Page 108 - Review of Medical Microbiology and Immunology ( PDFDrive )

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CHAPTER 12 Bacterial Vaccines
its immunogenicity. A combined vaccine consisting of this
TABLE 12–2 Vaccines Recommended for Children
1
vaccine plus the diphtheria, tetanus, and pertussis (DTP)
Age 0–6 Years
vaccines is available.
Bacterial Vaccines
Viral Vaccines
(4) One of the vaccines against typhoid fever contains
the capsular polysaccharide of Salmonella typhi. It is indi-
Hepatitis A
Diphtheria toxoid, tetanus toxoid,
acellular pertussis (DTaP)
a high risk of typhoid fever and for persons in close contact
Haemophilus influenzae type b (Hib)
Meningococcal
Influenza
Measles, mumps, rubella (MMR)
Pneumococcal Hepatitis B cated for persons living or traveling in areas where there is
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Toxoid Vaccines

Poliovirus, inactivated
(1) Corynebacterium diphtheriae vaccine contains the
Rotavirus

toxoid (formaldehyde-treated exotoxin). Immunization
Varicella

1
Vaccines are listed in alphabetical order. A complete description of the vaccine
in three doses at 2, 4, and 6 months of age, with boosters
schedule is available on the Centers for Disease Control and Prevention Web site,
www.cdc.gov.
given 1 year later and at intervals thereafter.
(2) Clostridium tetani vaccine contains tetanus toxoid
and is given to everyone both early in life and later as
Capsular Polysaccharide Vaccines
boosters for protection against tetanus.
(1) Both versions of the vaccine against Streptococcus
(3) Bordetella pertussis vaccine contains pertussis toxoid
pneumoniae contain the capsular polysaccharide of the bac-
but includes other proteins as well. It is, therefore,
teria as the immunogen. One version contains the capsular
described in the next section.
polysaccharide of the 23 most prevalent serotypes. It is rec-
ommended for persons older than 60 years of age and adult
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patients of any age with such chronic diseases as diabetes and
(1) There are two types of B. pertussis vaccines: an acellu-
cirrhosis or with compromised spleen function or splenec-
lar vaccine containing purified proteins and a vaccine con-
tomy. A second version containing the capsular polysaccha-
taining whole killed bacteria. The acellular vaccine is now
ride of 13 pneumococcal serotypes coupled to a carrier
recommended in the United States. The principal antigen in
protein (diphtheria toxoid) is available for the protection of
the acellular vaccine is inactivated pertussis toxin (pertussis
young children who do not respond well to the unconjugated
toxoid), but other proteins, such as filamentous hemaggluti-
vaccine. The function of the carrier protein is explained in
nin and pertactin, are also required for full protection.
Figure 57–5.
Pertussis toxin for the vaccine is inactivated genetically by
A potential problem regarding the use of the pneumococ-
cal vaccine (or a vaccine against any organism with multiple
(ADP-ribosylating) activity but retain its antigenicity. It is the
serotypes) is that of serotype replacement. Will the vaccine
first vaccine to contain a genetically inactivated toxoid. The
reduce the incidence of disease caused by the serotypes in
vaccine is indicated for every child as a protection against
the vaccine but not the overall incidence of disease because introducing two amino acid changes that eliminate its toxic
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whooping cough. It is usually given in combination with
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other serotypes that are not in the vaccine will now cause
diphtheria and tetanus toxoids (DTP or DTaP vaccine).
disease? In fact, this occurred. An increase in invasive pneu-
(2) Bacillus anthracis vaccine contains “protective antigen”
mococcal disease caused by serotype 19A, a serotype not in
the previous vaccine, was observed. In view of this, serotype
occupations place them at risk of exposure to the organism.
19A is included in the current 13 serotype vaccine.
(2) Neisseria meningitidis vaccine contains capsular
Live, Attenuated Bacterial Vaccines
polysaccharide of four important types (A, C, W-135,
(1) The vaccine against tuberculosis contains a live,
and Y). Two forms of the vaccine are available: one contains
attenuated strain of Mycobacterium bovis called BCG and,
the polysaccharides conjugated to a carrier protein (diphthe-
ria toxoid), and the other contains only the polysaccharides.
risk for exposure to active tuberculosis.
It is given when there is a high risk of meningitis (e.g., during
an outbreak, when students enter college and are living in a
(2) One of the vaccines against typhoid fever contains
dormitory, when military recruits enter boot camp, or for in some countries, is recommended for children at high
live, attenuated S. typhi. It is indicated for persons living or
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traveling in areas where there is a high risk of typhoid fever
travelers to areas where meningitis is hyperendemic).
(3) Haemophilus influenzae vaccine contains the type
and for persons in close contact with either infected
patients or chronic carriers.
b polysaccharide conjugated to diphtheria toxoid or other
(3) The vaccine against tularemia contains live, attenu-
carrier protein. It is given to children between the ages of
2 and 15 months to prevent meningitis. The capsular
polysaccharide alone is a poor immunogen in young chil-
in people who are exposed in their occupation, such as
laboratory personnel, veterinarians, and hunters.
dren, but coupling it to a carrier protein greatly enhances
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