Topic Editors

1. Department of Medicine and Sciences of Aging, University “G. D’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy
2. Internal Medicine, School of Medicine, UniCamillus, Saint Camillus International University of Health Sciences, 00131 Rome, Italy
Retired, Dipartimento di Medicina Clinica e Molecolare, Sapienza Università di Roma, AOU S. Andrea, Via di Grottarossa 1035-1039, 00189 Roma, Italy

Advances in Vaccines and Antimicrobial Therapy

Abstract submission deadline
closed (30 July 2023)
Manuscript submission deadline
closed (30 December 2023)
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12263

Topic Information

Dear Colleagues,

The fields of prevention and treatment of infectious diseases have been gaining momentum after the strike of the coronavirus pandemic, with several advances both in vaccine technology and in the development of new antimicrobials. The usefulness of monoclonal antibodies has been tested, along with several old and new compounds with antiviral activity, but the search for new avenues, combining diverse strategies and reexamining older drugs for potential new activities, is quickly evolving. Interactions of drugs with the local microbiota, combinations of systemic approaches, targeting immune defense mechanisms together with arresting microbial host invasion, refinements in nano-formulations, drug delivery, rapid genotyping of microorganisms and engineering of bacteriophages in the fight against multidrug resistance are just some of the areas in which breakthrough research is expected to bring significant advances in the near future. The aim of this Topic is to offer an updated view of the advances in all the fields of antimicrobial therapy and prevention. This Topic collection invites contributions of research articles, reviews and metanalyses, exploring the new horizons of antimicrobial therapy and vaccine development. Both in vitro and in vivo studies, field studies and reports, as well as bold new hypotheses based on original observations are also welcome. We as Editors expect both academic research institutions and industry research to be represented in this collection on issues of primary relevance for health systems and individual safety in the near future.

Dr. Roberto Paganelli
Dr. Raffaele D’Amelio
Topic Editors

Keywords

  • drug delivery
  • phage therapy
  • antibiotic resistance
  • antivirals
  • vaccine technology

Participating Journals

Journal Name Impact Factor CiteScore Launched Year First Decision (median) APC
Antibiotics
antibiotics
4.8 5.5 2012 13.7 Days CHF 2900
Biomedicines
biomedicines
4.7 3.7 2013 15.4 Days CHF 2600
Microorganisms
microorganisms
4.5 6.4 2013 15.1 Days CHF 2700
Parasitologia
parasitologia
- - 2021 19.8 Days CHF 1000
Pathogens
pathogens
3.7 5.1 2012 16.4 Days CHF 2700
Vaccines
vaccines
7.8 7.0 2013 19.2 Days CHF 2700

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Published Papers (10 papers)

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13 pages, 936 KiB  
Article
Activity of Epsilon-poly-L-lysine against Multidrug-Resistant Pseudomonas aeruginosa and Klebsiella pneumoniae Isolates of Urinary Tract Infections
by Telma de Sousa, Carolina Sabença, Miguel Ribeiro, Mario Pino-Hurtado, Carmen Torres, Michel Hébraud, Olimpia Alves, Sara Sousa, Eliana Costa, Gilberto Igrejas and Patrícia Poeta
Biomedicines 2024, 12(3), 638; https://doi.org/10.3390/biomedicines12030638 - 13 Mar 2024
Viewed by 742
Abstract
Pseudomonas aeruginosa and Klebsiella pneumoniae are notorious for their resistance to antibiotics and propensity for biofilm formation, posing significant threats to human health. Epsilon-poly-L-lysine (ε-PL) emerges as a naturally occurring antimicrobial poly(amino acid), which positions it as a prospective agent for addressing challenges [...] Read more.
Pseudomonas aeruginosa and Klebsiella pneumoniae are notorious for their resistance to antibiotics and propensity for biofilm formation, posing significant threats to human health. Epsilon-poly-L-lysine (ε-PL) emerges as a naturally occurring antimicrobial poly(amino acid), which positions it as a prospective agent for addressing challenges linked to multidrug resistance. ε-PL symbolizes a promising avenue in the pursuit of efficacious therapeutic strategies and warrants earnest consideration within the realm of clinical treatment. Thus, our objective was to determine the antibiotic susceptibility profiles of 38 selected P. aeruginosa and ESBL-producing K. pneumoniae clinical isolates and determine the ability of ε-PL to inhibit biofilm formation. After PCR analysis, detection of genes related to β-lactamases was observed among the selected isolates of P. aeruginosa [blaSPM (35.7%), blaKPC (35.7%), blaSHV (14.3%), blaCTX-M (14.3%), blaOXA (14.3%), blaTEM (7.1%), blaPER (7.1%), blaVIM (7.1%), and blaVIM-2 (7.1%)] and K. pneumoniae [blaCTX-M (91.7%), blaTEM (83.3%), blaKPC (16.7%), blaNDM (12.5%), and blaOXA (4.2%)]. The results of testing the activity of ε-PL against the clinical isolates showed relatively high minimum inhibitory concentrations (MICs) for the P. aeruginosa (range: 8–64 µg/mL) and K. pneumoniae isolates (range: 16–32 µg/mL). These results suggest the need for prior optimization of ε-PL concerning its viability as an alternative to antibiotics for treating infections caused by P. aeruginosa and K. pneumoniae of clinical origin. It is noteworthy that, in the context of a low antibiotic discovery rate, ε-PL could play a significant role in this quest, considering its low toxicity and the unlikely development of resistance. Upon exposure to ε-PL, P. aeruginosa and K. pneumoniae isolates exhibited a reduction in biofilm production, with ε-PL concentration showing an inverse relationship, particularly in isolates initially characterized as strong or moderate producers, indicating its potential as a natural antimicrobial agent with further research needed to elucidate optimal concentrations and application methods across different bacterial species. Further research is needed to optimize its use and explore its potential in various applications. Full article
(This article belongs to the Topic Advances in Vaccines and Antimicrobial Therapy)
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11 pages, 3020 KiB  
Article
The Stability and Efficency of CPB Cells Were Acclimated for Virus Proliferation
by Yinjie Niu, Saiya Ma, Hongru Liang, Xiaozhe Fu, Baofu Ma, Qiang Lin, Xia Luo and Ningqiu Li
Vaccines 2024, 12(3), 220; https://doi.org/10.3390/vaccines12030220 - 20 Feb 2024
Viewed by 606
Abstract
Background: Vaccinations are still the most effective means of preventing and controlling fish viral diseases, and cells are an important substrate for the production of a viral vaccine. Therefore, the rapid-stable growth and virus sensitivity of cells are urgently needed. Methods: Chinese perch [...] Read more.
Background: Vaccinations are still the most effective means of preventing and controlling fish viral diseases, and cells are an important substrate for the production of a viral vaccine. Therefore, the rapid-stable growth and virus sensitivity of cells are urgently needed. Methods: Chinese perch brain 100th passage (CPB p100) were acclimated in a low serum with 5% FBS L-15 for 50 passages, then transferred to 8% FBS L-15 for 150 passages. Additionally, the morphology and cell type of CPB 300th passage (CPB p300) cells were identified. We analyzed the transfection efficiency and virus sensitivity of CPB p300 cells, and then optimized the conditions of ISKNV, SCRV, and LMBV multiplication in CPB cells. Results: CPB p300 cells were more homogeneous, and the spread diameter (20–30) µm in CPB p300 cells became the dominant population. The doubling time of CPB p300 was 1.5 times shorter than that of CPB p100.However, multiplication rate of CPB p300 was 1.37 times higher than CPB p100. CPB p300 cells were susceptible to ISKNV, SCRV, and LMBV, and the optimal conditions of ISKNV, SCRV, and LMBV multiplication were simultaneous incubation, 0.6 × 105 cells/cm2 and MOI = 0.1; infection at 48 h, 0.8 × 105 cells/cm2 and MOI = 0.01; simultaneous incubation, 0.7 × 105 cells/cm2 and MOI = 0.05, respectively. The time and economic costs of ISKNV, SCRV, and LMBV multiplication in CPB p300 cells were significantly reduced. Conclusions: The acquisition of CPB p300 cells laid a good material foundation for the production of ISKNV, SCRV, and LMBV vaccines. Full article
(This article belongs to the Topic Advances in Vaccines and Antimicrobial Therapy)
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13 pages, 1092 KiB  
Article
Quantitative Analysis of the Instant and Persistent Inhibition Effects of Maternal Poliovirus Antibodies on the Immune Response in a Phase IV Trial of a Sabin Strain-Based Inactivated Poliovirus Vaccine
by Qiongzhou Yin, Yan Zheng, Zhifang Ying, Jingyu Li, Ya Jiang, Wenmei Bao, Youjian Dou, Yi Pu, Jin Lei, Haitao Yang, Ruiju Jiang, Yan Deng, Zhimei Zhao, Jing Pu, Jing Yang, Yadong Li, Min Xu, Wei Cai, Yanchun Che and Li Shi
Vaccines 2024, 12(2), 217; https://doi.org/10.3390/vaccines12020217 - 19 Feb 2024
Viewed by 776
Abstract
Background: An inactivated poliomyelitis vaccine made from Sabin strains (sIPVs) has widely been used in China since 2015. However, the quantitative data on the instant and persistent inhibition effects of maternal poliovirus antibodies on the immune response to sIPV priming and booster vaccination [...] Read more.
Background: An inactivated poliomyelitis vaccine made from Sabin strains (sIPVs) has widely been used in China since 2015. However, the quantitative data on the instant and persistent inhibition effects of maternal poliovirus antibodies on the immune response to sIPV priming and booster vaccination have not been available yet. Objective: In this study, we aim to explore and quantify the instant and persistent inhibition effect of maternal poliovirus antibodies on the immune response elicited by sIPV primary and booster vaccination. Methods: The immunogenicity data consisting of the days 0 and 30 after the prime and booster vaccination of the sIPV in a phase IV trial were pooled for a quantitative analysis of the inhibition effect of maternal poliovirus antibody. The geometric mean ratio (GMR) was calculated using linear regression models, representing that every 2-fold higher maternal poliovirus antibody titer may result in a (1-GMR) lower postimmunization antibody titer. Results: The GMRs for poliovirus types 1, 2, and 3 were 0.79 (0.77–0.82), 0.85 (0.81–0.89), and 0.87 (0.83–0.91) at 30 days after the priming series, 0.86 (0.83–0.89), 0.81 (0.76–0.85), and 0.86 (0.80–0.93) at one year after the priming series, and 0.96 (0.94–0.99), 0.89 (0.86–0.93), and 0.98 (0.93–1.03) at 30 days after the booster dose. The inhibition effect continued to exist until the booster dose 1 year later, and such a persistent inhibition effect was almost attenuated for poliovirus types 1 and 3, and partly reduced for type 2 at 30 days after the booster dose. Conclusion: A wider interval between the four sIPV doses might be a consideration for reducing the effect of maternal antibodies and subsequently eliciting and maintaining higher antibody levels to protect against poliovirus transmission and infection at the final stage of polio eradication in the global world. This study’s clinical trial registry number is NCT04224519. Full article
(This article belongs to the Topic Advances in Vaccines and Antimicrobial Therapy)
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16 pages, 3424 KiB  
Article
Enhanced Downstream Processing for a Cell-Based Avian Influenza (H5N1) Vaccine
by Fang Li, Bo Liu, Yu Xiong, Zhegang Zhang, Qingmei Zhang, Ran Qiu, Feixia Peng, Xuanxuan Nian, Dongping Wu, Xuedan Li, Jing Liu, Ze Li, Hao Tu, Wenyi Wu, Yu Wang, Jiayou Zhang and Xiaoming Yang
Vaccines 2024, 12(2), 138; https://doi.org/10.3390/vaccines12020138 - 29 Jan 2024
Viewed by 1160
Abstract
H5N1 highly pathogenic avian influenza virus (HPAIV) infections pose a significant threat to human health, with a mortality rate of around 50%. Limited global approval of H5N1 HPAIV vaccines, excluding China, prompted the need to address safety concerns related to MDCK cell tumorigenicity. [...] Read more.
H5N1 highly pathogenic avian influenza virus (HPAIV) infections pose a significant threat to human health, with a mortality rate of around 50%. Limited global approval of H5N1 HPAIV vaccines, excluding China, prompted the need to address safety concerns related to MDCK cell tumorigenicity. Our objective was to improve vaccine safety by minimizing residual DNA and host cell protein (HCP). We developed a downstream processing method for the cell-based H5N1 HPAIV vaccine, employing CaptoTM Core 700, a multimodal resin, for polishing. Hydrophobic-interaction chromatography (HIC) with polypropylene glycol as a functional group facilitated the reversible binding of virus particles for capture. Following the two-step chromatographic process, virus recovery reached 68.16%. Additionally, HCP and DNA levels were reduced to 2112.60 ng/mL and 6.4 ng/mL, respectively. Western blot, high–performance liquid chromatography (HPLC), and transmission electron microscopy (TEM) confirmed the presence of the required antigen with a spherical shape and appropriate particle size. Overall, our presented two-step downstream process demonstrates potential as an efficient and cost-effective platform technology for cell-based influenza (H5N1 HPAIV) vaccines. Full article
(This article belongs to the Topic Advances in Vaccines and Antimicrobial Therapy)
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15 pages, 4231 KiB  
Article
Protective MVA-ST Vaccination Robustly Activates T Cells and Antibodies in an Aged-Hamster Model for COVID-19
by Sabrina Clever, Lisa-Marie Schünemann, Federico Armando, Christian Meyer zu Natrup, Tamara Tuchel, Alina Tscherne, Malgorzata Ciurkiewicz, Wolfgang Baumgärtner, Gerd Sutter and Asisa Volz
Vaccines 2024, 12(1), 52; https://doi.org/10.3390/vaccines12010052 - 03 Jan 2024
Viewed by 1280
Abstract
Aging is associated with a decline in immune system functionality. So-called immunosenescence may impair the successful vaccination of elderly people. Thus, improved vaccination strategies also suitable for an aged immune system are required. Modified Vaccinia virus Ankara (MVA) is a highly attenuated and [...] Read more.
Aging is associated with a decline in immune system functionality. So-called immunosenescence may impair the successful vaccination of elderly people. Thus, improved vaccination strategies also suitable for an aged immune system are required. Modified Vaccinia virus Ankara (MVA) is a highly attenuated and replication-deficient vaccinia virus that has been established as a multipurpose viral vector for vaccine development against various infections. We characterized a recombinant MVA expressing a prefusion-stabilized version of SARS-CoV-2 S protein (MVA-ST) in an aged-hamster model for COVID-19. Intramuscular MVA-ST immunization resulted in protection from disease and severe lung pathology. Importantly, this protection was correlated with a potent activation of SARS-CoV-2 specific T-cells and neutralizing antibodies. Our results suggest that MVA vector vaccines merit further evaluation in preclinical models to contribute to future clinical development as candidate vaccines in elderly people to overcome the limitations of age-dependent immunosenescence. Full article
(This article belongs to the Topic Advances in Vaccines and Antimicrobial Therapy)
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23 pages, 4711 KiB  
Review
Amebicides against Acanthamoeba castellanii: The Impact of Organism Models Used in Amebicide Assays
by Leonardo Fernandes Geres, Elena Sartori, João Marcos dos Santos Neves, Danilo Ciccone Miguel and Selma Giorgio
Parasitologia 2024, 4(1), 15-37; https://doi.org/10.3390/parasitologia4010002 - 01 Jan 2024
Viewed by 959
Abstract
Acanthamoeba castellanii is a free-living amoeba capable of causing keratitis in humans, with most cases related to contact lens wearers and surgical procedures. In addition, A. castellanii may cause pneumonia, granulomatous encephalitis, and skin lesions in immunocompromised individuals. Considering the lack of adequate treatment [...] Read more.
Acanthamoeba castellanii is a free-living amoeba capable of causing keratitis in humans, with most cases related to contact lens wearers and surgical procedures. In addition, A. castellanii may cause pneumonia, granulomatous encephalitis, and skin lesions in immunocompromised individuals. Considering the lack of adequate treatment for acanthamoebiasis, the aim of this review is to assess relevant original articles that covered the current arsenal of drugs and models of organisms used in the field of experimental A. castellanii infection that have been published within the last 5 years (2018–2023) in journals indexed by the following databases: Electronic Library Online (SciELO), PubMed, Medical Literature Analysis and Retrieval System Online (Medline), Latin American and Caribbean Literature in Health Sciences (Lilacs), Google Academic, and Capes Periodical Portal. Thirty articles were selected, and the main findings showed that the available therapeutics for acanthamoebiasis are still limited and nonspecific, and no innovations have occurred in the last few years. In terms of novel chemotherapeutic advances, the last findings have focused on the activity of natural products (plant-based extracts), nanoemulsions, coated particles, and photodynamic association against A. castellanii, without advancing from the bench to bedside perspective. The choice of a non-representative model system for acanthamoebiasis, as well as the limitations of studies in vivo, impairs the advancement of toxicity analyses. Efforts should be made to expand the model systems used, standardize tests for evaluating anti-A. castellanii drug candidates, and increase and support research groups focusing on the biology of A. castellanii and the pharmacology of acanthamoebiasis. Full article
(This article belongs to the Topic Advances in Vaccines and Antimicrobial Therapy)
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13 pages, 2765 KiB  
Article
Anti-Hcp1 Monoclonal Antibody Is Protective against Burkholderia pseudomallei Infection via Recognizing Amino Acids at Asp95-Leu114
by Pan Wu, Chenglong Rao, Wenzheng Liu, Ziyuan Zhang, Dongqi Nan, Jiangao Chen, Minyang Wang, Yuan Wen, Jingmin Yan, Juanjuan Yue, Xuhu Mao and Qian Li
Pathogens 2024, 13(1), 43; https://doi.org/10.3390/pathogens13010043 - 31 Dec 2023
Cited by 1 | Viewed by 1172
Abstract
Melioidosis, a severe tropical illness caused by Burkholderia pseudomallei, poses significant treatment challenges due to limited therapeutic options and the absence of effective vaccines. The pathogen’s intrinsic resistance to numerous antibiotics and propensity to induce sepsis during acute infections further complicate management [...] Read more.
Melioidosis, a severe tropical illness caused by Burkholderia pseudomallei, poses significant treatment challenges due to limited therapeutic options and the absence of effective vaccines. The pathogen’s intrinsic resistance to numerous antibiotics and propensity to induce sepsis during acute infections further complicate management strategies. Thus, exploring alternative methods for prevention and treatment is crucial. Monoclonal antibodies (mAbs) have emerged as a promising strategy for the prevention and treatment of infectious diseases. This study focused on generating three mAbs (13F1, 14G11, and 15D9) targeting hemolysin-coregulated protein 1 (Hcp1), a protein involved in the type VI secretion system cluster 1 (T6SS1) of B. pseudomallei. Notably, pretreatment with 13F1 mAb significantly reduced the intracellular survival of B. pseudomallei and inhibited the formation of macrophage-derived multinucleated giant cells (MNGCs). This protective effect was also observed in vivo. We identified a sequence of amino acids (Asp95-Leu114) within Hcp1 as the likely binding site for 13F1 mAb. In summary, our findings reveal that 13F1 mAb counteracts infection by targeting Hcp1, offering potential new targets and insights for melioidosis prevention. Full article
(This article belongs to the Topic Advances in Vaccines and Antimicrobial Therapy)
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4 pages, 652 KiB  
Editorial
Successful Allergen-Specific Immunotherapy: Induction of Unresponsiveness by ‘Vaccination’
by Martin F. Bachmann, Monique Vogel and Daniel E. Speiser
Vaccines 2023, 11(12), 1852; https://doi.org/10.3390/vaccines11121852 - 14 Dec 2023
Viewed by 889
Abstract
The mechanisms of action of allergen-specific immunotherapy (AIT) are often referred to as the induction of ‘tolerance’. However, immunological ‘tolerance’ is defined as an alteration in the function or composition of immune cells. For AIT, this is not always the case, because it [...] Read more.
The mechanisms of action of allergen-specific immunotherapy (AIT) are often referred to as the induction of ‘tolerance’. However, immunological ‘tolerance’ is defined as an alteration in the function or composition of immune cells. For AIT, this is not always the case, because it can also induce allergen-specific IgG antibodies that block allergic responses. To include all possible mechanisms that may mediate successful AIT, it is advantageous to use the scientific term ‘unresponsiveness’ instead of ‘tolerance’. In praxis, the term ‘vaccination’ is also appropriate, as AIT medications are specialized vaccines. Full article
(This article belongs to the Topic Advances in Vaccines and Antimicrobial Therapy)
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13 pages, 570 KiB  
Article
Pathotypes and Phenotypic Resistance to Antimicrobials of Escherichia coli Isolates from One-Day-Old Chickens
by Katerina Nedbalcova, Jaroslav Bzdil, Aneta Papouskova, Monika Zouharova, Katarina Matiaskova, Kamil Stastny, Vladimir Sladecek, David Senk, Matej Petr and Petr Stolar
Pathogens 2023, 12(11), 1330; https://doi.org/10.3390/pathogens12111330 - 08 Nov 2023
Cited by 1 | Viewed by 865
Abstract
The aim of this work was to describe the pathotypes of Escherichia coli strains isolated from one-day-old chickens, as well as the occurrence of resistance and multidrug resistance (MDR) in these strains. A total of 429 mixed swabs from 4290 one-day-old chicks were [...] Read more.
The aim of this work was to describe the pathotypes of Escherichia coli strains isolated from one-day-old chickens, as well as the occurrence of resistance and multidrug resistance (MDR) in these strains. A total of 429 mixed swabs from 4290 one-day-old chicks were examined between August 2021 and July 2023 (24 months) during routine point-of-destination inspections at 12 poultry farms in the Czech Republic. All samples were processed via cultivation methods using meat-peptone blood agar and Mc Conkey agar under aerobic conditions at 37 ± 1 °C for 18–24 h. The identification of the strains was performed using MALDI-TOF mass spectrometry. All confirmed strains of E. coli were screened via single or multiplex PCRs for the presence of genes encoding the virulence-associated factors iroN, cvaC, iss, felA, iutA, frz and tsh. Antimicrobial susceptibility tests were performed using the minimal inhibitory concentration (MIC) method, focusing on ampicillin, cefotaxime, tetracycline, doxycycline, enrofloxacin, florfenicol, amoxicillin with clavulanic acid and trimethoprim with sulfamethoxazole. A total of 321 E. coli strains (prevalence of 74.8%) were isolated, and 300 isolates were defined as avian pathogenic strains of E. coli (APEC) via multiplex PCR. Based on the defined virulence genes, the isolates were classified into 31 pathotypes. A total of 15.9% of the tested isolates were susceptible to all the tested antimicrobials. On the other hand, 20.5% of the isolates were identified as multidrug-resistant (8.7% of isolates were resistant to three antimicrobials, 7.3% to four antimicrobials, 3.6% to five antimicrobials and 0.9% to six antimicrobials). Monitoring pathogenic strains of E. coli in different animals and in the environment makes it possible to understand their spread in animal and human populations and, at the same time, reveal the sources of virulence and resistance genes. Full article
(This article belongs to the Topic Advances in Vaccines and Antimicrobial Therapy)
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14 pages, 262 KiB  
Article
Development of a Novel Canine Parvovirus Vaccine Capable of Stimulating Protective Immunity in Four-Week-Old Puppies in the Face of High Levels of Maternal Antibodies
by Jacqueline Pearce, Norman Spibey, David Sutton and Ian Tarpey
Vaccines 2023, 11(9), 1499; https://doi.org/10.3390/vaccines11091499 - 18 Sep 2023
Cited by 2 | Viewed by 2632
Abstract
Many highly effective vaccines have been developed to protect dogs against disease caused by canine parvovirus, but despite this vaccine interference by maternally derived antibodies continues to cause immunisation failure. To help overcome this limitation we have developed a novel, recombinant canine parvovirus [...] Read more.
Many highly effective vaccines have been developed to protect dogs against disease caused by canine parvovirus, but despite this vaccine interference by maternally derived antibodies continues to cause immunisation failure. To help overcome this limitation we have developed a novel, recombinant canine parvovirus type 2c vaccine strain, based on the structural and non-structural elements of an established type 2 vaccine. This novel CPV-2c vaccine strain has unique efficacy in the field, it is able to induce sterilising immunity in naïve animals 3 days after vaccination and is able to overcome very high levels of maternally derived antibodies from 4 weeks of age—thus closing the immunity gap to canine parvovirus infection in young puppies. The vaccine strain, named 630a, has been combined with an established canine distemper virus Onderstepoort vaccine strain to produce a new bivalent vaccine (Nobivac DP PLUS), intended to immunise very young puppies in the face of high levels of maternally derived antibody. Here, we describe the onset of immunity and maternal antibody interference studies that support the unique efficacy of the strain, and present overdose studies in both dogs and cats that demonstrate the vaccine to be safe. Full article
(This article belongs to the Topic Advances in Vaccines and Antimicrobial Therapy)
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