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14-September-2008 18:02:41 - Vaccine For other uses, see Vaccine disambiguation. A vaccine is a biological preparation which is used to establish or improve immunity to a particular disease. Vaccines can be prophylactic e.g. to prevent or ameliorate the effects of a future infection by any natural or wild pathogen, or therapeutic e.g. vaccines against cancer are also being investigated; see cancer vaccine. Contents 1 Name and history 2 Types 3 Developing immunity 4 Schedule 5 Efficacy 6 Types of vaccine developments 7 Controversy 8 Economics of development 9 Intellectual property 10 Preservatives 11 Delivery systems 11.1 Plasmids 12 Use in nonhumans 13 See also 14 References 15 External links Name and history The term vaccine derives from Edward Jenner's 1796 use of cowpox Latin variolæ vaccinæ, adapted from the Latin vaccÄ«n-us, from vacca cow, which, when administered to humans, provided them protection against smallpox. The earliest vaccines were based on the concept of variolation originating in China, in which a person is deliberately infected with a weak form of smallpox as a form of inoculation. Jenner realized that milkmaids who had contact with cowpox did not get smallpox. The process of distributing and administrating vaccines is thus referred to as vaccination . Jenner's work was continued by Louis Pasteur and others in the 19th century. Since vaccination against smallpox was much safer than smallpox inoculation, the latter fell into disuse and was eventually banned in England in 1849. The 19th and 20th centuries saw the introduction of several successful vaccines against a number of infectious diseases. These included bacterial and viral diseases, but not to date any parasitic diseases. Please help improve this section by expanding it. Further information might be found on the talk page or at requests for expansion. August 2008 Types Avian Flu vaccine development by reverse genetics techniques. Avian Flu vaccine development by reverse genetics techniques. Vaccines may be dead or inactivated organisms or purified products derived from them. There are four types of traditional vaccines:1 Vaccines containing killed microorganisms - these are previously virulent micro-organisms which have been killed with chemicals or heat. Examples are vaccines against flu, cholera, bubonic plague, and hepatitis A. Vaccines containing live, attenuated virus microorganisms - these are live micro-organisms that have been cultivated under conditions that disable their virulent properties or which use closely-related but less dangerous organisms to produce a broad immune response. They typically provoke more durable immunological responses and are the preferred type for healthy adults. Examples include yellow fever, measles, rubella, and mumps. The live tuberculosis vaccine is not the contagious strain, but a related strain called BCG; it is used in the United States very infrequently. Toxoids - these are inactivated toxic compounds in cases where these rather than the micro-organism itself cause illness. Examples of toxoid-based vaccines include tetanus and diphtheria. Not all toxoids are for micro-organisms; for example, Crotalis atrox toxoid is used to vaccinate dogs against rattlesnake bites. Subunit - rather than introducing an inactivated or attenuated micro-organism to an immune system which would constitute a whole-agent vaccine, a fragment of it can create an immune response. Characteristic examples include the subunit vaccine against HBV that is composed of only the surface proteins of the virus produced in yeast and the virus-like particle VLP vaccine against human papillomavirus HPV that is composed of the viral major capsid protein. A number of innovative vaccines are also in development and in use: Conjugate - certain bacteria have polysaccharide outer coats that are poorly immunogenic. By linking these outer coats to proteins e.g. toxins, the immune system can be led to recognize the polysaccharide as if it were a protein antigen. This approach is used in the Haemophilus influenzae type B vaccine. Recombinant Vector - by combining the physiology of one micro-organism and the DNA of the other, immunity can be created against diseases that have complex infection processes DNA vaccination - in recent years a new type of vaccine, created from an infectious agent's DNA called DNA vaccination, has been developed. It works by insertion and expression, triggering immune system recognition into human or animal cells, of viral or bacterial DNA. Some cells of the immune system that recognize the proteins expressed will mount an attack against these proteins and cells expressing them. Because these cells live for a very long time, if the pathogen that normally expresses these proteins is encountered at a later time, they will be attacked instantly by the immune system. One advantage of DNA vaccines is that they are very easy to produce and store. As of 2006, DNA vaccination is still experimental. While most vaccines are created using inactivated or attenuated compounds from micro-organisms, synthetic vaccines are composed mainly or wholly of synthetic peptides, carbohydrates or antigens. Vaccines may be monovalent also called univalent or multivalent also called polyvalent. A monovalent vaccine is designed to immunize against a single antigen or single microorganism.2 A multivalent or polyvalent vaccine is designed to immunize against two or more strains of the same microorganism, or against two or more microorganisms.3 Developing immunity The immune system recognizes vaccine agents as foreign, destroys them, and 'remembers' them. When the virulent version of an agent comes along the body recognises the protein coat on the virus, and thus is prepared to respond, by 1 neutralizing the target agent before it can enter cells, and 2 by recognizing and destroying infected cells before that agent can multiply to vast numbers. Vaccines have contributed to the eradication of smallpox, one of the most contagious and deadly diseases known to man. Other diseases such as rubella, polio, measles, mumps, chickenpox, and typhoid are nowhere near as common as they were just a hundred years ago. As long as the vast majority of people are vaccinated, it is much more difficult for an outbreak of disease to occur, let alone spread. This effect is called herd immunity. Polio, which is transmitted only between humans, is targeted by an extensive eradication campaign that has seen endemic polio restricted to only parts of four countries.2 The difficulty of reaching all children as well as cultural misunderstandings, however, have caused the eradication date to be missed several times. Schedule Main article: Vaccination schedule See also: Vaccination policy In order to provide best protection, children are recommended to receive vaccinations as soon as their immune systems are sufficiently developed to respond to particular vaccines, with additional 'booster' shots often required to achieve 'full immunity'. This has led to the development of complex vaccination schedules. In the United States, the Advisory Committee on Immunization Practices, which recommends schedule additions for the Center for Disease Control, recommends routine vaccination of children against: hepatitis A, hepatitis B, polio, mumps, measles, rubella, diphtheria, pertussis, tetanus, HiB, chicken pox, rotavirus, influenza, meningococcal disease and pneumonia. The large number of vaccines and boosters recommended up to 24 injections by age two has led to problems with achieving full compliance. In order to combat declining compliance rates, various notification systems have been instituted and a number of combination injections are now marketed e.g., Prevnar and ProQuad vaccines, which provide protection against multiple diseases. Besides recommendations for infant vaccinations and boosters, many specific vaccines are recommended at other ages or for repeated injections throughout life -- most commonly for measles, tetanus, influenza, and pneumonia. Pregnant women are often screened for continued resistance to rubella. The human papillomavirus vaccine is currently recommended in the U.S. and UK for ages 11-25. Vaccine recommendations for the elderly concentrate on pneumonia and influenza, which are more deadly to that group. In 2006, a vaccine was introduced against shingles, a disease caused by the chicken pox virus, which usually affects the elderly. In Australia, a massive increase in vaccination rates was observed when the federal government made certain benefits such as the universal 'Family Allowance' welfare payments for parents of children dependent on vaccination. As well, children were not allowed into school unless they were either vaccinated or their parents completed a statutory declaration refusing to immunize them, after discussion with a doctor, and other bureaucracy. Similar school-entry vaccination regulations have been in place in some parts of Canada for several years. It became easier and cheaper to vaccinate one's children than not to. When faced with the annoyance, many more casual objectors simply gave in.citation needed Efficacy Vaccines do not guarantee complete protection from a disease. Sometimes this is because the host's immune system simply doesn't respond adequately or at all. This may be due to a lowered immunity in general diabetes, steroid use, HIV infection or because the host's immune system does not have a B-cell capable of generating antibodies to that antigen. Even if the host develops antibodies, the human immune system is not perfect and in any case the immune system might still not be able to defeat the infection. Adjuvants are typically used to boost immune response. Adjuvants are sometimes called the dirty little secret of vaccines 3 in the scientific community, as not much is known about how adjuvants work. Most often aluminium adjuvants are used, but adjuvants like squalene are also used in some vaccines and more vaccines with squalene and phosphate adjuvants are being tested. The efficacy or performance of the vaccine is dependent on a number of factors: the disease itself for some diseases vaccination performs better than for other diseases the strain of vaccine some vaccinations are for different strains of the disease 4 whether one kept to the timetable for the vaccinations see Vaccination schedule some individuals are 'non-responders' to certain vaccines, meaning that they do not generate antibodies even after being vaccinated correctly other factors such as ethnicity or genetic predisposition When a vaccinated individual does develop the disease vaccinated against, the disease is likely to be milder than without vaccination. The following are important considerations in the effectiveness of a vaccination program:citation needed careful modelling to anticipate the impact that an immunisation campaign will have on the epidemiology of the disease in the medium to long term ongoing surveillance for the relevant disease following introduction of a new vaccine and maintaining high immunisation rates, even when a disease has become rare. In 1958 there were 763,094 cases of measles and 552 deaths in the United States.45 With the help of new vaccines, the number of cases dropped to fewer than 150 per year median of 56.5 In early 2008, there were 64 suspected cases of measles. 54 out of 64 infections were acquired outside of the United States, and 63 of 64 either had never been vaccinated against measles, or were uncertain whether they had been vaccinated.5 Types of vaccine developments This section does not cite any references or sources. Please help improve this section by adding citations to reliable sources. June 2008 Rational attenuation Specific modifications or deletions of genes that confer virulence removes the pathogenicity of the microbe while still allowing an immune response to be generated. This type of rational attenuation can be viewed as creating a live attenuated vaccine. Vector-mediated subunit delivery Introducing a non-infectious, non-pathogenic subunit into a live vector can prompt an immune response without presence of the pathogen. This is called vector-mediated subunit delivery. For example, rabies surface protein gene has been inserted into vaccinia virus. Virus-like particles Capsid proteins of icosahedral viruses assemble without the presence of a genome. These virus-like particles are antigenically authentic, but non-infectious. This has been used for HPV-16 and HPV-18 vaccines. Controversy James Gillray, The Cow-Pock-or-the Wonderful Effects of the New Inoculation! 1802 James Gillray, The Cow-Pock-or-the Wonderful Effects of the New Inoculation! 1802 Main article: Vaccine controversy Opposition to vaccination, from a wide array of vaccine critics, has existed since the earliest vaccination campaigns.6 Disputes have arisen over the morality, ethics, effectiveness, and safety of vaccination. The mainstream medical opinion is that the benefits of preventing suffering and death from serious infectious diseases greatly outweigh the risks of rare adverse effects following immunization.78 Some vaccination critics say that vaccines are ineffective against disease9 or that vaccine safety studies are inadequate.89 Some religious groups oppose vaccination as a matter of doctrine,10 and some political groups oppose mandatory vaccination on the grounds of individual liberty.6 Economics of development One challenge in vaccine development is economic: many of the diseases most demanding a vaccine, including HIV, malaria and tuberculosis, exist principally in poor countries. Pharmaceutical firms and biotech companies have little incentive to develop vaccines for these diseases, because there is little revenue potential. Even in more affluent countries, financial returns usually minimal and the risks are great.11 Most vaccine development to date has relied on 'push' funding by government, universities and non-profit organizations.citation needed Many vaccines have been highly cost effective and beneficial for public health.11 The number of vaccines actually administered has risen dramatically in recent decades. This increase, particularly in the number of different vaccines administered to children before entry into schools may be due to government mandates and support, rather than economic incentive.citation needed Many researchers and policymakers are calling for a different approach, using 'pull' mechanisms to motivate industry. Mechanisms such as prizes, tax crs, or advance market commitments could ensure a financial return to firms that successfully developed a HIV vaccine. If the policy were well-designed, it might also ensure people have access to a vaccine if and when it is developed.citation needed Intellectual property Intellectual property can also be viewed as an obstacle to the development of new vaccines. Because of the weak protection offered through the patent of the final product, the protection of the innovation regarding vaccines is often made through the patent of processes used on the development of new vaccines as well as the protection of secrecy.12 Preservatives Many vaccines need preservatives to prevent serious adverse effects such as the Staphylococcus infection that in one 1928 incident killed 12 of 21 children inoculated with a diphtheria vaccine that lacked a preservative.13 Several preservatives are available, including thiomersal, 2-phenoxyethanol, and formaldehyde. Thiomersal is more effective against bacteria, has better shelf life, and improves vaccine stability, potency, and safety, but in the U.S., the European Union, and a few other affluent countries, it is no longer used as a preservative in childhood vaccines, as a precautionary measure due to its mercury content.14 Controversial claims have been made that thiomersal contributes to autism; no convincing scientific evidence supports these claims.15 Delivery systems There are several new delivery systems in development, which will hopefully make vaccines more efficient to deliver. Possible methods include liposomes and ISCOM16 immune stimulating complex. Plasmids The use of plasmids has been validated in preclinical studies as a protective vaccine strategy for cancer and infectious diseases. However, the crossover application into human studies has been met with poor results based on the inability to provide clinically relevant benefit. The overall efficacy of plasmid DNA immunization depends on increasing the plasmid's immunogenicity while also correcting for factors involved in the specific activation of immune effector cells. 17 Use in nonhumans See also: Influenza vaccine#Flu vaccine for nonhumans and Vaccination of dogs Vaccinations of animals are used both to prevent their contracting diseases and to prevent transmission of disease to humans. Both animals kept as pets and animals raised as stock are vaccinated. In some instances, wild populations may be vaccinated. This is sometimes accomplished with vaccine-laced food spread in a disease-prone area and has been used to attempt to control rabies in raccoons. Where rabies occurs, rabies vaccination of dogs may be required by law. Other canine vaccines include canine distemper, canine parvovirus, canine hepatitis virus, adenovirus-2, leptospirosis, bordatella, canine parainfluenza virus, and Lyme disease among others. See also Influenza vaccine Immune system OPV AIDS hypothesis, a refuted hypothesis that the AIDS pandemic emerged from polio vaccine manufacture. Immunology Immunization Inoculation Bacterin TA-CD, a vaccine which negates the effects of cocaine The Horse Named Jim Virosomes Vaccination List of vaccine topics References ^ 1 ^ Monovalent at Dorland's Medical Dictionary ^ Polyvalent vaccine at Dorlands Medical Dictionary ^ Orenstein WA, Papania MJ, Wharton ME May 2004. Measles elimination in the United States. J. Infect. Dis. 189 Suppl 1: S1-3. PMID 15106120. ^ a b c Measles--United States, January 1-April 25, 2008 May 2008. MMWR Morb. Mortal. Wkly. Rep. 57 18: 494-8. PMID 18463608. ^ a b Wolfe R, Sharp L 2002. Anti-vaccinationists past and present. BMJ 325 7361: 430-2. doi:10.1136/bmj.325.7361.430. PMID 12193361. ^ Bonhoeffer J, Heininger U 2007. Adverse events following immunization: perception and evidence. Curr Opin Infect Dis 20 3: 237-46. doi:10.1097/QCO.0b013e32811ebfb0. PMID 17471032. ^ a b Demicheli V, Jefferson T, Rivetti A, Price D 2005. Vaccines for measles, mumps and rubella in children. Cochrane Database Syst Rev 19 4. doi:10.1002/14651858.CD004407.pub2. PMID 16235361. Lay summary - Cochrane press release PDF 2005-10-19. ^ a b Halvorsen R 2007. The Truth about Vaccines. Gibson Square. ISBN 9781903933923. ^ White AD 1896. Theological opposition to inoculation, vaccination, and the use of anæsthetics, A History of the Warfare of Science with Theology in Christendom. New York: Appleton. Retrieved on 2007-08-17. ^ a b Goodman, Jesse L. 2005-05-04. Statement of Jesse L. Goodman, M.D., M.P.H. Director, Center for Biologics, Evaluation and Research Before the Committee on Energy and Commerce United States House of Representatives. Retrieved on 2008-06-15. ^ Hardman Reis T 2006. The role of intellectual property in the global challenge for immunization. J World Intellect Prop 9 4: 413-25. doi:10.1111/j.1422-2213.2006.00284.x. ^ Thimerosal in vaccines. Center for Biologics Evaluation and Research, U.S. Food and Drug Administration 2007-09-06. Retrieved on 2007-10-01. ^ Bigham M, Copes R 2005. Thiomersal in vaccines: balancing the risk of adverse effects with the risk of vaccine-preventable disease. Drug Saf 28 2: 89-101. doi:10.2165/00002018-200528020-00001. PMID 15691220. ^ Offit PA 2007. Thimerosal and vaccines-a cautionary tale. N Engl J Med 357 13: 1278-9. doi:10.1056/NEJMp078187. PMID 17898096. ^ Advanced Drug Delivery Reviews, 2004 Vol. 56 No. 10 1367-1382 Morein, B., Hu KeFei, Abusugra, I ^ Lowe et al 2008. Plasmid DNA as Prophylactic and Therapeutic vaccines for Cancer and Infectious Diseases, Plasmids: Current Research and Future Trends. Caister Academic Press. ISBN 978-1-904455-35-6. External links Vaccines and Antisera at the Open Directory Project Immunization. MedlinePlus. U.S. National Library of Medicine 2007-12-27. Retrieved on 2008-01-14. VIOLIN: Vaccine Investigation and Online Information Network v d e Vaccines, Vaccination, Immunization, and Inoculation see also artificial induction of immunity Development Adjuvants Cancer vaccines DNA vaccination HIV Live vector vaccine Models Timeline Trial Administration Global: GAVI Policy Schedule Vaccine injury USA: ACIP VAERS VSD Vaccine court Vaccines live Anthrax BCG tuberculosis Flu MMR MMRV PolioOPV Rotavirus Smallpox Varicella Yellow fever Inactivated/toxoid inactivated virus: Flu HAV PolioIPV inactivated bacteria/toxoid: DTwP conjugate: Hib PCV Other subunit: Anthrax DTaP HPV recombinant DNA: HBV other: Anthrax PPV Controversy General A-CHAMP MMR NCVIA Pox party SafeMinds Thiomersal See also List of vaccine topics Epidemiology Eradication of infectious diseases v d e Major drug groups Gastrointestinal tract/metabolism A stomach acid Antacids, H2 antagonists, Proton pump inhibitors Antiemetics Laxatives Antidiarrhoeals/Antipropulsives Anti-obesity drugs Anti-diabetics Vitamins Dietary minerals Blood and blood forming organs B Antithrombotics Anticoagulants, Antiplatelets, Thrombolytics Antihemorrhagics Cardiovascular system C cardiac therapy/antianginals Cardiac glycosides, Antiarrhythmics, Cardiac stimulant Antihypertensives Diuretics Vasodilators Beta blockers renin-angiotensin system ACE inhibitors, Angiotensin II receptor antagonists, Renin inhibitors Antihyperlipidemics Skin D Emollients Cicatrizant Antipruritics Reproductive system G Hormonal contraception Fertility agents SERMs Sex hormones Endocrine system H Corticosteroids Sex hormones Thyroid hormones Antithyroid agent Infections and infestations J, P Antibiotics Antivirals Vaccines Antifungals Antiparasitic Antiprotozoals, Anthelmintics Malignant and immune disease L Anticancer agents Immunostimulators Immunosuppressants Muscles, bones, and joints M Anabolic steroids Anti-inflammatories NSAID Antirheumatics Corticosteroids Muscle relaxants Brain and nervous system N Anesthetics General, Local Analgesics Anticonvulsants Mood stabilizers Psycholeptic Anxiolytics, Antipsychotics, Hypnotics/Sedatives Psychoanaleptic Antidepressants, Stimulants/Psychostimulants Respiratory system R Bronchodilators Decongestants H1 antagonists Other ATC V Antidotes Contrast media Radiopharmaceuticals Dressing Retrieved from http://en..org/wiki/Vaccine Categories: Virology | Vaccination | Infectious diseases | Microbiology | ImmunologyHidden categories: Articles to be expanded since August 2008 | All articles to be expanded | All articles with statements | Articles with statements since January 2008 | Articles needing additional references from June 2008 | Articles with statements since June 2008 Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Türkçe العربية Avañe'ẽ Català Česky Dansk Deutsch Español Esperanto Ù?ارسی Français Furlan í•œêµì–´ Bahasa Indonesia Italiano עברית Nederlands 日本語 ‪Norsk bokmÃ¥l‬ ‪Norsk nynorsk‬ Polski Português Română РуÑ?Ñ?кий SlovenÄ?ina SlovenÅ¡Ä?ina Suomi తెలà±?à°—à±? ไทย Tiếng Việt УкраїнÑ?ька ä¸æ–‡ This page was last modified on 6 September 2008, at 23:27
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