Oral vaccination – can adjuvants improve immunity?

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Since its inception, vaccination has proven to be one of the most significant medical accomplishments and is undoubtedly the most effective intervention by which to prevent or limit the spread of disease. While the practice itself can be traced back to China as early as the 15th century under the guise of variolation, it was the pioneering studies of Edward Jenner and Louis Pasteur in the late 18th and 19th centuries respectively that laid the foundations for the modern day field of vaccinology. Subsequent work by Ramon, Glenny and others paved the way for research into immune-stimulatory compounds, now referred to as adjuvants.

Glenny’s seminal observation in 1926 that aluminium salts possessed immune-potentiating properties has been fundamental in the development of several efficacious vaccines. Indeed alum is the adjuvant component of choice in several licensed vaccines, including those against diphtheria–pertussis–tetanus and HPV, and up until very recently persisted as the only US FDA-approved adjuvant for use in human vaccines. In fact it is only within the last decade that licensure has been expanded to include alternative adjuvant systems including AS04 – a combination of alum and monophosphoryl lipid A – and MF59® – an oil in water emulsion of squalene oil – which are components of the FDA approved HPV and influenza vaccines – Cervarix™ and FLUAD™ – respectively.

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