How Do Vaccines Work?
Host factors such as age, nutritional factors, genetics, and coexisting disease, may also affect the response. CDC- http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/prinvac.pdf
CDC- The more similar a vaccine is to the disease-causing form of the organism, the better the immune response to the vaccine.
CDC- Anything that either damages the live organism in the vial (e.g., heat, light) or interferes with replication of the organism in the body (circulating antibody) can cause the vaccine to be ineffective.
Although live attenuated vaccines replicate, they usually do not cause disease such as may occur with the “wild” form of the organism. When a live attenuated vaccine does cause “disease,” it is usually much milder than the natural disease and is referred to as an adverse reaction.
The immune response to a live attenuated vaccine is virtually identical to that produced by a natural infection. The immune system does not differentiate between an infection with a weakened vaccine virus and an infection with a wild virus. Live attenuated vaccines produce immunity in most recipients with one dose, except those administered orally. However, a small percentage of recipients do not respond to the first dose of an injected live vaccine (such as MMR or varicella) and a second dose is recommended to provide a very high level of immunity in the population.
CDC- Live attenuated vaccines may cause severe or fatal reactions as a result of uncontrolled replication (growth) of the vaccine virus. This only occurs in persons with immunodeficiency (e.g., from leukemia, treatment with certain drugs, or human immunodeficiency virus (HIV) infection).
CDC- A live attenuated vaccine virus could theoretically revert to its original pathogenic (disease-causing) form. This is known to happen only with live (oral) polio vaccine.
Active immunity from a live attenuated vaccine may not develop because of interference from circulating antibody to the vaccine virus. Antibody from any source (e.g., transplacental, transfusion) can interfere with replication of the vaccine organism and lead to poor response or no response to the vaccine (also known as vaccine failure).
Currently available live attenuated viral vaccines are measles, mumps, rubella, vaccinia, varicella, zoster (which contains the same virus as varicella vaccine but in much higher amount), yellow fever, rotavirus, and influenza (intranasal). Oral polio vaccine is a live viral vaccine but is no longer available in the United States. Live attenuated bacterial vaccines are bacille Calmette-Guérin (BCG—not currently available in the U.S.) and oral typhoid vaccine.
Inactivated vaccines are produced by growing the bacterium or virus in culture media, then inactivating it with heat and/ or chemicals (usually formalin). In the case of fractional vaccines, the organism is further treated to purify only those components to be included in the vaccine (e.g., the polysaccharide capsule of pneumococcus.)
Inactivated vaccines are not alive and cannot replicate. The entire dose of antigen is administered in the injection. These vaccines cannot cause disease from infection, even in an immunodeficient person. Inactivated antigens are less affected by circulating antibody than are live agents, so they may be given when antibody is present in the blood (e.g., in infancy or following receipt of antibody-containing blood products.)
Inactivated vaccines always require multiple doses. In general, the first dose does not produce protective immunity, but “primes” the immune system. A protective immune response develops after the second or third dose. In contrast to live vaccines, in which the immune response closely resembles natural infection, the immune response to an inactivated vaccine is mostly humoral. Little or no cellular immunity results. Antibody titers against inactivated antigens diminish with time. As a result, some inactivated vaccines may require periodic supplemental doses to increase, or “boost,” antibody titers.
Currently available whole-cell inactivated vaccines are limited to inactivated whole viral vaccines (polio, hepatitis A, and rabies). Inactivated whole virus influenza vaccine and whole inactivated bacterial vaccines (pertussis, typhoid, cholera, and plague) are no longer available in the United States. Fractional vaccines include subunits (hepatitis B, influenza, acellular pertussis, human papillomavirus, anthrax) and toxoids (diphtheria, tetanus.) A subunit vaccine for Lyme disease is no longer available in the United States.
Vaccine antigens may also be produced by genetic engineering technology. These products are sometimes referred to as recombinant vaccines. Four genetically engineered vaccines are currently available in the United States. Hepatitis B and human papillomavirus (HPV) vaccines are produced by insertion of a segment of the respective viral gene into the gene of a yeast cell or virus. The modified yeast cell produces pure hepatitis B surface antigen or HPV capsid protein when it grows. Live typhoid vaccine (Ty21a) is Salmonella Typhi bacteria that have been genetically modified to not cause illness. Live attenuated influenza vaccine has been engineered to replicate effectively in the mucosa of the nasopharynx but not in the lungs.
All of the above- CDC- http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/prinvac.pdf