Vaccine resistance

Vaccine resistance is the evolutionary adaptation of pathogens to infect and spread through vaccinated individuals, analogous to antimicrobial resistance. It concerns both human and animal vaccines. Although the emergence of a number of vaccine resistant pathogens has been well documented, this phenomenon is nevertheless much more rare and less of a concern than antimicrobial resistance.

Vaccine resistance may be considered a special case of immune evasion, from the immunity conferred by the vaccine. Since the immunity conferred by a vaccine may be different from that induced by infection by the pathogen, the immune evasion may also be easier (in case of an inefficient vaccine) or more difficult (would be the case of the universal flu vaccine). We speak of vaccine resistance only if the immune evasion is a result of evolutionary adaptation of the pathogen (and not a feature of the pathogen that it had before any evolutionary adaptation to the vaccine) and the adaptation is driven by the selective pressure induced by the vaccine (this would not be the case of an immune evasion that is the result of genetic drift that would be present even without vaccinating the population).

Some of the causes advanced for less frequent emergence of resistance are[1][2] that

  • vaccines are mostly used for prophylaxis, that is before infection occurs, and usually act to suppress the pathogen before the host becomes infectious
  • most vaccines target multiple antigenic sites of the pathogen
  • different hosts may produce different immune responses to the same pathogen

For diseases that confer long lasting immunity after exposure, typically childhood diseases, it was argued that a vaccine may provide the same immune response as natural infection, so it is expected that there should be no vaccine resistance.[3][4]

If vaccine resistance emerges the vaccine may retain some level of protection against serious infection, possibly by modifying the immune response of the host away from immunopathology.[5]

The best known cases of vaccine resistance are for the following diseases

Other less documented cases are for avian influenza,[24] avian reovirus,[25] Corynebacterium diphtheriae,[26] feline calicivirus,[27] H. influenzae,[28] infectious bursal disease virus,[29] Neisseria meningitidis,[30] Newcastle disease virus,[31] and porcine circovirus type 2.[32]

References

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  2. Kennedy, David A.; Read, Andrew F. (2018-12-18). "Why the evolution of vaccine resistance is less of a concern than the evolution of drug resistance". Proceedings of the National Academy of Sciences. 115 (51): 12878–12886. doi:10.1073/pnas.1717159115. PMC 6304978. PMID 30559199.
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  7. Read, Andrew F.; Baigent, Susan J.; Powers, Claire; Kgosana, Lydia B.; Blackwell, Luke; Smith, Lorraine P.; Kennedy, David A.; Walkden-Brown, Stephen W.; Nair, Venugopal K. (2015-07-27). "Imperfect Vaccination Can Enhance the Transmission of Highly Virulent Pathogens". PLOS Biology. 13 (7): e1002198. doi:10.1371/journal.pbio.1002198. ISSN 1545-7885. PMC 4516275. PMID 26214839.
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  12. Cecchinato, Mattia; Catelli, Elena; Lupini, Caterina; Ricchizzi, Enrico; Clubbe, Jayne; Battilani, Mara; Naylor, Clive J. (2010-11-20). "Avian metapneumovirus (AMPV) attachment protein involvement in probable virus evolution concurrent with mass live vaccine introduction". Veterinary Microbiology. 146 (1–2): 24–34. doi:10.1016/j.vetmic.2010.04.014. ISSN 0378-1135. PMID 20447777.
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  15. Brueggemann, Angela B.; Pai, Rekha; Crook, Derrick W.; Beall, Bernard (2007-11-16). "Vaccine Escape Recombinants Emerge after Pneumococcal Vaccination in the United States". PLOS Pathogens. 3 (11): e168. doi:10.1371/journal.ppat.0030168. ISSN 1553-7374. PMC 2077903. PMID 18020702.
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  23. Safarchi, Azadeh; Octavia, Sophie; Luu, Laurence Don Wai; Tay, Chin Yen; Sintchenko, Vitali; Wood, Nicholas; Marshall, Helen; McIntyre, Peter; Lan, Ruiting (2015-11-17). "Pertactin negative Bordetella pertussis demonstrates higher fitness under vaccine selection pressure in a mixed infection model". Vaccine. 33 (46): 6277–6281. doi:10.1016/j.vaccine.2015.09.064. ISSN 0264-410X. PMID 26432908.
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