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INFECTIOUS DISEASES
AND THEIR CONTROL

Antibiotics
Inhibitors of cell wall synthesis
Penicillins – Penicillium notatum - one modifiable side chain, first
type of antibiotics discovered
...
Primarily effective against Staph and strep
infections, although resistance mechanisms such as metalo-betalactamases which use zinc instead of serine which changes the
conformation of the binding site enough that it is rendered
invisible to the penicillin
...
Penicillin binds to the PBP which usually binds
alanine to L-lysine in a cross link and makes the structure stable
...
Once
the balance between building and destroying has been tipped in
favour of destroying then then the cell will rapidly begin dying
(cytolysis)
...
Due to the size of penicillin’s they can
penetrate into straight into the cell wall unlike glycopeptides
which require the use of amoxicillin and clavulanic acid (coamoxiclav) to get into cells
...
aureus it is
effective to MRSA
...

Cephalosporins – Beta lactams, no cross allergies with people who are allergic to penicillin
...
Wide ranges of resistance have formed such as
metalo
First Gen – against G-ve and penicillinase staph, not stable, used to much
...

Second Gen – Usually parenteral, stable against some b-lactamases
...

Third Gen – whipped out a lot of hospital infectious organisms, Synthetic chemistry now used
...

4th Gen – made due to resistance, parenteral only, active against g-ve
...
These can pass the blood brain barrier and are effective at treating meningitis
...

Some are mixed with a B-lactamase inhibitor such as tazobactam
...
They are
Beta-lactams which kill bacteria by binding to PBPs (penicillin-binding-proteins and inhibiting cell
wall synthesis
...
Highly
effective against G-ve and a narrower activity against G+ve
...

Examples are:
Imipenem which must be co-formulated with Dehydropeptidase inhibitor, cilastatin, (which are

found in the kidney and are Nephrotoxic)
...

Glycopeptides – A class of drugs which are composed of glycosylated cyclic or polycyclic nonribosomal peptides
...
aureus) and
Televancin
...
Due to their toxicity they are
restricted to use by the more critically ill, those who are allergic to Beta-lactams or are infected with
a Beta-lactam resistance organism
...


Others:
Bacitracin – Produced by Bacillus subtilis serovar Tracy, this peptide disrupts both G+ve and G-ve
bacteria via inhibition of the cell wall and peptidoglycan synthesis
...
Localised treatment is associates with a smaller chance of antibiotic
resistance
...
11 slightly differing types with varying
antibacterial abilities
...
epidermidis and Streptococcus pyogenes
...

Fosfomycin – Broad spectrum antibiotic produced by the Streptomyces sp
...
low incidence of side effects
...
It is a bacteriocidal that inhibits cell wall synthesis
by inactivating an enzyme known as MurA (UDP-N-acetylglucosamin-3-enolpyruvatetransferase)
...
Fosfomycin is a PEP analogue which inhibits MurA by alkylating the active
site
...
Enters cells by use of the glycerophosphate
transporter which is lost in resistant strains due to it being non-essential
...

Cycloserine – Used against multidrug resistant M
...
As it
can pass into the CNS it can cause a range of psychological issues
...
It acts against two crucial enzymes involved in the cytosolic stages of peptidoglycan
synthesis:
Alanine racemase (Alr) converts L-alanine into D-alanine
D-alanine-D-alanine ligase (Ddl) which joins two D-alanines together with the aid of ATP
The inhibition of these two enzymes leads to the inability of the organism to produce peptidoglycan
...

Prontosil
Bound to a red dye it is an antibacterial related to azo dyes and is a sulphonamide, with broad
activity against g+ve cocci but not against Enterobacteria
...
Folate is converted into THF
(Tetrahydrofolate) a co-factor to DNA synthesis, repair and methylation
...
Prontosil will not affect humans as we rely on dietary
supplements of folate and do not synthesise our own
...

In humans these drugs can cause serious side effects such as Steven-Johnson syndrome, a form of
toxic epidermal necrolysis
...
Broad spectrum and side effects are rare
...
This is an
antibiotic used mainly in the treatment of bladder infections but can be used for ear infections and
traveller’s diarrhoea
...
Interrupting this system inhibits DNA synthesis
...

Use during an EHEC infections may lead to an increase in the expression of the shiga toxin
...
They can
cause bone marrow toxicity and are rarely used in the UK except when there is a resistance to Betalactams
...

Quinolones
Family of synthetic spectrum antibiotics
...
Includes:
- Nalidixic acid which effects all G-ve’s except pseudomonas sp
...
Taken orally and excreted well in urine (so used against UTI’s)
- Flouroquinolones are broad spectrum antibiotics that are important in treating serious and
hospital acquired infections
...
difficle infections (as it’s a broad
spectrum and wipes out everything)
...
If DNA stays in this wound up
state, then it will break
...

Resistance mechanism is a chromosomal mutation which removes the fluoroquinolone binding site

and G-ves have produces species with less porins so the molecules can’t get into the cell as easily
...
Some have
produced modified DNA enzymes which are not affected by the drug
...

Nitrofurans - Nitrofurantoin
Used to UTIs due to rapid excretion through urine, it also becomes inactivated in tissues
...
and Pseudomonas sp
...
May cause nausea
...
This stops all
synthesis in the cell as well as energy metabolism
...

Rifampicin
Well absorbed orally and is bacteriocidal, one of the most effective drugs to treat M
...

leprae, Staphylococcus sp
...

Binds to the beta subunit of the DNA-dependant-RNA-polymerase and inhibits mRNA synthesis
...
Because of this
fact it is typically used in combination with other drugs
...
influenzae type b disease
...

Pigmentation of the drug can cause coloured bodily secretions
...
Resistance is uncommon
...
The drug is partially
reduced, only in anaerobic cells, and damages the enzymes involved in a similar way to nitrofurans,
the exact mechanism is unknown
...


Cell membrane active agents
Includes: Polymixins, Polymixin B and Colistin E, Polypeptides with long hydrophobic tails
...

Very toxic substances so systemic use is limited and intramuscular injections, used topically
...
Used to aid Cystic fibrosis sufferers with Pseudomonas infections
...

Aminoglycosides
Isolated from Streptomyces and Micromonospora
...
Very potent broad spectrum
agents
...

Includes: Streptomycin, Neomycin, Kanamycin, Gentamycin
Mostly active against G-ve bacilli and staph
...
Poor penetration of mammalian cells so not used for
intracellular organisms
...

Mode of action is via binding to the ribosomal subunit and causing a misreading of the mRNA and
creating defective proteins
...
The drug
enters cells via active transport involving respiratory quinones
...

Resistance by target modification, Aminoglycoside modification enzymes, phosphotransferase,
adenyltransferase and acetyl transferase
Tetracyclines
First was Chlortetracycline produced by Strep
...
Effects G+ve,
G-ve and intracellular parasitic organisms via a similar method
...
The drugs are
bacteriostatics taken up by active transport into the cell
...
Resistance occurs via the production
of a new protein which prevents intracellular drug accumulation via efflux mechanisms, this gives
cross resistance to all tetracyclines
...

Effective against G+ve and –ve, as well as some intracellulars
...
Mainly bacteriostatic
but is bacteriocidal to some organisms
...

Resistance is uncommon but exists as enzymes which acetylate the hydroxyl groups, becoming a
problem in developing world
...

Once used in meningitis but the neonatal metabolism isn’t fast enough to break down the drug,
leading the doses being far too high and being fatal in many cases
...
Now only used as a topical antibiotic
...
of fungi
...
Can be used against both G+ and –ve organisms but the complex
cell wall of –ve prevents entry
...
infections only, penetrates bones and
tissues which can lead to osteomyelitis (inflammation of the bones surrounding tissue)
...

Oral admin – no side effects, IV – reversible jaundice, Topical – non but resistance can be a problem
...
Usually used
for Staph and Strep infections, also used for intercellular and intra tissue infections such as
chlamydia and legionella respectively
...
Resistance can occur via modification of the 50S
rRNA and/or the inactivation of the RNA
...

Clarithromycin – Batter absorbed by the body and fewer side effects
...
Used to treat G+ve cocci and
anaerobes, no action against g-ve bacilli and is accoiated with an increase of C
...

Includes: Clindamycin
Mupirocin: Pseudomonas fluorescens
Blocks the incorporation of aa into polypeptides, active against Staph and Strep which are
inactivated in the body so are used topically only
...


Oxazolidinones
Narrow spectrum against – Staph, pneumococci and enterococci but well absorbed in the oral route
...
Resistance is slow to occur (caused by mutations in the 23S RNA) there are no known
cross-resistances with other drugs
...
faecium), MRSA and TB
...

Most recently a mechanism has appeared, cfr
...
It is a RNA methyltransferase which modifies the target the drugs would usually bind to
...
(CH3 (methylates) 23S), the gene is carried on a conjugative
plasmid
...

Also called non-susceptible as they aren’t technically resistance (as this is acquired), these organisms
can be predicted
...
aureus to penicillin was 1% in 1941, now it’s around 90%
...
S
...
No clear explanation
for the rate or the extensiveness that the resistance is in a bacterial populous
...


Mechanisms
1 – Prevent the drug from entering the cell
...
aeruginosa
...

tuberculosis
...
Organisms are 100-1000 times more resistant to
antibiotics
...

Resistance to Beta lactams and quinolones – decrease in porins
...

Aminoglycosides – alter proteins that would allow active transport
...

Efflux pumps in both G+ve and –ve, intrinsic and can be acquired by plasmids for example MexABOprM of P
...

5 families of bacterial efflux pumps
...

MFS (Major Facilitator Superfamily)
SMR (Small Multidrug Resistance)
ABC (ATP-binding cassette) are the 3 major families involved in drug efflux in G+ve
MATE (Multidrug and toxic compound extrusion)
STY4874 confers resistance to at least 10 antimicrobial drugs
3 – Inactivation/Modification of the antibiotic
B-lactamases degrade b-lactam antibiotics
...

Two origins for B-lactamases:
Chromosomal encoded – Constitutive expression, often produced in small amounts, some organisms
over produce it
...
Found almost exclusively in Staph
...


Extended spectrum B-lactamases include TEM-1, 2, CTX-M and SHV-1
Affect cephalosporins
CTX-M over 80 versions found in Klebsiella, e
...
Hydrolyses cefotaxime
...
aeruginosa and Bacteriodes
...

There are hundreds of B-lactamases but very few B-lactams:
Penams: Narrow, broad and extended spectrum types
Cephems: 1 – 5th generation
Monobactams
This is because the enzymes are ancient being 2 – 3 billion years old
4 – Target change by mutagenesis
Fluoroquinolones target the gryA (DNA Gryase), which is essential for bacteria and absent in higher
eukaryotes
...
Does not affect the activity of
the enzyme but give resistance to fluoroquinolones
...

Altering the target examples:
Beta-lactams: PBP is modified in MSRA, S
...
gonorrhoeae
Glycopeptides: Vancomycin, after 30 years of use in enterococci D-alanyl-D-Alanine has been
replaces with D-Alanyl-D-Lactate of D-alanyl-D-Serine, Stpah with overproduce peptidoglycan
precursors to soak up vancomycin
...

Metabolic Bypass – Sulphonamides
Hyper-production of PABA or mutation in Dihydropteroate Synthase (DHPS, chromosomal) or the
duplication of DHPS (plasmids)
MB – Trimethoprim
Duplication of the Dihydrofolate reductase plasmid

Global Perspective
Antimicrobial resistance reduced the overall effectiveness of a treatment, infections last longer and
the rate of death increases along with chance of spread
...

Plasmodium falciparum becoming resistant to artemisinin, one of the strongest drugs used against
the pathogen
...

Res to first line drugs means more expensive therapies must be used, stay in hospital longer,
increase healthcare costs, increases the economic burden on families and society
...

Res spread rapidly due to global trade and travel due to both humans and food
...

Affects developing economies proportionally more than developed ones
...

Untreated gonococcal infections increase rate of illness and complications, will reverse to step made
to control the spread of the STD
...

Since 1996 incidence of carba res K
...
Currently
available penicillin, cepha, and carba are not active
...
Tigecycline and colistin are still active
but one is concentrated low in the plasma, whilst the other is toxic
...

These structures are usually
polysaccharides, but can be DNA
or proteins
...

Stromatolites are earliest example
and are still visible today
...

Bacteria can shrink to spore like
state such as L-forms (those
without cell wall and can be in
metabolic arrest for a period of
time until environmental
conditions are correct)
...
These bacteria will continue
growing and will begin producing a slime layer (microcolony)
...
As chemical gradients
stabilise and micro-environments created, bacteria will find their place in the structure dependant
on metabolic activity especially in the case of multispecies biofilms (sociomicrobiology)
...

Mature biofilms will have streamers caused by the flow of nutrients through the intestines (for
example)
...

Nutritional gradients include:
A nutritional gradient, oxygen gradient

Quorum sensing (QS)
Communication through molecules (auto inducers) that are synthesized by bacteria, to which
bacteria react by automatically changing gene expression
...

In many G+ve bacteria these molecules are peptides
...

See Molecular Micro folder
...

in a clinical setting these can be: Dental plaque, contaminated prosthetic devices, catheters
...
MIC being up to 1000
times higher
...

They have an increased production of B-lactamases
...

Possible matric antibiotic binding and causing the retardation of diffusion into the biofilm
...

- In Cystic fibrosis
Effects 1 in 2000 caucasian births, caused by mutations in the CFTR gene which
causes a malfunction in a chlorine channel which would normally allow water into the mucous filled
areas and make it more easily removed
...

Patients suffer from recurrent and chronic respiratory tract infections
...
Aggressive early therapy has increased life
expectancy such as oral ciprofloxacin and nebulised colistin for 3 weeks – 3 months, nebulised
monotherapy using tobramycin or Ivacaftor (in those with a specific mutation found in 4-5% of CF
sufferers (Delta F508 a class II mutation), Nebulised DNase (pulmonozyme, breaks down
extracellular DNA therefore aiding the breakdown of mucous)
...

- Nebulised drugs are best for the upper respiratory tract
...
Even after majorly
successful antibiotic therapy hypermutator strains can persist
...

-Treatment is chronic suppressive antibiotic therapy
Daily nebulised DNase as well as colistin or tobramycin/ivacaftor for life combined
with either 2 week courses of IV antibiotics every 3 months, or IV therapy when needed
...

Alternative Strategies for the prevention and/or treatment of biofilm-mediated infections
Quorum sensing as a therapeutic target
Some antibiotics inhibit QS when used at sub-MIC concentrations, includes:
Ceftaxidime, ciprofloxacin, azithromycin (continuous treatment improves lung function in those with
CF but risks macrolide resistance in potential pathogens), clarithromycin
...

Inhibition of curli fibres and type 1 pili
Bacteria use amyloid fibres on their surface to interact with the biofilm as well as adhesion in
general, first being found on E
...

Peptide drugs block the formation of these fibres and therefore are anti virulence and biofilm
producing
...

Foreign body infections
Can be caused by the use of any foreign body entering the body for a prolonged amount of time
...
Sonication of implantable devices
can “shake” off organisms from a device for culturing
...

Biofilm streamers can cause clog water systems in a very rapidly
...
Biomaterials, such as plastics impregnated/coated with antibiotics or
microstructures which act to puncture the bacteria (although these could also work against
eukaryotic cells and cause an inflammatory response)
...

Chelating agents, as Mg2+ and Ca2+ are importance in the formation of a biofilm
...
strain 240B1 – although the human body uses many lactones to remain in
a healthy state
...
aeruginosa PA01
...

Evidence suggesting prions may cause a variety of neurodegenerative disorders
...

Infective endo carditis
See notes

HIV
ssRNA, enveloped
Several factors contribute to viral
entry to the host cell
...

Availability of host cell receptor (Such
as in the case of those with the CCR5
Delta 32 , this is a mutation which
deletes a segment of the original
gene (a C-C chemokine receptor type
5 found on the surface of white blood
cells
...
Usually binds to CCDR5 via
Glycoprotein 120 (GP120)
...

- Masking of conserved viral epitopes
...

HIV vaccine not available as it is a retrovirus and an extremely varied
viral species Quasispecies
...
Mainly
substrain M type B
...
CRF = Circulated
Recombinant Form
...
Surveys
of chimps in southern Cameroon found Simian immunodeficiency
virus (SIV) most closely related to the HIV-1 strain Group M
...

Analysis shows that the virus most likely came from Kinshasa in
around 1920 (1909 – 1930)
...
Cross-species transmission of SIV predated the common ancestor of the Group M
virus strain and is believed to have happened in the south of Cameroon and spread into the local
population and to Kinshasa due to the water way trade set up by Germans in the area (meats
(chimp), rubber and ivory
...
The
increase in commercial sex workers in these areas (due to a mix of foreign nations arriving and
people in Africa living in poverty) as well as a lack of sterile medical equipment in STD (sexually
transmitted disease clinics)
...
This data included an outbreak of hepatitis C and B viruses at the time which HIV would
have been unknowingly spread (Faria et al 2014)
...

Detection using Nucleic Acid Amplification Techniques
...

1, Attachment and Fusion
CCR5 inhibitors stop the binding of GP120
...

All the above proteins act to pull in the HIV virion and bind in to the cell surface
...
Slightly active against HIV-2 isolates
...

2, Uncoated and replication (Nucleotide Reverse Transcriptase Inhibitor) inhibits DNA polymerase
...

Portmanteau inhibitors which inhibit both reverse transcriptase and intergrase
3, Intergration
INSTIs – IN Strand Transfer Inhibitor – Binds to the co-factor region of the intergrase enzyme (where
Mg2+ and Mn2+ would usually bind)
...

Examples are: Elvitegravir and Raltegravir

4, Maturation
Protease Inhibitors – One of the most important finds in the ongoing treatment of HIV
...
These work by introducing a molecular bond to the
active site of the HIV aspartyl protease that it cannot break and therefore gets stuck, disabling the
enzyme
Bacterial pathogenesis is a measure of virulence and the damage that organism can cause through
colonising the host
...

Chlamydia does this by re-routing transport vesicles and hi-jacking organelles
...
Has a
nucleotide transport system which imports ATP whilst exporting ADP
...

 Salmonella, listeria

Macropinocytosis - Salmonella
invades host cells to evade the
immune system and can also alter
the host cell machinery to benefit its
own life style
...
SCV – aided by the
recruitment of mTOR which
catalyses and polymerises actin
...


M protein my some streptococcal species is a strong anti-phagocytic, binds to factor H, causing the
destruction of c3 convertase and preventing opsonisation by c3b
...


Destructive toxins also count, Anthrax
...
jejuni LPS may aid the cause of Gullain
Barre Syndrome, immune system attacking
the peripheral immune system
...
Tetanus and
botulinum may have been a way for the
organism to make sure it spreads, after
around 8 day the effected animals
becomes paralysed and dies, carcas is
eaten by other animals
...
Some of the
infected animals may die somewhere
with no surrounding animals leading to
the disease not becoming an epidemic
...
pylori is found in the gut of 70% of the world population (25% in the western world)
...

Strains virulent in one population are no not always pathogenic in another
...

Varies wildly around the world
...


Autoimmunity against gastric parietal cells causing autoimmune gastritis
...

Between the two insertion sequences, intervening DNA is present
...
Additional genetic instability of cag results
from deletions and inversions
...
CagA was identified as the first protein of the PAI and appeared to be a major
virulence factor
...
At the protein level, the absence of
repeats corresponds to a molecular weight of 128 kDa, while every repeat up to a maximum of four
repeats shifts the molecular weight of CagA by approximately 4 kDa
...
The repeats have a modular structure, which is a
result of duplications and rearrangements of DNA from the central region of the cagA gene
...
These local differences appear to be a result
of frequent genetic recombination events and accumulation of mutations within the cagA gene that
were maintained by geographic segregation
...
Although the function of CagA on the molecular level is still
unknown, it was suggested that CagA is involved in the rearrangements of the actin cytoskeleton,
which results in the formation of cup-like structures underneath the adherent bacteria
...

The fact that cag interferes with the cell cycle might offer a possible explanation for the increased
risk of gastric cancer
...


Anthrax, some biting flies have shown to be transmitters of the bug
...

Superficial mycoses are the most common – effecting the skin
...

Systemic Mycoses – most serious
...
All three types are infections which are difficult to
control due to lack of specific anti-fun gals and the ubiquitous nature of the pathogens
...


Superficial
Dermatophytosis – Infection of the keratinized tissues such as hair, nail and skin
...

These are able to digest keratin
...

Occurs in humans and animals, the most common is athletes foot (tinea pedis, ringworm of the
foot)
...

Less common are hair and other regions of the body
...

Digest keratin and push their hyphae into new keratinized cells, infection causes an immune
response
...


Tinea faciei – affects the face
...


Can be diagnosed by microscopy such as KOH – Potassium hydroxide – to differentiate
dermatophytes
...

Trichophyton, Epidermophyton, Microsporum
...

Trichophyton interditale – Tinea Capitis, T
...
pedis
Microsporum audouinii – Tinea Capitis

Subcutaneous Mycoses – mostly from the tropics
Mycetoma – Madura foot (Madurella fungi) causes swollen lesions
...
Cryosurgery is used for smaller lesions and anti-fungals
for the larger patches
...
C
...
glabrata
Yeast overgrowth due to an altered microflora or immune system
...

Can become invasive as a result of doctors interference (iatrogenic)
...

Surgery
...

Damage to epithelial cells such as from catheters
...
However prolonged immunosuppression can lead to systemic infection
...

Those with a persistent fever who fails to respond to antibiotics
...

Can spread and cause: meningitis, renal abscesses, Myocarditis, osteomyelitis, arthritis
...

Treatment for invasion candidiasis is amphotericin B via IV and then fluconazole
...
Only 100 species and fumigatus is the most common pathogenic variant
...

We breath 100 – 200 a day
...


These diseases can be aided
due to materials entering the
normally sterile lungs
(alcoholism may cause vomit to
enter the lungs, ethanol also
decreases the immune system
in the lungs, inhibits the bone
marrows ability to work
properly and diminishes the
ability of the immune systemto
produce CD4+ T-cells and their
ability to produce IFN-Gamma)
...
This pocket is out of
reach of the immune system
and allows the formation of a
mass
...

Rarely it can disrupt blood
vessels in the lungs (in the
immunocompromised – still rare) Treatment is managing all lung conditions well to not cause
scarring
...

Invasive Aspergillosis is a very severe condition 1 – 2 weeks from onset then death
...
There are four
types dependant on location:
Pulmonary – Lungs = 86% mortality
Tracheobronchitis (bronchial mucosa and cartilage) 70 – 100% mortality
Acute Rhiosinusitus 66% mortality
Disseminated (brain, heart, kidneys and eyes), meningitis caused has a 99% mortality
Positive ID is a culture/microscopy of sputum, Ag in serum and/or CT scan/
Typhoid and Enteric fever
Salmonella enterica spp enterica sv
typhi
Paratyphoid A, B, and C cause
paratyphoid fever
...

ID via blood culture, stool and urine on
XLD, Serological test includes Widal test
(Abfrom infected mixed with sample)
50% effective
...
O (Cell wall), Vi (LPS) and H (Flagella) antigens tested
...

Those with CF – may
be resistant to
The clinical disease
coincides with the
symptoms – fever
...

Incubation period
is between 5 – 50
days although
typically 2 weeks
...

The similar but less
severe disease is
caused by Paratyphi
...
A
live attenuated oral
Ty21a Vaccine is
available for those over
5
...
T3SS allows bacterial to be taken into cells
...
If not sensitive, then use Ceftriaxone (a cephalosporin) and azithromycin (a
long life macrolide
...
8 – 10
...
cholera 01 – major cause of epidemics, Non-01 v
...
Two
serotypes 01 and 0139
...
Non 01 or 0139 variants do not cause epidemics
...

Causes an acute intestinal disease caused by the ingestion of contaminated food or water
...
Death will occur if
the patient is not treated
...
When illness does occur, 90% are mild
...
EST of those effected are 3 – 5 million per annum, and 110, 000
deaths
...

7 Pandemics with many more epidemics
...
Organisms migrate and adhere to the epithelial
cells (Toxin co-reg pilus) and produce toxin, map that fucking!!
Symptoms are sudden vomiting, profuse watery diarrhoea which can lead to rapid dehydration and
shock – fatal in a day
...

Treatment is oral rehydration, IV in serious cases
...
Children under 12 given a 3 das course of
erythromycin
Under 5 should be given zinc for ten days
...

Tissue culture, toxin testing, serotyping and genetic typing
...

Active immunisation is prophylactic
...

Passive are passed from one to another (Ab)
...
These will be toxoids such as DPT
A vaccine needs to have a long shelf life, be safe (minimal number of side effects)
...
Vaccines against these can
cause a protective immunity against pathogens or their products such as the DPT vaccines
...
This makes it look more like a
organism to the immune system
...


Whole cell vaccines – Active

Virus like particles 0 Outer coat proteins of virus
are produced recombinantly, these self assemble
into viral particles but lack the viral genome to
really make them work
...

DNA vaccines – expression of a Ag
via a plasmid intramuscularly
injected into the body
...

Or Gene gun DNA on gold
particles
...

1796 first vaccine for small
pox by Edward jenner, led to
the illegalisation of
variolation
...

Smallpox believed to be
extinct in the wold due to
vaccination
...

Not everyone gets vaccinated, some cant due to immunocompromised status or allergies to
ingredients or lack of access
...

BCG is a live attenuated vaccine – Myco
...
Repeatedly sub cultured until no longer
causes disease in humans
...

Polio – Inactivated and attenuated variants
...

MMr vaccine contains live attenuated Measles, Mumps and rubella
...

Rabies and HepA is a passive Ab vaccine
...

Yellow fever, chicken pox (varicella) and Influenza are Active
DTAP-IPV-Hib is a toxoid one
...




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