up to the year 2000, vaccines have largely been developed empirically, with little or no understanding of how they activate the immune system. Subsequently, the antigens to be included in vaccines such as meningococcal group B, subunit zoster, RTS/S malaria, human papillomavirus (HPV), and SARS-CoV-2 vaccines were defined based on their biological importance and presented in various ways to…

A Short History of Vaccination

Vaccination as a deliberate attempt to protect humans against disease has a short history when measured against the myriad years that humans have sought to rid themselves of plagues and pestilence. Only in the 20th century did the practice flower into the routine vaccination of large populations. Yet, despite its relative youth, the impact of vaccination on the health of the world’s peoples is hard to…

Nutrition

Food security remains a major challenge for communities that are dependent on climate-vulnerable subsistence farming and in settings of major humanitarian crisis including natural disaster, war and massive population displacement. According to the World Food Programme, in 2015 one in nine people on the planet went to bed hungry each night. The management of severe acute malnutrition (SAM) in children has been revolutionized by a technological…

Bites, stings, venoms, toxins

Venomous invertebrate and vertebrate animals are to be found anywhere in the world but are especially common in the tropics and subtropics, where they may be particularly hazardous. The following figures illustrate a few examples, including marine and terrestrial invertebrates and vertebrates. Although bites and stings are usually individual hazards and recognition depends upon understanding of the local epidemiology, the problem can take on public health…

Ectoparasites

Some arthropods are of medical importance predominantly because of the direct effect of infestation and these are considered in this chapter. Arthropods that cause illness through envenomation (mainly arachnids) are discussed in the following chapter along with other noxious exposures (bites, stings, venoms, toxins). Others, considered elsewhere ( Chapter 1 ), are responsible for disease primarily because they are vectors of viral, bacterial or parasitic pathogens.…

Infections Acquired by Airborne Transmission

Pneumonia continues to exert a terrible toll on health, especially in childhood, where it is the leading infectious cause of death in under-fives. Airborne infections, whether viral, bacterial or fungal, are principally acquired by inhalation of pathogenic organisms, either directly from the environment as spores or attached to dust particles, or within aerosolized droplets and droplet nuclei generated by the respiratory tract mucosa. Some respiratory tract…

Infections Acquired Through the Gastrointestinal Tract

Many of the important pathogens that gain entry through the gastrointestinal tract are cosmopolitan in their distribution. They include viruses, bacteria, protozoa, helminths and endoparasitic arthropods. The first three of these can be directly infectious for humans when they are passed in the faeces but, in the case of helminths, the eggs may become infectious only after maturation in the soil (e.g. Ascaris lumbricoides ) or…

Infections Acquired Percutaneously

Soil There are estimated to be billions of microorganisms in a handful of soil, so it might be considered surprising that it does not serve as a source for more pathogens. Indeed, given that soil cannot be decontaminated globally, and thus soil-acquired infections like tetanus can never be eradicated, this is fortunate. ‘Soil-transmitted helminths’ (STHs) is the collective term (interchangeable with ‘geohelminths’) applied principally to three…

Arthropod-Borne Diseases

Arthropods can transmit viruses, bacteria and parasites. To date, there is no known arthropod-borne fungal infection. Mosquitoes transmit more disease, and a greater variety of disease, than any other arthropod. However, other biting flies, fleas, ticks, lice and mites are also responsible for transmission of some infections. Most of these infections are zoonotic; animal and human hosts may exhibit disparate behaviour and inhabit differing environments, thus…

Clostridioides difficile infection

Clostridioides difficile , formerly knowns as Clostridium difficile, is a Gram-positive, anaerobic bacillus, with a spore phase that prolongs survival in the environment. Ingestion of spores that are resistant to gastric acid results in maturation into the bacillus stage. C. difficile replicates disproportionally to other colonic flora when the balance is affected by another pathogen, absence of enteral feeds, exposure to antimicrobials, or chemotherapeutics. C. difficile…

Gastrointestinal viruses

Diarrheal disease is the second most common cause of death in children younger than 5 years worldwide, according to the World Health Organization (WHO). In the United States, viruses are the major cause of acute gastroenteritis in children; norovirus, rotavirus, adenovirus, astrovirus, and sapovirus are the most commonly detected. Viral gastroenteritis also affects immunocompromised children, in whom it causes more morbidity and mortality, including longer duration…

Strongyloides, cryptosporidium , and other parasitic infections

Parasitic infections are an uncommon but potentially important cause of morbidity and mortality in children undergoing solid organ transplantation (SOT). Although few data have been published relating to parasitic infections in children undergoing hematopoietic stem cell transplantation (HSCT) or being treated for cancer, the high degree of immunodeficiency relating to treatment with chemotherapy and ablation therapy early after HSCT transplant, as well as the potential presence…

Pneumocystis pneumonia

Epidemiology and risk factors Pneumocystis jirovecii (formerly Pneumocystis carinii ) is an infrequent though potentially deadly cause of fungal pneumonia ( P. jirovecii pneumonia [PJP]) in immunocompromised patients. P. jirovecii is a ubiquitous unicellular organism found around the world with an affinity for the respiratory tract. Most individuals are exposed in childhood and many are colonized, but disease occurs almost exclusively in immunocompromised hosts. Individuals with…

Nocardia and actinomyces

Nocardia Epidemiology and risk factors Nocardia species are a heterogeneous group of ubiquitous aerobic, gram-positive filamentous organisms that reside in soil and decaying organic matter and are associated with an array of infections in both immunocompetent and immunocompromised hosts. First described by Edmond Nocard in 1888, Nocardia infections are associated with a range of illnesses, from localized suppurative skin lesions and chronic mycetomas, to invasive pulmonary…