Upload
lenguyet
View
216
Download
0
Embed Size (px)
Citation preview
Vaccine success stories: from initial idea to the market
Jerusha Naidoo MBChB (UCT)
Pfizer Vaccines
Outline
How vaccine producers look at vaccines
and vaccination, in general
“The needs and gaps in the vaccine R&D
pipeline and technology transfer”
« EVM - European Vaccine Manufacturers »
Conclusions
2
Vaccines and future vaccine-preventable diseases
BACTERIAL VIRAL
B. anthracis anthrax Cytomegalovirus congenital infections
C. trachomatis chlamydia Dengue virus hemorrhagic fever
C. difficile diarrhea Epstein-Barr virus infectious mononucleosis
Enterotoxigenic E. coli diarrhea Hepatitis B, C, E hepatitis
H. pylori gastic cancer HIV AIDS
M. tuberculosis tuberculosis HSV-2 herpes
N. meningitidis meningitis Human papillomavirus cervical cancer
S. aureus skin and systemic infections Influenza virus influenzae
S. pneumoniae meningitis & pneumonia Japanese encephalitis virus encephalitis
S. typhi typhoid fever Parainfluenza pneumonia
Shigella spp shigellosis Rotavirus diarrhea
Streptococcus, Group A skin and systemic infections RSV pneumonia
Streptococcus, Group B meningitis SARS pneumonia
V. cholera cholera
Y. pestis plague PARASITIC
A. duodenale, N. americanus hookworm
Leishmania spp leishmaniasis
Plasmodium spp malaria
3 http://www.ifpma.org/pdf/2008_05_20_IFPMA_Value_of_Vaccines.pdf
Vaccines and
vaccination
4
Fletcher MA, Saliou P. Vaccines and infectious disease. EXS 2000;89:69-88
10,000 1,000 100 10 1
YEARS AGO
Smallpox HIV/AIDS Hepatitis B Rotavirus DISEASE
GERM
VACCINE
VACCINATION
DISEASE CONTROL
A brief history of vaccines
“ERADICATION”
5
H. influenzae type b
N. meningitides (4 Serogroups) CONJUGATE
Ps. aeruginosa (8 serotypes)
S. pneumoniae (13 serotypes)
S. typhi
H. influenzae type b S. typhi POLYSACCHARIDE
N. meningitides (Serogroups A, C, W135, Y)
S. pneumoniae (23 serotypes)
Influenza virus Hepatitis B virus SUBUNIT
HPV
B. pertussis
C. diphtheriae B. pertussis TOXOID
C. tetani
Rabies virus B. pertussis B. anthracis Hepatitis A virus INACTIVATED
S. typhi B. pertussis
V. cholera C. burnetti
Y. pestis Influenza virus
Japanese encephalitis virus
Poliovirus
Tick-borne encephalitis virus
Vaccinia M. tuberculosis B. anthracis Influenza virus LIVE-ATTENUATED
Yellow fever virus F. tularensis Rotavirus
Poliovirus S. typhi
Measles / rubella / mumps viruses VZV
1940s to 1970s
6
Based on: Fletcher MA, Saliou P.
Vaccines and infectious disease.
EXS. 2000;89:69-88
Antiquity
1880s to 1890s
1920s to 1930s
1980s to present
Expanded Programme on
Immunization vaccines
Vaccines that have been used or are currently licensed
Thanks to novel technologies, new vaccines are
now possible
Novel technologies Targeted diseases
Conjugation Pneumococcal infections
Meningococcal infections
Subunits, with new
adjuvant formulations
Influenza, pandemic or pre-
pandemic
Recombinant / virus-like
particles (VLP) Cervical cancer (HPV)
Live-attenuated Chicken-pox (VZV)
Herpes zoster (VZV latent)
Reassortments Diarrhea (rotavirus)
http://www.ifpma.org/pdf/2008_05_20_IFPMA_Value_of_Vaccines.pdf 7
H. influenzae type b
N. meningitides (4 Serogroups) CONJUGATE
Ps. aeruginosa (8 serotypes)
S. pneumoniae (13 serotypes)
S. typhi
H. influenzae type b S. typhi POLYSACCHARIDE
N. meningitides (Serogroups A, C, W135, Y)
S. pneumoniae (23 serotypes)
Influenza virus Hepatitis B virus SUBUNIT
HPV
B. pertussis
C. diphtheriae B. pertussis TOXOID
C. tetani
Rabies virus B. pertussis B. anthracis Hepatitis A virus INACTIVATED
S. typhi B. pertussis
V. cholera C. burnetti
Y. pestis Influenza virus
Japanese encephalitis virus
Poliovirus
Tick-borne encephalitis virus
Vaccinia M. tuberculosis B. anthracis Influenza virus LIVE-ATTENUATED
Yellow fever virus F. tularensis Rotavirus
Poliovirus S. typhi
Measles / rubella / mumps viruses VZV
1940s to 1970s
8
Based on: Fletcher MA, Saliou P.
Vaccines and infectious disease.
EXS. 2000;89:69-88
Antiquity
1880s to 1890s
1920s to 1930s
1980s to present
Expanded Programme on
Immunization vaccines
Vaccines that have been used or are currently licensed
H. influenzae type b
N. meningitides (4 Serogroups) CONJUGATE
Ps. aeruginosa (8 serotypes)
S. pneumoniae (13 serotypes)
S. typhi
H. influenzae type b S. typhi POLYSACCHARIDE
N. meningitides (Serogroups A, C, W135, Y)
S. pneumoniae (23 serotypes)
Influenza virus Hepatitis B virus SUBUNIT
HPV
B. pertussis
C. diphtheriae B. pertussis TOXOID
C. tetani
Rabies virus B. pertussis B. anthracis Hepatitis A virus INACTIVATED
S. typhi B. pertussis
V. cholera C. burnetti
Y. pestis Influenza virus
Japanese encephalitis virus
Poliovirus
Tick-borne encephalitis virus
Vaccinia M. tuberculosis B. anthracis Influenza virus LIVE-ATTENUATED
Yellow fever virus F. tularensis Rotavirus
Poliovirus S. typhi
Measles / rubella / mumps viruses VZV
1940s to 1970s
9
Based on: Fletcher MA, Saliou P.
Vaccines and infectious disease.
EXS. 2000;89:69-88
Antiquity
1880s to 1890s
1920s to 1930s
1980s to present
Expanded Programme on
Immunization vaccines
Vaccines that have been used or are currently licensed
Les vaccins combinés
10
« Fortunately,
medical
researchers have
been able to
combine tetanus,
smallpox and
rubella
vaccinations into
one shot »
Pediatric combination vaccines can protect children
against tetanus (T), diphtheria (D), whooping cough (P),
poliomyelitis (IPV), bacterial meningitis (Hib), and
hepatitis B (HBV)
Each new pediatric vaccine must be compatible with the
various infant immunisation schedules in place
Number of primary series doses (“two-dose” or “three-dose”)
Age at first dose and spacing between each primary dose
Association with other new vaccines
• Pneumococcal conjugate, meningococcal conjugate, rotavirus, influenza,
varicella, etc.
Pediatric combination vaccines, European Union (1)
11
http://www.euvac.net/graphics/euvac/vaccination/pertussis.html
Primary Booster Revaccination(s)
Pertussis vaccination overview in the EU
12
Young infants in some EU countries receive the whole-
cell pertussis vaccine
Three-vaccine combinations
• DTPw
Four-vaccine combinations
• DTPw | Hib
Five-vaccine combinations
• DTPw | IPV | Hib
Acellular pertussis vaccines have been introduced over
the last decade in many other EU countries
Four- to six-vaccine combinations
• DTPa | Hib | IPV | HBV
Pediatric combination vaccines, European Union (2)
13
14
The challenge of new vaccines
« Good stability, lots of
antibodies, well
tolerated, safe, but
lacking a bit of a
protective immune
response… »
WHO Pre-ICDRA Conference, Sept. 14, 2008, Bern
Vaccine Development Presents
Unique Challenges
Preventive vaccines are given to healthy people
Many vaccines are used widely and routinely in infants
Vaccines must be safe
Essential to maintain public confidence
Vaccines must be effective
Higher level of efficacy expected than for therapeutics
15
Fletcher MA, Saliou P. Vaccines and infectious disease. EXS 2000;89:69-88
DISEASE
Doctor & Patient
Transmission
Reservoir
(Koch's postulate)
Incidence & prevalence
Vaccine efficacy
Disease classification
Possibility of diagnosis
Geographic distribution
Hospitalisation rates
Public perception of the vaccine PATHOGEN
Infectious disease experts VACCINE
Healthcare system
Keys to vaccine development
Age groups affected
Risk group affected
Public perception of the disease
Seriousness of the disease
Likelihood of treatment
16
PERCEPTION OF VACCINATORS AND VACCINE RECIPIENTS
THE INFECTION IS SERIOUS BECAUSE IT Yes No Uncertain
inspires fear and dread
may kill the patient ("acute mortality")
makes the patient seriously ill ("acute morbidity")
predisposes to a secondary infection
leads to a chronic illness
may permanently disable the patient
INFECTION BY THIS PATHOGEN Yes No Uncertain
is incurable
resists palliative / symptomatic treatments
Gravity of the infection
Gravity of the infection
Possibility of treatment
PERCEPTION OF PUBLIC HEALTH AUTHORITIES Gravity of the infection
Modes of transmission
Reservoir / carrier state
THE MICRO- ORGANISM IS TRANSMITTED TO MAN VIA Yes No Uncertain
air
animal hosts
food
health care facilities
sexual activity
vectors
water
Yes No Uncertain
HE ONLY RESERVOIR IS MAN
with a prolonged period of infectiveness
with isolation precautions or quarantine recommended
INFECTION LEADS TO A CHRONIC CARRIER STATE
PERCEPTION OF PUBLIC HEALTH AUTHORITIES Gravity of the infection
Incidence & prevalence of the disease
Geographic distribution
THIS INFECTION IS CONSEQUENTIAL BECAUSE Yes No Uncertain
it has a high attack rate
incidence (seasonal) has been increasing recently
incidence (secular) has been increasing recently
recent outbreaks suggest an impending epidemic
recent epidemics were severe
it's an "emerging or re-emerging" infectious disease
it is prevalent in the population
THE DISEASE IS FOUND IN Yes No Uncertain
China
Established Market Economies
Former Socialist Economies
India
Latin America and the Caribbean
Middle East Crescent
Other Asia and Islands
Sub-Saharan Africa
PERCEPTION OF PUBLIC HEALTH AUTHORITIES Gravity of the infection
Populations most affected by the disease
INFECTION PRIMARILY AFFECTS Yes No Uncertain
neonates
infants
toddlers
children
adolescents
young adults
adults
the elderly
PERCEPTION OF PUBLIC HEALTH AUTHORITIES Gravity of the infection
High-risk groups
PARTICULAR "AT RISK GROUPS" HAVE BEEN IDENTIFIED: Yes No Uncertain
certain occupations
children in day-care centers
chronically-ill people
frail elderly
hospital patients
immuno-suppressed
indigent
military recruits
people with a lifestyle risk
refugees
students
the poor
travellers
PERCEPTION OF PUBLIC HEALTH AUTHORITIES Gravity of the infection
The vaccination option
VACCINE PROPHYLAXIS IS REASONABLE BECAUSE Yes No Uncertain
there are few predominant sero-groups or serotypes
infection pre-disposes to secondary infections
natural infection confers lifelong protective immunity
elimination or eradication of the agent is possible
the pathogen is resistant to a first-line antimicrobial agent
vaccination is simpler than current preventive measures
an effective cure is unavailable
PERCEPTION OF HEALTHCARE SYSTEM Gravity of the infection
Clinical presentation of the patient THE PATHOGEN CAUSES Yes No Uncertain
an infectious or parasitic disease
AIDS
bacterial meningitis & meningococcemia
childhood-cluster diseases
dengue
diarrheal diseases
hepatitis B / hepatitis C
intestinal nematode infections
japanese encephalitis
leprosy
malaria
STDs (except AIDS)
trachoma
tropical-cluster diseases
tuberculosis
a respiratory infection
lower respiratory infections
otitis media
upper respiratory infections
a maternal condition
a "condition arising during the perinatal period"
a malignant neoplasm
diabetes mellitus
a neuro-psychiatric disorder
a sense organ disease
a cardiovascular disease
a respiratory disease
a digestive disease
a genito-urinary disease
a skin disease
a musculo-skeletal disease
a congenital anomalie
an oral condition
PERCEPTION OF PUBLIC HEALTH AUTHORITIES Gravity of the infection
Burden of the infectious disease
Yes No Uncertain
INFECTION LEADS TO HOSPITALIZATION
INFECTION LEADS TO LONG-LASTING INCAPACITATION
Burden of the infectious disease
THE INFECTION CAN BE DIAGNOSED BECAUSE Yes No Uncertain
of a readily-identifiable clinical syndrome
standard laboratory methods identify the pathogen
Public perception of vaccination VACCINATION WOULD BE READILY ACCEPTED SINCE Yes No Uncertain
each vaccine will recognize benefit from immunization
the popular press highlights this pathogen / disease
Opinion Leaders recommend development of the vaccine
www.evm-vaccines.org www.evm-vaccines.org www.evm-vaccines.org www.evm-vaccines.org www.evm-vaccines.org www.evm-v
The needs and gaps in the vaccine R&D pipeline and
technology transfer
Vaccines
October 2010
Michael Watson,
Vice President Global Immunisation Policy
EVM Board
Chair of IFPMA B&V Committee
Sanofi pasteur, France
Vaccines’ contribution to Europe’s future
26
Filling the Vaccine Funnel
Phase 1
Research & Pre-clinical
Registration
Phase 2
Phase 3
Launch
PUSH & PULL for Research & Pre-Clinical
Vaccines’ contribution to Europe’s future
27
PULL: Target priorities, Market attractiveness, Financing, Prizes, Recognition, Corporate social responsibility, Intellectual property
Assay development
& validation
High-throughput
screening
Epidemiology
Antigens
Adjuvants
Animal
models
Understanding
disease pathology
Immunology
Disease/targets
Delivery
platforms
In-vitro
models
Vaccinology
VISION
PUSH: Competence, Resources, Funding & useful data in Vaccinology
Research & Pre-clinical
Vaccines’ contribution to Europe’s future
28
The future can be so bright…
Genomics, proteomics
& Genetic engineering
Immunology &
adjuvants
Cell culture, expression
& production
Epidemiology
Funding &
Financing
Many important new and emerging
targets
Unmet needs - HIV, TB, malaria, HCV
Socio-politico-financial
feasability - TB, malaria
Emerging disease - SARS, pandemic flu,
Clostridium difficile
Re-emerging diseases - TB
Migrating diseases - JE, Dengue, West Nile virus
Resistant diseases - MRSA, TB
Social acceptability - HSV-2, Chlamydia
Improve existing
vaccines - Rabies, TB (BCG)
Vaccines’ contribution to Europe’s future
29
The easy targets have been done!
The remaining targets are difficult…
Approximately 70 infectious disease vaccine targets: »~25 vaccines already have been developed
»~45 vaccines remaining
»Antigenic diversity
»HIV, HCV, rhinoviruses
»Biology of the pathogen
»Chlamydia, HSV, TB
»Limits of ‘natural’ immunity
»HIV, HSV-2, Chlamydia, TB
»Immunopathology
»SARS, RSV, Dengue (?)
Of those where market potential exists, there are
technical challenges
Vaccines’ contribution to Europe’s future
30
Technic
al
Feasi
bil
ity
Many diseases, but a technical feasibility and market
attractiveness that varies
Market Attractiveness
Hepatitis E
/ Anthrax
/ Chikungunya
E. coli / UTI
E. coli 0157 /
Enterovirus 71 /
H. pylori (therapeutic) /
/ Dental carries
S. paratyphi /
ETEC /
GAS /
/ Leishmaniasis
Norovirus /
/ Otitis media
Parvo B19 /
PIV /
/ Schistosomiasis
Shigella [protein] /
Rhinovirus /
Meningococcus Serogroup B /
S. aureus /
Staphylococcus CoNS /
RSV /
Bocavirus /
C. jejuni /
/ Cholera
Epstein-Barr virus /
HHV-6 /
Legionella /
M. pneumoniae /
M. gonorrhea /
Trypanosiasis /
Hantavirus /
Hepatitis C (therapeutic) /
hMPV /
HSV 2 /
hMPV-PIV combo /
CMV /
P. acnes /
Enterovirus (T1D) /
Enterococcus sp /
/ Latent TB
Acinetobacter baumannii /
Klebsiella /
E. coli / Nosocomial
P. aeruginosa /
HPV (L2)
/ TBE
Flu (M2E)
/ Periodontal
100 %
0 % 100 %
Preferred Quadrant
Pro
gre
ss
th
e s
cie
nce
GBS
Create the incentive
Caveat - Personal not EVM classification 31 EVM 2010 - Vaccines’ contribution to Europe’s future
Progressing the science
Vaccines’ contribution to Europe’s future
32
PULL: Target priorities, Market attractiveness, Financing, Prizes, Recognition, Corporate social responsibility, Intellectual property, VISION
Assay development
& validation
High-throughput
screening
Epidemiology
Antigens
Adjuvants
Animal
models
Understanding
disease pathology
Immunology
Disease/targets
Delivery
platforms
In-vitro
models
Vaccinology
VISION
PUSH: Competence, Resources, Funding & useful data in Vaccinology
Research & Pre-clinical
Vaccines’ contribution to Europe’s future
33
Antigen presenting -
platforms
Antigen discovery
Formulation &
adjuvants
Modes of administration
(Needleless devices)
Analysis of immune
responses in humans (immunochips, robots,
flow cytometry…)
Molecular
adjuvants, emulsions,
microparticles
Viral vectors, DNA, peptides,
recombinant proteins, chimeric
viruses, VLPs, …
Patch, microneedle,
nasal route, …
Structure determination,
genome mining
(bioinformatics)
Vaccine-specific goals of progressing the science
New production methods
ANTIGEN PRESENTATION ANTIGEN
FORMULATION
DELIVERY SYSTEM
MEASUREMENT OF
IMMUNOGENICITY
Vaccines’ contribution to Europe’s future
34
Vaccine R&D & Lifecycle Activities
Many years 1-2 years 4-8 years 1 year 2 years Continued
Exploratory
PRECLINICAL CLINICAL DEVELOPMENT REGISTRATION
• Antigen
production
• Assay
development
• Animal model
validation
• Preclinical
toxicity
Phase I
•Safety
•Initial
•immunogenicity
Phase II a
• Dose finding
• Dose/schedule
finding
• Immunogenicity
Phase II b
• Early POC
Phase III
• Large scale safety
+
• Lot to lot
consistency
+
• Non-inferiority
(combos)
or
• Efficacy
Lifecycle
management
Launches
Industrial investment
Filing
Post-marketing
commitments
• Safety
• Effectiveness
• Identification
of target
antigens
• Understanding
of pathologies
• Natural history
of disease
• Animal model
Preclinical Proof-of-concept
Vaccines’ contribution to Europe’s future
35
1-2 years
PRECLINICAL
Vaccine R&D & Lifecycle - Partnerships
Many years 4-8 years 1 year 2 years continue
Exploratory CLINICAL DEVELOPMENT REGISTRATION
Launch Industrial investment
Filing Preclinical
Academio-Governmental-Regulatory-Policy-funding axis
BioTechs
R&D Based Vaccine Industry/Producers
“Me-Too” Vaccine Industry/Producers – Accelerated timelines/reduced costs
Lifecycle
management
Proof-of-concept
Vaccines’ contribution to Europe’s future
36
The value of partnership
In-house expertise • Boosters, adolescent & adult – SP & GSK
• Combination infant vaccines
- MMRV, Pentavalent and Hexavalent – SP/SPMSD, Merck & GSK
• H1N1 vaccines – SP, Novartis, Baxter, GSK, Crucell
• Menactra® – SP
• Menveo® – Novartis
• Prevnar® – Pfizer
• Synflorix® – GSK
• Zostavax® – Merck
Partnerships • Cervarix® – GSK, MedImmune, Corixa, NCI, University of Rochester
• Flumist® – Wyeth, MedImmune
• Gardasil® – Merck, CSL, NCI, University of Queensland
• Hib conjugate – GSK, Merck, SP, University of Rochester
• Rotarix® – GSK, AVANT Immunotherapeutics, University of Cincinnati Children's Hospital
• Rotateq® – Merck, Wistar Institute and CHOP
Provenance of recently-licensed vaccines
37
Funding and Financing
Self-funding ↔ Industry, hospitals
Equity / Private ↔ Biotech
Government ↔ Academia, hospitals
Non-governmental ↔ Industry, biotech,
academia, NGOs
Partnerships ↔ Any or all
38
Generating “Vaccine Vision”
•Clear shared understanding of the future:
•Disease impact and target priorities:
• Epidemiology, morbidity, mortality and socio-economic
impact
•Demand
• Realistic product profile, production & presentation
• Realistic assessment of development costs and timelines
• Realistic assessment of future value (NPV)
• Clear vision of future demand, price and financing
•Political will
• Shared commitment to need, priorities, demand, price and cost
•Partnerships
• Who will play what role?
•Multilaterally prepared to take some risks
GAVI Update by Nina Schwalbe
Marrakesh 2012 39
39
GAVI Overview
40
• GAVI is a public-private global health partnership committed to
saving children’s lives and protecting people’s health by
increasing access to immunization in poor countries.
• The Alliance brings together developing country and donor
governments, the WHO, UNICEF, the World Bank, the vaccine
industry, research and technical agencies, civil society, the Bill &
Melinda Gates Foundation and other private philanthropists.
• Efforts directed through the financing mechanisms of the GAVI
Fund optimize product availability and market pricing, and
coordinate the field support necessary to plan and implement
programs in the world’s poorest countries.
GAVI Business Model
GAVI’s Partnership Model
As a public-private partnership, GAVI represents the sum of its partners' individual strengths, from WHO's scientific expertise and UNICEF's procurement system to the financial know-how of the World Bank and the market knowledge of the vaccine industry. GAVI aims to maximize its partners' expertise, build upon existing networks and facilitate collaboration to find new solutions.
The Bill & Melinda Gates Foundation's initial five-year pledge of US$ 750 million in 1999 provided the seed money to launch GAVI.
As a co-founder of GAVI and the UN's specialist agency on global health issues, WHO is a key implementing partner.
As the world's biggest buyer and supplier of vaccines for developing countries, UNICEF has a pivotal role in the GAVI Alliance.
The World Bank brings the expertise of the world's biggest source of development assistance to the Alliance.
41 Source: http://www.gavialliance.org/about/partners/the-partnership-model/
Developing country governments
Industrialized country
governments
Civil society
Developing country pharmaceutical
industry
Industrialized country
pharmaceutical industry
Research and technical health
institutes
Developing countries are the most important part of the Alliance. They apply for support, manage grants and finance immunization.
Industrialized country governments‘ experience in overseas development and funding ensure health is prioritized in aid programs.
CSOs help deliver vaccines to remote communities, implement vaccine programs and advocate for immunization.
GAVI aims to make vaccines more affordable for low income countries by expanding the range of suppliers to include developing country manufacturers.
GAVI harnesses the technical expertise of the IFPMA to ensure new vaccines are available that address the needs of developing countries.
Partnership with the research community allows GAVI to tap in the latest information and thinking from the scientific, medical and product delivery communities.
Conclusions
42
“Vaccination in the 21st Century”
AGE GROUPS VACCINES
Prenatal Group B Streptococcus, RSV
Neonatal RSV, rotavirus, hepatitis B, M. tuberculosis
2 to 6
months
Pediatric combinations (DTacP / Hib / IPV / hepatitis B),
pneumococcus / meningococcus, RSV / PIV, adenovirus,
hepatitis A
Under-
industrialized
Diarrheal (ETEC, Shigella, Campylobacter)
Vector-borne (malaria, JEV, dengue fever)
1 to 2 years MMRV, pediatric combinations boosters
Under-
industrialized Schistosoma, rabies, S. typhi
4 to 6 years Influenza (intranasal), MMRV booster, Streptococcus mutans
(oral)
11 to 12
years STDs (HIV, HPV, HSV-2), pre-pregnancy (CMV, parvovirus)
Young
adults TdacP, Helicobacter pylori, [travel vaccines]
>55 years Influenza (booster), pneumococcus (booster), varicella-zoster
(booster)
Source: Plotkin, S. A. (1996). "A hundred years of vaccination: the legacy of Louis
Pasteur." Pediatric Infectious Disease Journal 15(5): 391-4 43
Seriousness of disease & incidence of infection
Seriousness of disease This is a deadly disease (high "acute mortality") Infection causes permanent disability
Acute morbidity is considerable
The pathogen is resistant to chemotherapy
Incidence of infection Disease rates have attracted Public Health Authority
attention
Perception of the vaccine-preventable disease Is considered to be easily contracted
Inspires fear and dread
44
H. influenzae type b
N. meningitides (4 Serogroups) CONJUGATE
Ps. aeruginosa (8 serotypes)
S. pneumoniae (13 serotypes)
S. typhi
H. influenzae type b S. typhi POLYSACCHARIDE
N. meningitides (Serogroups A, C, W135, Y)
S. pneumoniae (23 serotypes)
Influenza virus Hepatitis B virus SUBUNIT
HPV
B. pertussis
C. diphtheriae B. pertussis TOXOID
C. tetani
Rabies virus B. pertussis B. anthracis Hepatitis A virus INACTIVATED
S. typhi B. pertussis
V. cholera C. burnetti
Y. pestis Influenza virus
Japanese encephalitis virus
Poliovirus
Tick-borne encephalitis virus
Vaccinia M. tuberculosis B. anthracis Influenza virus LIVE-ATTENUATED
Yellow fever virus F. tularensis Rotavirus
Poliovirus S. typhi
Measles / rubella / mumps viruses VZV
1940s to 1970s
45
Based on: Fletcher MA, Saliou P.
Vaccines and infectious disease.
EXS. 2000;89:69-88
Antiquity
1880s to 1890s
1920s to 1930s
1980s to present
Expanded Programme on
Immunization vaccines
Vaccines that have been used or are currently licensed
Vaccine success stories: from initial idea to the market
Mark A. Fletcher, M.D
Pfizer Vaccines, Paris, FRANCE