leprosy vaccines by aseem final
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HANSEN’S DISEASE : IMMUNOPROPHYLAXIS &IMMUNOTHERAPY
Introduction
• Vaccine : Lat ‘ La Vaccha’ – ‘Cow’
• Chronic infectious disorder with long, variable incubation period and high generation time
• Immunomodulators regulate immune system prevent Neuritis / Reactions to live / dead bacilli with Chemotherapy targeted at live bacilli
Immunoprophylaxis
• Enhance Host Immunity to control infection by provoking protective repsonse to AGs
Types of Vaccines :
• Killed (No inf / high Antigenicity)• Live, Attenuated (Low Virulence / High AG – natural
history)• Cross-reacting AGs ; Non-pathogenic• Immunogenic Subunits
Vaccines in use
• BCG
• HKML / HKML-A
• Mw
• M vaccae
• ICRC
BCG
• 20th C ; used for immunization in cattle / humans against Mtb
• Live, Attenuated
• M bovis derivative
• Modest response alone
• may prevent BT / BB
• Used with HKML / HKML-A to increase AG and initiate protective response
Mw
• M welchii - HK
• Mycobacterium indica praNII
• cultivable Non-pathogenic Mycobacterium used for Cross-sensitization
• Shares AG with ML / Mtb (65/18/13 kDa)
M vaccae
• Derived from cowdung
• HK
• Cultivable non-pathogenicbacteria with shared AG
• Commercially available
ICRC bacillus
• Indigenous, HK
• Cultivable MAIC or from Leprosy patients
• HMW Glycolipoprotein PP-I Sonicated Subunit vaccine in Ph I / II Clincial trials In India
• aa
Immunotherapy
• Addition of Immunomodulators and Cross-reacting antigens to regulate host immunity and achieve :-
– Higher Bacillary Clearance (Viable / Dead)– Reduce Incidence and severity of Reactions /
Neuritis– Restore effective immunity prevent relapses and
re-infection– Reduce duration of treatment– Lepromin conversion
Classification
• Antigenically-related Mycobacteria with shared Ags (BCG/HKML/Mw/ICRC/M vaccae, habana, gordonnae, phlei)
• Drugs (Levamisole/Corticosteroids/Zinc/Clofazimine/Colchicine/Thalidomide/CsA)
• Other Immunomodulators (Transfer Factor/CK-Ils/AA-ML/DCC/CWC)
BCG• Maiden Immunomodulator
• 0.1 ml ID at 0-6-12-18-24 months with MB-MDT in LL patients
• Lepromin Conversion / Smear negativity / fall in BI / faster granuloma clearance
• No change in Reactional severity / incidence
• BCG + HKML = Beneficial in Indeterminate Hansen’s / LL / Household contacts with Histological Upgradation
Mw
• HK preparation with MB-MDT @ 0.1 mL ID (5 x 109 bacilli) as 1st dose 0.05 mL ID every 03 months (Total = 08 doses) in BL/LL patients
• Reduction in BI / MI, Granuloma resolution, Smear Negativity @ 52 months, reduction in ENL incidence
• ICRC + MB-MDT Lepromin Conversion with RRs reported
• Other Cross-Sensitizing cultivable Mycobacterium species viz gordonnae / habana / phlei are being studied
LEVAMISOLE
• Broad-spectrum Anthelminthic
• Regulates defective T-cell function
• 150 mg 2 /wk PO x 06 wks Pt on DDS 100 mg daily for 05 years showed Smear Negativity in 01 yr
ZINC
• Immunomodulator for LL / ENL
• Inhibits complement-dependent Immune complex formation / PMN chemotaxis
• Faster clinical improvement, reversal of Madarosis, histological upgradation with DDS as compared to DDS alone
Other Drugs
• Corticosteroids
• Thalidomide
• CsA
• Clofazimine
• Colchicine
• AZA
Other Immunomodulators
• LAWRENCE’S TRANSFER FACTOR transient
• CYTOKINES (IFN-G / IL-2) I/L ; local effect
• ACETO-ACETYLATED ML (AA)
• DE-LIPIDIFED CELL COMPONENTS ML (DCC)
• SOLUBLE PROTEIN CELL WALL COMPONENT (SPC)
• ISOLATED CELL WALL CORE AG (CWC)
THANK YOU