Pre-Clinical Evaluation of a Novel Nanoemulsion-Based Hepatitis B Mucosal Vaccine

Hepatitis B virus infection remains an important global health concern despite the availability of safe and effective prophylactic vaccines. Limitations to these vaccines include requirement for refrigeration and three immunizations thereby restricting use in the developing world. A new nasal hepatitis B vaccine composed of recombinant hepatitis B surface antigen (HBsAg) in a novel nanoemulsion (NE) adjuvant (HBsAg-NE) could be effective with fewer administrations.Physical characterization indicated that HBsAg-NE consists of uniform lipid droplets (349+/-17 nm) associated with HBsAg through electrostatic and hydrophobic interactions. Immunogenicity of HBsAg-NE vaccine was evaluated in mice, rats and guinea pigs. Animals immunized intranasally developed robust and sustained systemic IgG, mucosal IgA and strong antigen-specific cellular immune responses. Serum IgG reached > or = 10(6) titers and was comparable to intramuscular vaccination with alum-adjuvanted vaccine (HBsAg-Alu). Normalization showed that HBsAg-NE vaccination correlates with a protective immunity equivalent or greater than 1000 IU/ml. Th1 polarized immune response was indicated by IFN-gamma and TNF-alpha cytokine production and elevated levels of IgG(2) subclass of HBsAg-specific antibodies. The vaccine retains full immunogenicity for a year at 4 degrees C, 6 months at 25 degrees C and 6 weeks at 40 degrees C. Comprehensive pre-clinical toxicology evaluation demonstrated that HBsAg-NE vaccine is safe and well tolerated in multiple animal models.Our results suggest that needle-free nasal immunization with HBsAg-NE could be a safe and effective hepatitis B vaccine, or provide an alternative booster administration for the parenteral hepatitis B vaccines. This vaccine induces a Th1 associated cellular immunity and also may provide therapeutic benefit to patients with chronic hepatitis B infection who lack cellular immune responses to adequately control viral replication. Long-term stability of this vaccine formulation at elevated temperatures suggests a direct advantage in the field, since potential excursions from cold chain maintenance could be tolerated without a loss in therapeutic efficacy

Foundations in Microbiology

XX, 916 tr. ; 28 cm

Foundations in microbiology

1 v. (various pagings) : col. ill. ; 29 cm

Foundations in microbiology: basic principles

xvi, 534 p.ill.,25 cm

Delirium og forebygging

Høy alder fører til redusert evne til å mestre stressfaktorer som oppstår i det postoperative forløp. Dette fører igjen til at pasienten er i risiko for å utvikle postoperativ delirium. Helsepersonellet sin oppgave er å forebygge at denne tilstanden oppstår, da delirium relateres til høy dødelighet, økt liggetid på sykehus og feildiagnostisering. For å kunne forebygge at postoperativ delirium oppstår, er økt kunnskap om tilstanden sentralt. Hensikten med denne oppgaven er å tilegne kunnskap om delirium og hvordan sykepleieren kan iverksette tiltak for å forebygge at tilstanden oppstår. Oppgaven er basert på litteraturstudie, der relevant litteratur for problemstillingen er blitt benyttet. Funnene viser at kunnskaper om delirium er det mest sentrale aspektet for å kunne forebygge at postoperativ delirium oppstår. Tiltak som er viktige i et forebyggende arbeid er å observere og bruke screening verktøyet Mini-Cog i det preoperative og CAM i det postoperative, for å identifisere risikofaktorer den eldre pasienten er utsatt for. Videre ser vi at kommunikasjon er et viktig moment i det forebyggende arbeidet. Likevel ser man at blant annet tidspress hos sykepleiere fører til utfordringer for å kunne imøtekomme pasientens behov

Foundations in microbiology

xvii.834hal.;23x27.5c