Pulmonary vaccination

Amidi, M., Pellikaan, H.C., Hirschberg, H. et al. 2007a. Diphtheria toxoid-containmg microparticulate powder formulations for pulmonary vaccination Preparation, characterization and evaluation in guinea pigs. Vaccine. 25 6818-6829. 

Tonnis WF, Lexmond AJ, Frijlink FTW, De Boer AH, Hinrichs WLJ (2013) Devices and formulations for pulmonary vaccination. Expert Opin Drug Deliv 10(10) 1383-1397... 

Plasma digoxin levels may decrease when the drug is administered with bleomycin. When bleomycin is used witii cisplatin, there is an increased risk of bleomycin toxicity Pulmonary toxicity may occur when bleomycin is administered with other antineoplastic drugs. Plicamycin, mitomycin, mitoxantrone, and dactino-mycin have an additive bone marrow depressant effect when administered with other antineoplastic drugs. In addition, mitomycin, mitoxantrone, and dactinomycin decrease antibody response to live virus vaccines. Dactinomycin potentiates or reactivates skin or gastrointestinal reactions of radiation therapy There is an increased risk of bleeding when plicamycin is administered witii aspirin, warfarin, heparin, and the NSAIDs. 

Direct entry of alumina adjuvants through the skin may occur by the use of therapeutic vaccines, with a resultant transient uptake of aluminium in the brain (Redhead et al., 1992). The injection of talc (magnesium silicate)-containing drugs intended for oral consumption has been shown to induce progressive pulmonary fibrosis in drug abusers (Pare etal., 1989). 

Influenza vaccine should be given yearly to all adults 50 years of age or older. Younger adults with chronic disorders of the cardiovascular or pulmonary systems, chronic metabolic diseases, renal dysfunction, immunosuppression, or disorders that compromise respiratory function should also be vaccinated. Women who will be pregnant during the winter months should be vaccinated against influenza. 

The 23-valent pneumococcal polysaccharide vaccine is recommended for use in all adults 65 years of age or older and adults less than 65 years who have medical comorbidities that increase the risk for serious complications from S. pneumoniae infection, such as chronic pulmonary disorders, cardiovascular disease, diabetes mellitus, chronic liver disease, chronic renal failure, functional or anatomic asplenia, and immunosuppressive disorders. Alaskan natives and certain Native American populations are also at increased risk. Children over the age of 2 years may be vaccinated with the 23-valent pneumococcal polysaccharide vaccine if they are at increased risk for invasive S. pneumoniae infections, such as children with sickle cell anemia or those receiving cochlear implants. 

Medical indications Chronic pulmonary disease (excluding asthma) chronic cardiovascular diseases, diabetes mellitus chronic liver diseases, including liver disease as a result of alcohol abuse (e.g., cirrhosis) chronic alcoholism, chronic renal failure or nephrotic syndrome functional or anatomic asplenia (e.g, sickle cell disease or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]) immunosuppressive conditions and cochlear implants and cerebrospinal fluid leaks. Vaccinate as close to HIV diagnosis as possible. 

Vaccine is available for cutaneous, possibly inhalation, anthrax. Cutaneous anthrax responds to antibiotics (penicillin, terramydn, Chloromycetin), sulfadiazine, and immune serum. Pulmonary (inhaled) anthrax responds to immune serum in initial stages but is of little use after disease is well established. Intestinal, same as for pulmonary. 

Bivas-Benita M, Ottenhoff TH, Junginger HE, Borchard G (2005) Pulmonary DNA vaccination Concepts, possibilities and perspectives. J Control Release 107(1) 1—29. 

In a study of the mechanism whereby BordeteUa pertussis vaccine increased acute ozone toxicity in rats, Thompson ascribed the effects to /3-adrenergic blockade, and not to an immune-mediated response. It was further noted that both atropine and reserpine reduced mortality, whidi suggested that the acute lethal effects of ozone were due to shock and circulatory collapse, rather than pulmonary edema. 

Thompson, G. E. Experimental acute pulmonary edema in the rat. Effect of Bordetetta pertussis vaccine on ozone mortality. Arch. Environ. Health 23 154-160. 

One should consider infiuenza- and pneumococcal-vaccination in patients with increased risk for lower RTI including patients with chronic obstructive pulmonary disease like chronic bronchitis or emphysema and cystic fibrosis patients. It should be considered for the elderly population in general. There is no role for prophylactic antibiotic therapy in patients with frequent RTI. Attempts should be made to have those patients that smoke stop doing so. 

Vila-Corcoles A, Ochoa O, de Diego C, Valdivieso A, Herreros I, Bobe E et al. Effects of annual influenza vaccination on winter mortality in elderly people with chronic pulmonary disease. Int J Chn Pract 2008 62 10-7. 

Zanamivir is contraindicated in individuals with severe or decompensated chronic obstructive lung disease or asthma because it has not been shown to be effective in these individuals and can cause serious adverse pulmonary reactions. Individuals with mild to moderate asthma may have a decline in lung function when taking zanamivir. The safety and efficacy of this medication have not been determined in individuals with severe renal insufficiency. No clinically significant drug interactions have been reported. Zanamivir does not decrease the effectiveness of the influenza vaccine. 

The major expansion in this present volume concerns the subjects of proteomics and gene therapy, both of which offer so much promise for the future. Pulmonary administration is another likely route of delivery for the future and this is reviewed separately. Conventional wisdom suggests that proteins cannot be delivered orally but there is strong evidence suggesting that this is not always true and this is another exciting area that is reviewed here. The earlier review of vaccines has been expanded considerably since this is another area of current interest with potential for wider future application. 

Coulson, P.S. and Wilson, R.A. (1988) Examination of the mechanisms of pulmonary phase resistance to Schistosoma mansoni in vaccinated mice. American journal of Tropical Medicine and Hygiene 38, 529-539. 

Crabtree, J.E. and Wilson, R.A. (1987) Pulmonary cellular reactions to Schistosoma mansoni schistosomula in normal and vaccinated mice. Advances in Experimental Medical Biology 216A, 701-707. 

Wilson, R.A., Coulson, P.S., Betts, C., Dowling, M.A. and Smythies, L.E. (1996) Impaired immunity and altered pulmonary responses in mice with a disrupted interferon-gamma receptor gene exposed to the irradiated Schistosoma mansoni vaccine. Immunology 87, 275-282. 

Hall G, Houghton C, Rahbek J, Lamb J, Jarman E Suppression of allergen reactive Th2 mediated responses and pulmonary eosinophilia by intranasal administration of an immunodominant peptide is linked to IL-10 production. Vaccine 2003 21 549-561. 

Poole PJ, Chacko E, Wood-Baker RW, Cates CJ. Influenza vaccine for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006 CD002733. 

In contrast to antibacterial antibiotic therapy, inhibition of viral replication is usually difficult to achieve. Therefore preventive strategies, such as vaccination, are frequendy more successful and clinically important. However, vaccines are not available for all viruses furthermore, some viruses, such as Epstein-Barr virus (EBV) and cytomegalovirus (CMV), are ubiquitously present and usually not very pathogenic unless in an immunocompromised host. One strategy to combat viral infecdons in the immunocompromised host is the application of neutralizing mAbs. One such mAh is directed to the F protein of the respiratory syncytial virus (RSV), which afflicts premature newborns with often severe pulmonary infections this mAh appears to be useful in such situations (91). Other mAbs to viral antigens are in development. 

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