Typhoid vaccine parenteral

Three typhoid vaccines are available currently for use in the United States (1) an oral live-attenuated vaccine (Vivotif Berna-TM vaccine, Swiss Serum and Vaccine Institute), (2) a parenteral heat-phenol-inactivated vaccine (Typhoid Vaccine, Wyeth-Ayerst), and (3) a parenteral capsular polysaccharide vaccine (Typhim Vi, Pasteur Merieux). Immunization is recommended only for travelers going to endemic areas such as Latin America, Asia, and Africa household contacts of a chronic carrier and laboratory personnel who frequently work with S. typhi.13... 

In the 15 years since these criteria were promulgated by declaration, it will be evident that most vaccines are still administered parenterally with the exception of polio and typhoid vaccines. In many ways this can be attributed to the physicochemical characteristics of vaccine antigens themselves, which are large molecules susceptible to proteolytic degradation, denaturation, and rapid clearance from plasma. Some combination vaccines are available which reduce the number of injections. However, the MMR (measles, mumps, and rubella) combination vaccine has gained an unsafe image in the popular press, mainly due to a reputed link with autism in some children that as yet remains unproven scientifically. In some quarters the autism was associated with the use of thiomersalate as a mercurial preservative in multidose injections but, again, this supposition remains unproven. 

Multiple emulsions have been widely studied as means of delivering drugs via oral, topical, and parenteral routes. The applications include protein delivery (Cournarie et al., 2004), delivery of antibiotics to the vagina (Tedajo et al., 2005), sustained delivery (Vaziri and Warburton, 1994), and vaccine delivery (Bozkir and Hayta, 2004). The immunological response to a vaccine also depends on the route of administration. Most current vaccines are administered intramuscularly, which induces immunization as a systemic immunity. However, the live polio vaccine and the live typhoid vaccine are administered orally. Local immunization (oral, intranasal, or intravagina) may be preferred, since mucosal surfaces are the common entrance to many pathogens. Moreover local immunization induces both mucosal and systemic immunity. Ease of administration and avoidance of systemic side effects are additional advantages of local immunization (Walker, 1994 Shalaby, 1995). Nevertheless, successful local immunization has only been achieved with a limited number of oral vaccines. Also there are very few studies on multiple emulsions used in the immunization process, especially on parenteral and oral administration. 

The discovery of vaccines for smallpox, cholera, and typhoid and the variety of vaccines now available have led to a significant reduction in the mortality and morbidity due to many diseases, with smallpox being the first to have been completely eradicated and poliomyelitis targeted to be the next. At present, the World Health Organization is working toward the complete elimination of poliomyelitis throughout the world [188,189], However, since Jenner discovered the vaccine for smallpox more than two centuries ago [190], only some 50 vaccines have been approved for use, and few additional vaccines have been discovered. Most of those in current use are administered parenterally they can induce only a systemic immune response, not mucosal immunity. Obviously the latter is very important in the prevention and treatment of infectious diseases, be they due to viral, bacterial, or parasitic pathogens that attack via the mucosal surfaces [190],... 

A meta-analysis of studies of the efficacy and toxicity of typhoid fever vaccines (SEDA-23, 343) has been criticized as an interesting mathematical exercise but of httle practical relevance (4). The meta-analysis had lumped together different parenteral whole-ceU vaccines (alcohol-inactivated, formahn-inactivated, acetone-inactivated, and dried whole-ceU vaccines), but the only... 

Vaccines also may be used to boost specific immune processes directed against the bacteria themselves or against adherence appendages, cytotoxins, or enterotoxins. Currently available vaccines for typhoid fever in the United States are the parenteral Vi capsular polysaccharide vaccine, the oral live-attenuated Ty21a vaccine, and the older heat-phenol-inactivated parenteral vaccine. Only the older parenteral cholera vaccine is licensed for use in the United States, but it is not recommended owing to the low risk of cholera to the traveler and the limited efficacy of the vaccine. New oral five and killed vaccines are licensed outside the United States and are used by some travelers. The rotavirus vaccine, although effective, has presented complications in the form of rare cases of intussusceptions it is no longer marketed and thus is not recommended. ... 

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