[The 1st 10 years of life of the Salvioli diffusing vaccine. Report of an application center of said vaccination among the child population of Bologna].
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BACKGROUND: Little is known about barriers to pneumococcal vaccination in the primary care setting. METHODS: Mail survey to 405 randomly selected Massachusetts primary care physicians (response rate 68%). RESULTS: Seventy-nine percent considered themselves knowledgeable about current vaccination guidelines, and 75% said vaccination is an important clinical priority. Respondents answered a mean of five of six knowledge questions about vaccination "correctly," that is, consistent with current scientific evidence or expert opinion. Physicians reported high immunization rates: 51% thought over half their eligible patients were vaccinated; however, only 27% thought their colleagues immunized a similar number of patients. Physician attitude was the strongest independent predictor of high reported immunization rates (odds ratio of 4.7, P = 0.0001). Twenty-four percent of respondents thought physician oversight due to the need to attend to other active medical problems greatly reduces the number of patients they immunize. None of eight other financial, administrative, and clinical barriers were felt to be important by more than 7% of physicians. Sixty-six percent of physicians favored a standing order policy to immunize their eligible patients. CONCLUSIONS: Oversight and overestimation of immunization rates appear to be important barriers to pneumococcal vaccination. The literature suggests that reminder and performance feedback systems directed toward eliminating these barriers have had some success; interventions such as standing order policies may yield further improvements and appear to be acceptable to most physicians.
An analysis of clinico-immunological data has demonstrated a considerable decline in non-specific and specific defences against such major factors of hospital infection in esophageal cancer patients as staphylococcal, blue pus and Proteus bacilli. Immunization with a complex vaccine including concentrated staphylococcal anatoxin, blue pus and Proteus vaccines was shown to stimulate the said factors of anti-infectious immunity and to be followed by a 4.7-fold decrease in the incidence of postoperative pyo-inflammatory complications. The said vaccine may be recommended for prevention of infectious complications in cancer patients since its administration is followed by a low-level reaction matched by a marked increase in immunologic vigor.
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Vaccines to efficiently block or limit sexual transmission of both HIV and human papilloma virus (HPV) are urgently needed. Chimeric virus-like-particle (VLP) vaccines consisting of both multimerized HPV L1 proteins and fragments of SIV gag p27, HIV-1 tat, and HIV-1 rev proteins (HPV-SHIV VLPs) were constructed and administered to macaques both systemically and mucosally. An additional group of macaques first received a priming vaccination with DNA vaccines expressing the same SIV and HIV-1 antigens prior to chimeric HPV-SHIV VLP boosting vaccinations. Although HPV L1 antibodies were induced in all immunized macaques, weak antibody or T cell responses to the chimeric SHIV antigens were detected only in animals receiving the DNA prime/HPV-SHIV VLP boost vaccine regimen. Significant but partial protection from a virulent mucosal SHIV challenge was also detected only in the prime/boosted macaques and not in animals receiving the HPV-SHIV VLP vaccines alone, with three of five prime/boosted animals retaining some CD4+ T cells following challenge. Thus, although some immunogenicity and partial protection was observed in non-human primates receiving both DNA and chimeric HPV-SHIV VLP vaccines, significant improvements in vaccine design are required before we can confidently proceed with this approach to clinical trials.
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Prior infection with a nef-deleted simian immunodeficiency virus (SIV) protects macaques not only against a homologous pathogenic SIV challenge but also against challenge with a chimeric SIV expressing a human immunodeficiency virus type 1 env gene (SHIV). Since this SHIV is itself nonpathogenic, we sought to explore the use of a nonpathogenic SHIV as a live, attenuated AIDS virus vaccine. Four cynomolgus monkeys infected for greater than 600 days with a chimeric virus composed of SIVmac 239 expressing the human immunodeficiency virus type 1 HXBc2 env, tat, and rev genes were challenged intravenously with 100 animal infectious doses of the J5 clone of SIVmac 32H, an isolate derived by in vivo passage of SIVmac 251. Three of the four monkeys became infected with SIVmac. This observation underlines the difficulty, even with a live virus vaccine, in protecting against an AIDS virus infection.
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The experimental infection of macaques with simian immunodeficiency virus (SIV) has provided strong evidence that it may be possible to develop a vaccine against AIDS. Live attenuated SIV vaccines have been found to confer the most potent protection against challenge with a variety of pathogenic viruses. This article summarizes the work performed at NIBSC to characterize the protection conferred by live attenuated SIV and to identify mechanisms of vaccine protection. The results of these experiments are discussed in conjunction with observations from related studies made by other groups.
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A liposome vaccine formulation that has been successfully used in both animal immunization studies and clinical trials is described. Issues concerning the choice of components for the liposomal vaccine formulation are discussed, especially with respect to the lipid components and the adjuvant. A procedure is described for manufacturing liposomal vaccines using Good Manufacturing Practices as promulgated by the U.S. Food and Drug Administration. Quality control testing for clinical use is described, with particular emphasis on aspects relevant to liposomes. Utilization issues are discussed, including injection volumes, antigen and adjuvant doses, and routes of administration.
Control of the worldwide AIDS epidemic will only be achieved with a safe and effective prophylactic HIV-1 vaccine. DNA vaccination has recently emerged as a promising vaccine modality that can elicit both humoral and cellular immune responses. HIV-1- and SIV-specific immune responses have been elicited by DNA vaccines in both mice and nonhuman primates. However, these immune responses have not been capable of protecting nonhuman primates against pathogenic AIDS virus challenges. A number of approaches are therefore being investigated to augment DNA vaccine-elicited immune responses.
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