The human papillomavirus vaccines.

Ljubojević S.
Genital human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) among sexually active couples. Its annual incidence is approximately 5.5 million. Overall, an estimated 75% of sexually active men and women have been exposed to HPV at some point in their lives. HPV-16 and -18 account for about 70% of cancers of the cervix, vagina and anus, and for about 30%-40% of cancers of the vulva, penis and orophaynx. Cancer of the cervix uteri is the second most cancer among women worldwide. Cancer of the penis is a rare cancer, accounting for less than 0.5% of cancers in men. Spontaneous clearance of HPV infection is accompanied by humoral and cellular immune response against virus-specific antigens. Two vaccines, prophylactic and therapeutic ones, are considered. Prophylactic vaccines use L1 and L2 capsid proteins to induce production of conformationally-specific antibodies. They block HPV infection. Lone L1 and L2 proteins self-assemble into a capsid that is identical to the complete virion. In this way, an antibody-mediated response is induced before the body actually comes into contact with the live virion. Therapeutic vaccines are being developed to protect HPV-positive persons against tumor development. For these vaccines, researchers are targeting the activity of the E6 and E7 oncoproteines.On June 8, 2006, the U.S. Food and Drug Administration (FDA) approved an HPV vaccine for clinical use. The HPV vaccine that has been approved is the quadrivalent vaccine that consists of recombinant viral-like particles (VLPs) of HPV 6, 11, 16, 18 mixed with an aluminum-containing adjuvant. It is manufactured by Merck & Co., Inc. and sold under the name of Gardasil?.The new vaccine is approved for use in females 9-26 years of age. The primary target population for vaccination should be females aged 11-12 years. However, vaccination can be given to girls as young as 9 years of age. Vaccination can receive women aged 13-26 years who have been sexually active. There are still no data on the vaccine efficacy in women older than 26, and currently no data to demonstrate the efficacy of vaccination in males; male subjects should not be vaccinated until such data become available.The vaccine is to be administered intramuscularly either into the deltoid muscle of the arm or the high anteriolateral area of the leg. Each patient receives three 0.5 mL doses given according to the following schedule: first dose is given at the elected date, second dose two months after the first dose, and third dose six months after the first dose. According to statements from Merck, the list price of the vaccine is 120 USD per dose.GlaxoSmithKline is now conducting a phase III trial of a bivalent (HPV 16, 18) vaccine, and it is going to be presented under the name of Cervarix. Similar results to those obtained with the quadrivalent HPV vaccine have been reported with the bivalent vaccine. It is expected to be released in June next year.Evaluation of the HPV vaccine efficiency in preventing dysplasia and cancer has been recommended as a globally accepted endpoint for population based studies.
PMID: 17010274 [PubMed - indexed for MEDLINE]

HPV Vaccine

1: J Natl Cancer Inst. 2009 Mar 24. [Epub ahead of print]
Assessing the HPV Vaccine: Researchers Confront Complex Interplay of Factors.
Tuma RS.
PMID: 19318636 [PubMed - as supplied by publisher]
Related Links
The human papillomavirus vaccines. [Acta Dermatovenerol Croat. 2006]
PMID:17010274
Attitudes about human papillomavirus vaccine among family physicians. [J Pediatr
Adolesc Gynecol. 2005] PMID:16338604
Acceptability of a human papillomavirus (HPV) trial vaccine among mothers of
adolescents in Cuernavaca, Mexico. [Arch Med Res. 2001] PMID:11395192
Rates of human papillomavirus vaccination, attitudes about vaccination, and human
papillomavirus prevalence in young women. [Obstet Gynecol. 2008] PMID:18448742
A study of women's knowledge regarding human papillomavirus infection, cervical
cancer and human papillomavirus vaccines. [Aust N Z J Obstet Gynaecol. 2006]
PMID:16866792

Fonte:www.pubmed.gov

Vacina contra a Hepatite A

A incidência de hepatite A varia amplamente no mundo todo. A hepatite A é endêmica ou comum em boa parte do mundo, principalmente nos locais com baixo padrão de saneamento. Entretanto, é importante salientar que diferentes áreas ou regiões – inclusive no mesmo país – podem ter diferentes taxas de infecção por hepatite A. Além disso, surtos de hepatite A ocorrem em áreas com taxas baixas ou intermediárias de infecção, mesmo nas cidades mais modernas do mundo.

Existem algumas maneiras de prevenir-se contra a transmissão do vírus da hepatite A e proteger-se contra a infecção.

Prevenindo a transmissão A medida mais importante para evitar a transmissão da hepatite A é lavar as mãos de forma adequada e sempre seguir estas instruções simples:81. Molhe as mãos em água corrente quente.2. Passe o sabonete.3. Esfregue as mãos por pelo menos 20 segundos e ensaboe também partes expostas dos braços.4. Limpe a região entre os dedos e sob as unhas.5. Enxágüe abundantemente as mãos para remover todo o sabonete.6. Seque as mãos.
Sempre lave bem as mãos após ir ao banheiro ou manusear materiais que possam estar contaminados pelo vírus da hepatite A (inclusive fraldas sujas) e antes de manusear os alimentos.

http://www.msd-brazil.com/msdbrazil/patients/sua_saude/infecciosas/hepatitea/hepatitea1.html#section_7

Vacina contra a Hepatite A

É uma inflamação do fígado (hepatite) causada por um vírus chamado Vírus da Hepatite A (HAV). Pelo seu modo de transmissão, esse tipo de hepatite é típico de áreas menos desenvolvidas, com más condições de higiene e falta de saneamento básico. Nesses locais, incluindo a maior parte do Brasil, predomina em crianças pequenas (2 à 6 anos), porém, indivíduos que não tiveram a doença quando crianças, podem adquiri-la em qualquer idade.
A vacina para Hepatite A é recomendável para todas crianças a partir de 1 ano de idade e para pessoas que viajam para áreas onde a Hepatite A é muito freqüente, como o norte do Brasil e países tropicais subdesenvolvidos. Grupos de alto risco como crianças e adultos que vivem em creches, asilos ou prisões, homo e bissexuais, usuários de drogas injetáveis ou não, pacientes com doença hepática crônica, aqueles com AIDS ou doenças da coagulação também devem ser vacinados.
A aplicação da vacina é útil em profissionais da área da saúde com potencial contato com pacientes ou material contaminado.
Trabalhadores da indústria alimentícia, uma vez vacinados, evitam a transmissão do vírus através dos alimentos que preparam.
Fonte:http://www.abcdasaude.com.br/artigo.php?227

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Descritores ( MESH) no Pubmed

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1:
Vaccines
Links
Suspensions of killed or attenuated microorganisms (bacteria, viruses, fungi, protozoa, or rickettsiae), antigenic proteins derived from them, or synthetic constructs, administered for the prevention, amelioration, or treatment of infectious and other diseases.
2:
Diphtheria-Tetanus-Pertussis Vaccine
Links
A vaccine consisting of DIPHTHERIA TOXOID; TETANUS TOXOID; and whole-cell PERTUSSIS VACCINE. The vaccine protects against diphtheria, tetanus, and whooping cough.Year introduced: 1990
3:
Measles-Mumps-Rubella Vaccine
Links
A combined vaccine used to prevent MEASLES; MUMPS; and RUBELLA.Year introduced: 2001
4:
BCG Vaccine
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An active immunizing agent and a viable avirulent attenuated strain of Mycobacterium tuberculosis, var. bovis, which confers immunity to mycobacterial infections. It is used also in immunotherapy of neoplasms due to its stimulation of antibodies and non-specific immunity.Year introduced: 1979 (1974) ....

Optimization of intradermal vaccination by DNA tattooing in human skin.

van den Berg JH, Nujien B, Beijnen JH, Vincent A, van Tinteren H, Kluge J, Woerdeman LA, Hennink WE, Storm G, Schumacher TN, Haanen JB.
Department of Pharmacy and Pharmacology, Slotervaart Hospital, Amsterdam, The Netherlands.
The intradermal administration of DNA vaccines by tattooing is a promising delivery technique for genetic immunization, with proven high immunogenicity in mice and in nonhuman primates. However, the parameters that result in optimal expression of DNA vaccines that are applied by this strategy to human skin are currently unknown. To address this issue we set up an ex vivo human skin model in which DNA vaccine-induced expression of reporter proteins could be monitored longitudinally. Using this model we demonstrate the following: First, the vast majority of cells that express DNA vaccine-encoded antigen in human skin are formed by epidermal keratinocytes, with only a small fraction (about 1%) of antigen-positive epidermal Langerhans cells. Second, using full randomization of DNA tattoo variables we show that an increase in DNA concentration,needle depth, and tattoo time all significantly increase antigen expression ( p < 0.001), with DNA concentration forming the most critical variable influencing the level of antigen expression. Finally, in spite of the marked immunogenicity of this vaccination method in animal models, transfection efficiency of the technique is shown to be extremely low, estimated at approximately 2 to 2000 out of 1 x 10(10) copies of plasmid applied. This finding, coupled with the observed dependency of antigen expression on DNA concentration, suggests that the development of strategies that can enhance in vivo transfection efficacy would be highly valuable. Collectively, this study shows that an ex vivo human skin model can be used to determine the factors that control vaccine-induced antigen expression and define the optimal parameters for the evaluation of DNA tattoo or other dermal delivery techniques in phase 1 clinical trials.
PMID: 19301471 [PubMed - in process]