Smallpox vaccine

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Bifurcation needle for smallpox vaccination

A smallpox vaccine is a vaccine against the smallpox virus .

history

Comparison of the puncture sites in vaccination and variolation

Smallpox vaccines are the oldest known vaccines. Since probably around 1000 BC Variolations were carried out in India . The first secured documentation about smallpox vaccinations comes from the year 1549 by the Chinese doctor Wan Quan (1499–1582) in his work Douzhen xinfa (痘疹 心法). In this vaccination, ground smallpox scab was blown into the noses of the vaccinated. The resulting immunity lowered the mortality rate of smallpox virus infection from 20 to 30 percent to less than two percent. Until the 18th century, vaccinations were first carried out with smallpox virus (previously also Variola major ) as a live vaccine , which was calledVariolation was called. Smallpox vaccinations, which began in Jamaica in 1729, were carried out, “because otherwise the leaves often pull away a lot of people. So it is hoped that this procedure will make the negroes cheaper and that this will finally be able to influence the rum price ”. As early as 1767, the physician Franz Heinrich Meinolf Wilhelm (1725–1794) carried out the smallpox vaccination at the Würzburg Juliusspital . From the end of the 18th century, Edward Jenner provided evidence of the effectiveness of a smallpox vaccination with the vaccinia virus (previously also Variolae Vaccinae ), which also led to disease less often. One of the current names for vaccination is derived from this, the vaccination coined by Jenner's friend Richard Dunning in 1800.

The vaccinia virus was originally thought to be a cowpox virus (lat. Vacca - the cow). It is now known that the vaccinia virus is more closely related to horsepox than it is to cowpox. In the spring of 1800 Dunning went on a study trip to London to see Edward Jenner in order to learn , under his guidance, the vaccination against smallpox he developed in 1796 . On his return trip he carried out vaccinations in Dover and several French cities . On the occasion of his stay in Paris , he was invited to give lectures on the new type of pension at the Institut National de Paris . In addition to several high-ranking officers, Napoleon Bonaparte was also present, who inquired about the military benefits of vaccinations. Gerhard Reumont , the spa doctor of Empress Joséphines , introduced the smallpox vaccination on April 17, 1801 in Aachen and in the Département de la Roer . On August 26, 1807, Bavaria became the first country in the world to introduce compulsory vaccinations. As early as 1812, more than 10,000 children were vaccinated annually in the Département de la Roer and Reumont was publicly honored by Napoleon Bonaparte for his services in the fight against smallpox. From 1803 the vaccine was brought to the Spanish colonies in Latin America and Asia under the direction of Francisco Javier Balmis as part of the " Real Expedición Filantrópica de la Vacuna " (Royal Philanthropic Vaccination Expedition, also called "Balmis Expedition"), which was financed by the Spanish crown to initiate vaccination campaigns there too.

In the 20th century, attenuation of viruses by passing through cell cultures was discovered, which was used to produce smallpox virus vaccine strains with fewer side effects, e.g. B. NYCBH (USA), EM-63 (USSR), Temple of Heaven (China), Modified Vaccinia Ankara Virus (Germany) and ACAM2000 . From the 1960s onwards, smallpox vaccines were administered using a bifurcation needle (needle with a split tip) developed by Benjamin Rubin , which reduced the necessary dose of the vaccine to a quarter. In West Germany, the compulsory vaccination for smallpox vaccines, which had applied in Germany since the Vaccination Act of 1874, ended in 1976 . The worldwide use of smallpox vaccines, coordinated by Donald A. Henderson , resulted in the eradication of smallpox in 1980 . In 1981 the compulsory vaccination was lifted in Austria. Since then, smallpox viruses have been stored in the Centers of Disease Control and Prevention in Atlanta and in the state research center for virology and biotechnology "Vektor" in Kolzowo .

Since 1992, attenuated smallpox viruses have been used as viral vaccination vectors against other diseases, especially in the course of vaccine design . B. Modified Vaccinia Ankara Virus . The use as a vaccination vector against other diseases was developed in 1992 in the working group of Bernard Moss .

immunology

Damaging the skin with the bifurcation needle leads to an additional activation of the innate immune response . Various cytokines are induced. In the case of a smallpox vaccination, neither type I interferons nor interleukin-12 are necessary for T cells to multiply . During the vaccination reaction, neutralizing antibodies are formed that protect against infection with human smallpox viruses. Within one to two weeks, 95% of those vaccinated had neutralizing antibodies with a titer of one in over ten. A titer above values ​​between one in twenty and one in 32 (depending on the source) is associated with immunity. Cytotoxic T cells are involved in the removal of the virus. The vaccination protection through a smallpox vaccination decreases after about three to five years, after 20 years the vaccination protection is negligibly low. In the case of multiple vaccinations, the vaccine effect can last for over thirty years.

Vaccine strains

  • Lister / Elstree (GB)
  • Dryvax (USA)
  • EM63 (CIS)
  • ACAM2000 (USA)
  • Modified Vaccinia Ankara Virus (D)
  • LC16m8 (Japan)
  • CV-1 (USA)
  • Western Reserve
  • Copenhagen (Denmark)
  • Connaught Laboratories (Canada)

Side effects

Vaccination site after a few days, from which the typical vaccination scar later emerges

Adverse drug effects in vaccinations with the vaccine strain NYCBH include redness and swelling at the vaccination site, myocarditis and / or pericarditis (1: 2,000), ischemia (1: 4,000) and generalized vaccinia virus infections (1: 20,000).

With the Lister / Elstree vaccine strain, which is most widely used worldwide , pain at the injection site (71%), 25% of which is moderate or severe, and an elevated temperature of over 37.7 ° C (16%) can occur. Other effects observed are itching (72%), redness (27%), a swollen axillary lymph node (38%), flu-like symptoms (40%), and headache (23%). The flu-like symptoms and redness are less pronounced in people who have previously received a smallpox vaccination.

Manufacturing

The production took place from the middle of the 20th century in infected animals, embryonated chicken eggs or cell cultures with subsequent virus isolation . From the end of the 19th century, Sydney Arthur Monckton Copeman added glycerol as a preservative for the first time . In the 1940s, Leslie Collier added phenol as an additional preservative and 5% peptone to increase the shelf life of the smallpox viruses during freeze-drying . As a result, the freeze-dried vaccine no longer required a cold chain . In 1988, 39 smallpox vaccine manufacturers used infected calves, twelve sheep and six water buffalo manufacturers, while three manufacturers each used chicken eggs or cell cultures.

Stocks

After 1979, smallpox vaccines were stored by the WHO in an order of magnitude to vaccinate about 200 million people. Over the years, the stocks were initially reduced, according to the recommendation of the WHO in 1986 to 2 to 5 million vaccine doses. In recent years, however, stocks have been replenished, especially in developing countries.

literature

Web links

Commons : Smallpox Vaccine  - Collection of Images

Individual evidence

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  28. ↑ IJ Amanna, MK Slifka: Contributions of humoral and cellular immunity to vaccine-induced protection in humans. In: Virology. Volume 411, Issue 2, 2011, pp. 206-215. doi: 10.1016 / j.virol.2010.12.016 . PMID 21216425 . PMC 3238379 (free full text).
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