Overview of vaccines.

This article lists the vaccines current available for the control of both viral and bacterial infections. They may be attenuated live or inactivated whole microorganisms, or subunit preparations. Many more are in the pipeline and increasing attention is being given to establishing their safety before registration. Following the earlier eradication of smallpox, good progress is now being made toward the global eradication of poliomyelitis and a new program to eliminate measles from the Americas has begun. A variety of new approaches to vaccine development is now available. The hepatitis B virus surface antigen, made by DNA-transfected yeast or mammalian cells, is the basis of the first genetically engineered vaccine. Early in the 21st century, new vaccines based on oligopeptides, recombinant live viral or bacterial vectors (often existing live vaccines), or recombinant DNA plasmids are likely to be registered for human use. The efficacy of vaccines depends on the immune responses generated, and the recent substantial increase in our understanding of the mammalian immune system now offers great opportunities for manipulation to best obtain desired responses. These include mixing vaccine formulations to maximize immune responses, and combining vaccines to simplify their administration. Despite these advances, some persisting infections, such as those caused by HIV, plasmodia, and mycobacteria, still pose a great challenge to vaccine developers.