Global Conference on
April 13-15, 2015, Dubai, UAE

Scientific Programme(Day 1 : Apr-13-2015)

Keynote Forum

Giulio Tarro
Temple University Center for Biotechnology, USA
keynote: Vaccine research and development in oncology
Giulio Tarro graduated from Medicine School, Naples University (1962). Research Associate, Division of Virology and Cancer Research, Children’s Hospital (1965-1968), Assistant Professor of Research Pediatrics, College Medicine (1968-1969), Cincinnati University, Ohio. Oncological Virology Professor, Naples University (1972-1985). Chief Division Virology (1973-2003), Head Department Diagnostic Laboratories, (2003-2006). D. Cotugno Hospital for Infectious Diseases, Naples; Emeritus, 2006 -. Since 2007 Chairman Committee of Biotechnologies and VirusSphere, World Academy Biomedical Technologies, UNESCO, Adjunct Professor Department Biology, Temple University, College of Science and Technology, Philadelphia, recipient of the Sbarro Health Research Organization lifetime achievement award (2010). President Foundation de Beaumont Bonelli for Cancer Research.

There are at least two antiviral cancer vaccines: 1) anti-HBV vaccine was found to prevent some liver tumors. 2) anti-HPV vaccine is able to prevent most of the cervical cancers, the second cause of cancer death for woman in the world.
Tumor associated antigens (TAA) were studied in SV40 and Polyoma viruses that were patterns for human cancer. Cancer immunotherapy, or the manipulation of the naturally occurring oncolytic immune reaction, is based on the observation that both in animals and humans neoplastic cell antigens stimulate the onset of specific humoral and cellular antibodies. Antigens, from autologous and homolougus human cancer cells, were obtained by various purification procedures. Tumor Liberated Protein (TLP) is a protein extracted from tumors and from cultured transformed cells, detectable in blood as well as in cancer tissue. It behaves as a TAA of 50KD monomer, overexpressed in lung tumor and other epithelial adenocarcinomas. TLP is immunogenic in humans as evidenced by serum antibodies. When TLP is extracted from a tumor, purified in the laboratory, and reintroduced into the patient’s body, it boosts the immune system’s cancer responsive capabilities. The perspectives are that TLP may have the potential to greatly improve the cure rate and/or serve as a cancer vaccine.

Keynote Forum

Malcolm E Thomas
Arbovax, USA
keynote: A novel approach to the development of vaccines for dengue and chikungunya virus
Malcolm Thomas is a President and Chief Executive Officer of Arbovax, USA

Arbovax employs an innovative technology(Patent No. 6,589,533) to develop safe and effective live-virus vaccines coupled with a low-cost system of manufacture. Arbovax created a strategy based on the straightforward concept of developing stable mutations of arboviruses that can replicate successfully in insect cells but grow poorly in mammalian cells, thus creating live, attenuated host-range mutant virus vaccines for any virus that has an insect vector and for which a cDNA clone can be produced.
The first target is Dengue virus (DV), a mosquito-borne member of the Flavivirus family, which has four serologically distinct serotypes (DV1-4). Over 100 million people are at risk for dengue infection each year, and with the increasing global spread of its mosquito vectors, including Aedesalbopictus, the Asian tiger mosquito, this number is poised to dramatically increase. Currently no vaccine or therapeutic exists to counter DV. The use of live-virus vaccines for dengue is critical since virus-neutralizing epitopes have been found to be complexes only found in the whole, intact virus. Other types of vaccines which use denatured viral proteins or dengue virus domains taken out of the whole virus context may lead to the generation of sub- or non-neutralizing antibodies which has been implicated in the risk for developing dengue hemorrhagic fever upon secondary exposure.
A tetravalent vaccine,using the Arbovax host-range mutation technology, against Dengue fever was tested in 36 African Green monkeys with a wild-type challenge at day 62 post vaccination. The vaccinated animals showed 100% seroconversion to all four serotypes in addition to high levels of Dengue-specific neutralizing antibody to all four. No booster shot was administered to achieve these results. On two consecutive days, all four serotypes were found concurrently in the same vaccinated animals indicating good tolerance for all serotypes during peak virus replication. Animals receiving the vaccine showed a rapid increase in IgG after challenge indicating a strong anamnestic response. There were no observed adverse events and recovery of the vaccine from the animals also showed no reversion to wild-type.
Vaccines for Chikungunya virus (CHIKV) were also developed by Arbovax using the same method to generate host-range viral mutants. Chikungunya is an emerging mosquito-borne virus of the Alphavirus family. Infections with CHIKV can lead to severe rheumatic disease in humans. As with DV, there are no current vaccines or therapeutics available. We analyzed five host-range CHIKV vaccines in a mouse model and assessed for joint swelling, generation of neutralizing antibodies, and protection from challenge. One vaccine candidate produced no inflammation and no detectible viremia post-challenge.

Human vaccines - infectious diseases
Immunology/Animal models

Session Introduction

Samir A. Farghaly
Cornell University, USA
Title: Therapeutic vaccination for patients with epithelial ovarian cancer
Samir A Farghaly is a Physician/Scientist, and faculty member of the Medical College of Cornell University and The New York Presbyterian Hospital /Cornell University Medical Center, New York, NY, USA. He received his M.D Degree from University College London University (1985), and his PhD Degree in molecular biology from London university (1993). He received several clinical and research awards. He has been an invited speaker in several national and international conferences on cancer. He is a member of several national and international societies, organization and foundation of cancer and women health . He is an editor, member of editorial boards and reviewers of several medical journals of Oncology, Gynecology and Gynecological Cancers. He has published 74 articles. He is an editor of a book on ovarian cancer.

Ovarian cancer is the seventh most common cancer in women (and the 18th most common cancer overall) worldwide. Approximately 239 000 cases were recorded in 2012. In the USA, estimated new cases of ovarian cancer in 2014: 21,980, and estimated deaths from the disease: 14,270. It ranks 5th overall for cancer death in women. The overall five-year survival rate is 44%, but this varies widely depending on the extent (stage) of the cancer. If the cancer is diagnosed and treated before it has spread outside the ovaries, the five-year survival rate is 92%. If the cancer has spread to the surrounding organs or tissue (regional spread), the five-year survival rate is 72%. If the cancer has spread to parts of the body far away from the ovary (distant spread), the five-year survival rate is 27%. About 85 to 90 per cent of ovarian cancers are epithelial carcinomas. Ovarian cancer is immunogenic, and the ability of the immune system to recognize ovarian cancer is associated with improved prognosis. T cell infiltration in the ovarian cancers shown to improve prognosis. The presence of intratumoral T cells observed to be an independent prognostic factor for progression -free survival (PFS) and overall survival (OS) by multivariate analysis, specifically cytotoxic CD8+ T-cells. Regulatory T cells, which can modulate immune responses and maintain tolerance to self-antigen, have been shown to predict poor survival in ovarian cancer. Sixty percent of women diagnosed with ovarian cancer will have distant metastases however; response rates to initial chemotherapy and cytoreductive surgery can be 85%. Despite these initial responses, about two thirds of patients will recur and recurrence occurs even in patients who achieved complete remissions. These periods of remission may allow vaccines the necessary time in patients with low disease burdens to induce an effective antitumor response. This suggests that vaccines are capable of generating focused immune responses specifically targeting tumor antigens may be more effective. Cancer vaccines have been evaluated using a number of platforms including peptides/protein or DNA in combination with adjuvant, anti-idiotype vaccines, recombinant viruses or other microbes, tumor cells or tumor cell lysates. There are several strategies currently being studied for ovarian cancer. There are several critical issues that need to be addressed, such as weak immunogenicity of tumor-associated self-antigens (TAAs), T helper (Th)-1 polarization of the immune response, inefficient trafficking of responder T-cells (cytotoxic T-lymphocytes [CTL]) into tumor beds, and inhibitory effects of tumor-induced suppressor cells. Therapeutic vaccines and effective combination treatment strategies of cancer vaccines with immune modulators, with appropriate patient selection and integration of immunotherapy with standard of care treatments, are essential for successful oncogenic and clinical outcomes.

William H Hildebrand
University of Oklahoma, USA
Title: Direct interrogation of viral peptides presented by the class I HLA of HIV infected t cells

Abstract: Identification of CD8+ cytotoxic T lymphocyte (CTL) epitopes has traditionally relied upon testing overlapping peptide libraries for their reactivity with T cells in vitro. Here, we pursued Deep Ligand Sequencing (DLS) as an alternative method of directly identifying those ligands that are epitopespresented to CTL by the class I human leukocyte antigens (HLA) of infected cells.Class I HLA-A*11:01was gathered from HIV-1 NL4-3-infected human CD4+ SUP-T1 cells. HLA-A*11:01 harvested from infected cells was immunoaffinity purified and acid boiled to release heavy and light chains from peptide ligands that were then recovered by size exclusion filtration. Viral ligands were fractionated first by high pH HPLC and then subjected to separation by nano LCMS at low pH. Approximately 10 million ions were selected for sequencing by tandem mass spectrometry. HLA-A*11:01 ligand sequences were determined with PEAKS software and confirmed by comparison to spectra generated from synthetic peptides. DLS identified 42 HIV-1 ligands presented by HLA-A*11:01, 37 of which were previously undetected. These data demonstrate that (1) HIV-1 Gag and Nef are extensively sampled, (2) ligand length variants are prevalent, particularly within Gag and Nef “hot spots” where ligand sequences overlap, (3) non-canonical ligands are T cell reactive, and (4) HIV-1 ligands are derived from de novo synthesis rather than endocytic sampling. Next generation immunotherapies must factor these nascent HIV-1 ligand length variants,and the finding that CTL reactive epitopes may be absent during infection of CD4+ T cells, into strategies designed to enhance T cell immunity.

Hira L. Nakhasi
Division of Emerging and Transfusion Transmitted Diseases, USA
Title: Safety and immunogenicity of genetically modified live attenuated leishmania donovani vaccine candidates
Hira Nakhasi is currently the Director of the Division of Emerging and Transfusion Transmitted Diseases at the Center for Biologics Evaluation and Research (CBER) of the Food and Drug Administration (FDA), Bethesda, MD, USA. His main research focus is on the development of Leishmania donovani vaccine and diagnosis. He has published over 100 publications including reviews and book chapters, being a member of the review committees of several high impact journals, reviewer of grants, and being invited to speak at national and international forums. He is also a member of the several scientific organizations.

Visceral Leishmaniasis (VL) is transmitted by an infected sand fly bite and is fatal if untreated. No vaccine is available against leishmaniasis. Recovery from Leishmania infection provides lifelong protection. Therefore, limited parasite exposure may induce an effective protective response and may be achieved by immunization with irreversibly gene-deleted live attenuated parasites that do not cause disease. We have developed several gene-deleted live attenuated Leishmania donovani parasites with attenuated virulence and tested as vaccine candidates. Two candidate vaccines, one with a cell division specific centrin1 gene and another with an amastigote specific protein p27 gene deletion have been tested for safety, efficacy and immunogenicity in mice, hamsters and dogs. We have demonstrated the safety and induction of a strong Th1 effector response that correlates with protection against VL and cutaneous form of Leishmaniasis using either candidate vaccines. Adoptive transfer of both CD4 and CD8 T cells isolated from long term immunized mice protected naïve recipients against virulent challenge suggesting induction of a memory T cell response in the immunized mice. Both vaccine candidates conferred significant protection in both young and aged mice. Significant protection in immunized hamsters against sand fly mediated L. donovani infection was also observed. Both vaccine candidates induced a strong Th1 recall response in PBMCs from healed visceral leishmaniasis and post kala-azar dermal leishmaniasis cases and induced a strong Th1 response in PBMCs from healthy individuals. Future studies will assess clinical grade material of the candidate vaccine to evaluate the safety and immunogenicity in human subjects using bioinformatics tools.

Alwyn Rapose
University of Massachusetts, USA
Title: Changing recommendations regarding the Tdap, MMR, Menactra and Yellow Fever vaccines
Alwyn Rapose obtained his Doctorate in Dermatology/ Venereology / Leprology from King Edward VII Memorial Hospital, Bombay, India. Thereafter he obtained an MD in Internal Medicine from St. Vincent Hospital, Massachusetts, USA, followed by a Fellowship in Infectious Diseases at the University of Texas Medical Branch, Galveston, Texas, USA. He was a recipient of the NIH / NIAID supported UTMB postdoctoral research grant in Emerging and Reemerging Infectious Diseases. In July 2014 he was elected fellow of the American College of Physicians. He is presently Assistant Professor of Clinical Medicine at the University of Massachusetts, USA and practices as consultant in Infectious Diseases and Travel Medicine at the Reliant Medical Group and St. Vincent Hospital in Massachusetts, USA. He is a board certified in both Infectious Diseases and Internal Medicine.

Recently there have been a number of new recommendations regarding routine human vaccines including updates on vaccination with the Tdap, MMR, meningitis and yellow fever (YF) vaccines.
Recommendations regarding the Tdap vaccine have been impressive in that these have been expanded numerous times over the last few years. The most aggressive recommendation published in 2013 recommended that females be vaccinated with Tdap vaccine at every pregnancy irrespective of previous vaccination. Similarly, due to the episodic outbreaks of measles in the United States, expanded guidelines regarding testing for measles and vaccination with the MMR vaccine have been published with emphasis on ensuring two-dose MMR vaccine in children, measles immunity in health-care personnel and new recommendations for international travelers. With regards the meningitis vaccine, revaccination with menactra vaccine is now recommended more frequently (every 3 years) for those making pilgrimages to the religious sites in Saudi Arabia. In terms of the YF vaccine, a new report from the World Health Organization (WHO) is likely to change routine practice regarding vaccination of those travelling to YF-risk areas. In June 2013, the WHO published a position paper based on discussions by the WHO Strategic Advisory Group of Experts on Immunizations (SAGE). In this report, the group stated that a single dose of the vaccine was sufficient to confer life-long protection. They specifically stated “a booster dose is not necessary”.
These vaccines are often administered when patients visit the Travel Clinic. In the year 2013 more than 900 patients were evaluated at our Travel Clinic. Most of the above mentioned changes in recommendations resulted in significant shifts in clinical practice. These recommendations are also likely to have significant financial implications.

Aziz Alami Chentoufi
King Fahad Medical City, Saudi Arabia
Title: Advances in self adjuvanting lipopeptide vaccine strategy against HSV infection
Aziz Alami Chentoufi is a Consultant and Head of Immunology/Serology/HLA section at PCLMA, KFMC. He is also Assistant Professor of Immunology at the King Saud Ibn AbdulAziz University FOM-KFMC. He is the Chairperson of Research Committee of PCLMA, KFMC. Dr. Chentoufi is accredited by the European Society of Translational Medicine as PCTM. He received his Ph.D. in BioMedical Sciences (Tolerance induction to xenogenic and allogenic antigens using monoclonal antibody treatment) from the University Catholic of Louvain, Brussels, Belgium in 1999. Dr Chentoufi has done postdoctoral fellowship at McGill University, Montreal, Canada from 1999 to 2004 where he worked on immunogenetic of type 1 Diabetes and gene therapy for graft versus host disease. Then he was appointed as specialist at the University of California Irvine-Medical Center, Irvine, California, USA in 2006 where he was a key investigator in the development of mucosal vaccine against herpes simplex virus type 1 and 2. Dr. Chentoufi is an independent Immunologist, with a national and international reputation in vaccine development against both infectious and autoimmune diseases. Dr. Chentoufi is well integrated into the scientific community within the United States as well as Europe and Saudi Arabia; he is actively involved in a number of professional societies including American Society of Histocompatibility and Immunogenetic (ASHI), Association of Clinical Scientist, Canadian Society of Immunology and The Federation of Clinical Immunology Societies (FOCIS). Dr Chentoufi is PI and Co-PI in research grant proposals funded by Minster of Health, KACST and KFMC. Finally, Dr Chentoufi is associate editors in many scientific journals and has more than 40 publications in high impact factor journals. Specialties: Vaccines, Cellular & Molecular Immunology,Immunogenetics & Histocompatibility

Herpes simplex virus type 1 and type 2 (HSV-1 & HSV-2) are amongst the most common human infectious pathogens that cause serious clinical diseases at every stage of life including fatal disseminated disease in newborns, to cold sores, genital ulcerations, blinding eye disease, and fatal encephalitis in adults. In addition, genital herpes has played an important role in driving the prevalence of other sexually transmitted infection such as HIV. The immunity and immunopathology of herpes infections are not yet fully characterized. To better understand the immunopathology of herpes infections and ultimately design an efficient therapeutic herpes vaccine, it is fundamental to define the cellular and molecular immune mechanisms required for an efficient control of these ubiquitous pathogens. Current drug therapies, often used to suppress genital herpes, can also treat ocular herpes but do not prevent future outbreaks. The best hope of controlling HSV-1 and HSV-2 infections is the development of an effective vaccine. However, in spite of several clinical trials, starting as early as 1920s, no vaccine has been proven sufficiently safe and efficient to warrant commercial development. We recently discovered several discrete sets of HSV-1 symptomatic and asymptomatic CD4+ and CD8+ T cells epitopes. When these asymptomatic peptide epitopes are extended with an agonist of Toll-like receptor 2 (TLR-2), which is abundantly expressed on dendritic and epithelial cells of the vaginal and ocular mucosa, can lead to induction of strong and sustained protective immunity against herpes. Thus mucosal (topical ocular or intravaginal) immunization with self-adjuvanting lipid tailed peptides bearing “asymptomatic epitopes” appears to have attractive practical and immunological features. In this lecture, I will provide a brief overview of past clinical vaccine trials, outline current progress towards developing new generation of “asymptomatic” herpes self-adjuvanting lipopeptide vaccines, and discuss their protective immunity.

M. Miqdady
Sheikh Khalifa Medical City, UAE
Title: AGE and rota virus vaccines: The broader view
Dr. Mohamad Miqdady is American Board certified in Pediatric Gastroenterology, Hepatology and Nutrition. He is the Division Chief, Ped. GI, Hepatology & Nutrition Division at Sheikh Khalifa Medical City in UAE. Also an Adjunct Staff at Cleveland Clinic, Ohio USA. Dr. Miqdady completed his Fellowship in Pediatric Gastroenterology at Baylor College of Medicine and Texas Children’s Hospital in Houston, TX, USA. Main research interests include feeding difficulties, picky eating, obesity, procedural sedation, allergic GI disorders and celiac disease. He has several publications and authored few book chapters including On the Editorial Board of few journals including Gastroenterology & Hepatology.

Acute gastroenteritis (AGE) is still a common disease affecting almost all children around the world. Viral causes are the commonest cause of acute diarrheal disease in infancy & early childhood, among the viral causes Rotavirus is the commonest. Other viruses include: Adenovirus, Norwalk virus, Astrovirus, & Calicivirus and many others. Rota virus was first detected in 1973, by an Australia doctor from duodenal biopsies from children with acute diarrhea. It attacks the small intestine’s villi tips where absorption of water & electrolytes occurs and where the digestive enzymes reside causing malabsorptive diarrhea on. While the Crypt cells, relatively uninvolved and continue to excrete water & electrolytes causing secretory diarrhea. Severe & prolonged symptoms occur in the context of immunodeficiency, immunosuppression, co-morbid disease (GI & non GI) and mal-nutrition. Preventive measures includes; hand washing & good hygiene; public sanitation ensuring safe food & water supplies and encouraging breastfeeding for infants. Vaccines are of paramount importance. WHO states that vvaccination is the only control measure likely to have an impact on disease control. Rotavirus vaccines are life attenuated. Currently we have two types of vaccinations: • RV1:Monovalent, 1 strain (G1 P8), human , 2 doses • RV5: Pentavalent, 5 strains (G1, G2, G3, G4, & P1), reassortant, Human-Povine, 3 doses. Both vaccines are effective in decreasing the incidence of Rota infections and very efficient in reducing severe infections. Both are proven to be safe without increased risk of intussception as shown in many studies, post marketing surveillance. They can be co-administrated with other vaccines safely. Children who have AGE should be excluded from group child care settings until their diarrhea resolves. Contaminated surfaces should be washed with soap & water (preferably 70% ethanol ).

Leonora Hana Lleshi
ISA GREZDA”Regional Hospital, Kosovo
Title: The efficiency of immunotherapy to the subjects with allergy to bee venom and its influence in pollen allergy
Leonora Hana-Lleshi is a certified specialized allergologist-immunologist and The Faculty of General Medicine (1990-1996) in Craiova, Romania. She have received the title of a certified specialized allergologist-immunologist in University Clinical Center Kosovo-Prishtina(2001-2005). In 2012 She has received a master degree on medicine science from Ministry of Education in Albania (MoES), which has equivalented my diploma of medicine and specialization based in Bolognia equivalentation. She is working as a certified specialized allergologist-immunologist in” ISA GREZDA”Regional Hospital of Gjakova in Kosovo. She is a member of Kosovar Society of Allergology and Clinical Immunology, EAACI, WAO, ACAAI etc.

Introduction: Hymenoptera venom allergy is an immunoglobulin E (IgE)- mediated hypersensitivity to the venom of insects in the insect order Hymenoptera. This allergic reaction may be caused by stings from a number of species in this insect order, occurring only in persons who have previously been sensitized to Hymenoptera venom.
Insect sting allergy can develop at any age and usually manifests after several uneventful stings.
The incidence of systemic reactions to Hymenoptera venom is approximately 3% in adults. Although children are stung more often than adults, Systemic reactions occur in only about 1% of children younger than 17 years, and many of these reactions are relatively mild.
Large local reactions to Hymenoptera stings are more common in children, with an estimated incidence of 20% and 10%, respectively, for children and adults. The prevalence of insect sting allergy is twice as high in male as in female patients and may be a result of increased exposure rather than inherent susceptibility. Normally there is no clear association with other allergies, and only 30% of patients with venom allergy are atopic.
In addition, insect sting allergy is statistically not more likely to occur in persons with a family history of sting reactions. History: The first reports of stinging insect allergy came from the Middle East thousands of years ago.
Even at that time, people understood that a small insect, such as a bee or a wasp, had the potential to cause serious illness or even death. Hymenoptera Stinging insects: All the stinging insects belong to the insect order Hymenoptera, of which there are 16,000 species in North America.Less than 1% are responsible for human stings. All the species that are medically important belong to three families: Apidae , Vespidae, and Formicidae. Only the females of each species have stingers, which are ovipositors that have lost their egg-laying function and have been modified for stinging and envenomization. Most species sting in defense of themselves and their nests, although some species also sting as a means of capturing their prey.
Signs and Symptoms: Most Hymenoptera stings cause small local reactions of no significant medical consequence. These normal sting reactions are characterized by pain, itching, redness and swelling at the sting site that resolve within several hours and are caused by the pharmacologic properties of the venom. Some large local reactions are caused by a late-phase IgE-dependent reaction that is mild initially but progresses after 12 to 24 hours to a diameter of more than 5 cm; these usually peak in intensity at 48 to 72 hours. These reactions are contiguous with the sting site and occasionally involve an entire extremity. In rare cases, massive swelling causes local anatomic compression. Large local sting reactions typically resolve gradually over 5 to 10 days. Virtually all patients with large local reactions continue to have similar reactions with not subsequent stings. This tendency is not modified with venom immunotherapy; therefore, patients with large local reactions are candidates for further diagnostic evaluation. Systemic reactions cause signs and symptoms in one or more organ systems and are almost always IgE-mediated. Systemic reactions cause a spectrum of manifestations, ranging from cutaneous signs (pruritus, flushing, urticaria, angioedema) to respiratory involvement (cough, throat and/or chest tightness, dyspnea, wheezing) and cardiovascular compromise (dizziness, hypotension, unconsciousness), depending on the severity of the reaction. Gastrointestinal manifestations (nausea, vomiting and diarrhea) and uterine cramping also occur occasionally. Cardiac anaphylaxis with manifestations of coronary vasospasm, arrhythmias, or bradycardia can also occur following stings, even in persons with no underlying cardiac disease. Systemic reactions usually cause signs and symptoms starting with in minutes following a sting. In general, the sooner the symptoms occur, the more severe the reaction. Pathophysiology: Both systemic and large local reactions to stinging insects are usually caused by IgE-mediated reactions to Hymenoptera venom. At least one prior sting is required to sensitize a person to venom, and sensitization is more likely to occur following multiple simultaneous stings or subsequent stings occurring over a relatively short period of time. Once sensitization has occurred, a sting can cause mast cell and basophil degranulation, resulting in release of the histamine and other inflammatory mediators responsible for the signs and symptoms of anaphylactic and some large local reactions.
Family: Apidae; Scientific name: Apis mellifera; Common name: Bee; Apis mellifera, commonly known as the bee, is a very common insect. Believed to have originated in Africa, most likely this primitive species spread from France throughout Central Europe, north of the Alps, the British Isles, southern Scandinavia, down to the Ural mountains.•Worker bees can have a length between 1.1 and 1.5 cm with a light orange and dark brown coloring.•You can often see bees on flowering plants, on sources of sugar (honeydew, etc.) or on pools of water during hot days. Bees build nests in beehives or sometimes in hollow trees or cracks in the walls of buildings. Bees can attack en mass if not too far from their hives.A peculiar characteristic of the Apis mellifera is the serrated stinger. The stinger is barbed so that it lodges in the victim’s skin, tearing loose from the bee’s abdomen and leading to its death in minutes. Distribution: Throughout Italy.Period of exposure to allergens: All year round.Allergy testing: Allergic reactions to bee venom can be severe enough to cause anaphylactic shock, which can be fatal.
-Allergy Efficacy of Vit (Venom immunotherapy): Venom immunotherapy is extremely efficacious in preventing subsequent systemic reactions in patients with stinging insect allergy. •Efficacy is highest with mixed vespid venom; it is 98% effective in preventing subsequent systemic reactions with a maintenance dose of 300 μg (100 μg per venom). •For therapy with individual venoms (i.e., honeybee, yellow jacket, or wasp) at a dose of 100 μg per venom, immunotherapy is 75% to 95% effective in preventing systemic reactions to future stings. •Those few patients who continue to have systemic reactions usually have milder reactions than before beginning treatment. Increasing the maintenance dose of immunotherapy to 200 μg provides full protection for most patients who have had systemic reactions while receiving treatment with single venoms at a dose of 100 μg.
-IN KOSOVO as in the other parts of the globe, allergy diseases are very often presented in medical institutions. Also the percentage is almost same as in Europe, or in the other parts of the world. In general, approximately 1/4 or 1/5 of inhabitants is representing different kinds of allergy, starting from mild symptoms to severe life threatening allergy reactions.As a certified specialized allergologist – immunologist, while living and working in the small city of Gjakova in Kosovo, in my everyday experience, I meet different kind of allergies to my patients like: pollen allergies, food allergies, medication allergic reactions, contact allergies, and insect sting allergies such as bites: bee, wasp etc.• In one case, of my observed patient, I verified that the subject 12 years old; gender: female was allergic in: pollens and bee venom with anaphylactic allergic reaction. Specific Ig- E detected with POLYCHECK (Bio-Check) first analysis are shown below .This patient has started initial treatment in”Mother Theresa” University Hospital Center of Tirana in Albania, 2 years ago with rush method. After this process, the treatment was continued by me in “Isa Grezda” Regional Hospital of Gjakova. Until now I’m performing by schematic regimen SCIT and every time the patient is under my observation for 30 minutes. During the period of two years of immunotherapy, the treatment has indicated very well to the patient, with moderate local reaction in the beginning and now without any possible clinical adverse reactions. Every application of vaccine was performed deep subcutaneously in the upper external side of the arm. After one year of venom immunotherapy with Anallergo vaccine, the patient has repeated Specific Ig-E on pollens and hymenoptera venoms, with the parameters of: Bee venom has fallen down from 5-4;Alder pollen from 1-0;Birch pollen from 2-0; Hazelnut pollen from 2-1;Beech pollen from 2-0;Oak pollen from 2-1;Pine from 2-0;Rhizopus nigrans from 2-0;Grass mix from 3-1 and house dust from 2-0.
And concomitantly parameters of bee venom and parameters on pollens began to fall down without etiological treatment, it means without S.I.T on certain pollens.
Matherial and Methods: The patient was receiving L-Tyrosine-adsorbed subcutaneous immunotherapy (SCIT) for hymenoptera venom ANALLERGO vaccine (Apis mellifera) L-tyrosine delayed subcutaneous immunotherapy for hymenoptera venom consists of two initial vials of L-tyrosine delayed extract of purified venom, respectively one 5 ml vial containing 1 mcg/ml and one 5 ml vial containing 10 mcg/ml.

Luljeta Ahmetaj
Medical Faculty of Prishtina, Kosova
Title: The role of Specific Immunotherapy in reduction of viral infections in asthmatic patients
Luljeta Neziri-Ahmetaj is a specialist in Allergology and Immunology, Kosova

The role of Specific Immunotherapy in reduction of viral infections in asthmatic patients Luljeta Ahmetaj Kosova Introduction: Viral respiratory infections are the most common cause of an acute asthma exacerbation in both children and adults and represent a significant global health burden. They are found in approximately 80% of wheezing episodes in school-aged children and ½ or ¾ of acute wheezing episodes in adults (Clinical reviews in allergy and immunology), 2010
Viral infections implicates in asthma development in many stages:
1. Resp virus infections in infancy is a risk factor for,and may predispose to,the development of asthma later in life;
2. Resp.virus infection is associated with the acute exacerbation of bonchial asthma;
3. Glucocorticoids are not adequate for controlling asthma-related symptoms upon resp.virus infection(25).
Material and Methods: Our study is comparative clinical research, done in the University Clinical Center in Prishtina and in cooperation with specialized allergologic center Ylli in Prishtina.
This study is comparative clinical research, done in the University Clinical Center in Prishtina and in cooperation with specialized allergologic center Ylli in Prishtina.
The including criteria was: 60 adult patients diagnosed with allergic asthma(Intermitent mild, Mild persistent, Moderate persistent Asthma(according to GINA) aged between 15 and 30 years, both sexes.30 of patients are treated with specific Immunotherapy (SCIT)and 30 of them with another antiasthmatic drugs.
Results: The number of patients who visited the physician for bronchial hyperactivity (BH) depends on whether they were on immunotherapy or not p = 0.0001 In the first quarter, both groups are identified to have an equal number of coldness conditions. In the second quarter, a decreased frequency of coldness conditions is registered, in the group with immunotherapy 3/30 (10%), whereas in the group without immunotherapy that number was greater 11/30 (36%). In the third and fourth quarter the percentage of coldness condition of 3% has retained in the immunotherapy group, whilst in the group without immunotherapy there was an increase from 20/30 (66%) to 27/30 (90%).

Baxolele Mhlekude
University of Cape Town, South Africa
Title: Mucins as potential candidates for a new topical vaginal microbicide
Baxolele Mhlekude has completed his BSc (Med) (Hons) by 2012 from the University of Cape Town, specializing in Medical Biochemistry. He is currently completing his MSc (Med) degree in the same field and institution. His MSc research project is based on the anti-HIV-1 activities of the human cervical mucins. Soon he will be visiting to TWINCORE, Germany, as a research fellow for three months (01/12/2014-28/02/2015), where he will probe the cervical mucins against a panel of HIV strains and use different functional assays to uncover their anti-HIV activity. He will then come back to UCT and embark on his PhD.

HIV/AIDS continues to pose a global threat. It is highly convincing that the prenvetion of HIV transmssion through urogenital tract will prove to be the best biomedical intervention to curb the HIV pandemic, given that sexual intercourse is responsible for nearly 80% of HIV infections worldwide. Several attempts to develop effective vaginal microbicides have so far failed in clinical trials, prompting yet another desperate search for the efficacious microbicides with tolerable side effects. Regardles of a risky exposure to HIV during unprotected sexual intercourse, the ratio of viral transmission is 1:2000 in the absence of STIs, suggesting the presence of the natural biodefence mechanisms in the urogenital tracts. Using a modern and quantitative pseudo-viral neutralization assay, our laboratory has proved unequivocally that the mucins isolated from the body tract’s secretions can neutralize HIV-1 in an in vitro assay, regardless of the HIV status of the participants. To probe the mucins against a panel of HIV strains and uncover the exact mechanism behind their anti-HIV-1 activity will provide the crucial information on their state of readiness as new topical microbicides. The inhibition of HIV-coreceptor interaction would be the most effective method to curb the HIV pandemic, however, the development of the safe and efficacious coreceptor inhibitors that do not interfere with the chemokine system have proved unsuccessful. Among the proposed molecular targets for anti-HIV therapy, based on our findings we hypothesize that the mucins act as potential HIV fusion inhibitors that block the virus before it establishes infection and diversifies.

Javed N Agrewala
CSIR-Institute of Microbial Technology, India
Title: Self-adjuvanting promiscuous peptide of Mycobacterium tuberculosis augments polyfunctional Th17 cells and evokes better memory T cell response than BCG
Javed N Agrewala did his Ph.D. in 1986 from Agra University, Agra, India. In 1989 he joined as a faculty member at the CSIR-Institute of Microbial Technology, Chandigarh, India. He has done pioneer work in the field of Immunology of Infectious Diseases with particular interest in Vaccines. He is a recipient of the highest award in science in India “Shanti Swarup Bhatnagar Award” and a member of Indian Academy of Sciences. Dr. Agrewala has been a visiting scientist at the Hammersmith Hospital, London and Trudeau Institute, NY, USA. Dr. Agrewala has published 67 manuscripts in the high impact journals.

Background: Vaccines have been successful in worldwide eradication of dreaded diseases like smallpox, diphtheria, tetanus, yellow fever, whooping cough, polio, and measles. Unfortunately, such triumph has not been achieved in controlling tuberculosis (TB) globally. Bacillus Calmette Guérin (BCG) is the only available vaccine against TB. Paradoxically, BCG has deciphered successful results in the Western population but has failed in TB-endemic areas. Hence, it is quite crucial to understand the immunity responsible for controlling Mycobacterium tuberculosis infection and factors responsible for the failure of BCG in TB-endemic countries. Consequently, introducing radical changes in the vaccines that would impart protection in the populations where BCG has failed. One of the main reasons considered for BCG failure in TB-endemic areas is impediment by environmental mycobacteria in its processing by antigen presenting cells and generation of memory T-cell response.
Methods: The peripheral blood mononuclear cells of sputum positive pulmonary TB patients and their house-hold contacts were separated by ficoll-hypaque gradient method. The cells were cultured with L91 and proliferation was monitored by CFSE-dye dilution assay and phenotypic markers by flowcytometry using fluorochrome tagged appropriate antibodies and their isotype-matched controls.
Results: Keeping in view the shortcomings of BCG, we developed a unique lipopeptide (L91) by linking the promiscuous peptide (sequence 91-110) of 16 kDa antigen of Mycobacterium tuberculosis to Toll-Like Receptor-2 agonist Pam2Cys. L91 does not require extensive antigen processing and targets and activate dendritic cells. This is evidenced by the fact that L91 significantly improved the activation and proliferation of polyfunctional Th1 and Th17 cells of the TB patients and their house-hold contacts. Furthermore, L91 surmounts the barrier of major histocompatibility complex polymorphism. Importantly, this peptide has self-adjuvanting property and induces enduring memory T cell response, which is significantly better than BCG.
Conclusion: L91 can be a potent future vaccine candidate against tuberculosis in TB-endemic and non-endemic zones.

Kenneth Lundstrom
Pan Therapeutics, Switzerland
Title: Alphavirus-based Vaccines
Kenneth Lundstrom received his Ph.D from the University of Helsinki, Finland and conducted postdoctoral studies at Cetus Corporation in Palo Alto, California. He has served in various positions in the pharmaceutical industry in the fields of neuroscience, structural biology, gene expression and gene therapy. Currently, he is the CEO of PanTherapeutics. He has published more than 180 publications and has served on the editorial board of reputed international journals.

Alphavirus vectors provide high levels of transient heterologous gene expression both in vitro and in vivo and. For this reason they have found a number of applications for vaccine development. Semliki Forest virus, Sindbis virus and Venezuelan equine encephalitis virus are the most commonly used alphavirus delivery vectors. Alphavirus vectors can be employed as replication-deficient recombinant viral particles and, in vitro transcribed RNA, as well as layered DNA for immunization. Vaccination in multispecies animal models with alphavirus vectors carrying highly immunogenic viral structural proteins expressed elicited strong neutralizing antibody responses and demonstrated robust protection against challenges with lethal doses of virus in rodents and primates. Likewise, immunization with alphavirus vectors expressing tumor antigens resulted in tumor regression and prophylactic protection against challenges with tumor-inducing cancer cells. The occurrence of recent epidemics associated with alphaviruses has accelereated the development of vaccines against Chikungunya virus and Venezuelan equine encephalitis virus. Furthermore, recent progress in alphavirus vector development and vaccine technology has resulted in initiating clinical trials in humans.

Manuela Stoicescu
University of Oradea, Romania
Title: The vital importance of BCG vaccination at the newborns-Original case report
Manuela Stoicescu was an Assistant Researcher of University of Cluj Napoca. She completed her Ph.D. in Internal medicine and now she is a Consultant Internal Medicine Physician, Assistant Professor at University of Oradea, Romania. She also works at Emergency Hospital Internal Medicine Department. She has published two books, one monograph and papers in reputed journals. The topic of the monograph is: "High blood pressure in the young- an ignored problem?!" and the topic of the books is: Clinical cases for students of the faculty of medicine in English and Romanian language. She was invited as a speaker at many national and International Conferences. She is a Member of Romanian Society of Internal Medicine, Cardiology, Medical Chemistry, Biochemistry and Balkan Society of Medicine.

Objectives: The main objective of this clinical case presentation is to put in evidence the important role of BCG vaccination at the newborns.
Material and Methods: I present the clinical case of a young boy 22 years old who was hospitalized for a clinical symptoms and signs of pneumonia (chills, fever 39˚C, stabbing pain, draw cough, sweating in the night). At the objectives examination was presented resonance of the lung except a area of the right apex of the lung where was dull, vocal resonance decreased at this level, bronchial breathing and added sounds – fine crackles at this level, HR=89bates/min, BP=120/80mmHg. The blood tests showed: ESR=98/65(1h-2h), fibrinogen=568mg%, white blood cells=18 000mm³, neutrophiles= 64%, lymphocytes=82%, other blood tests was in normal range. The chest X-ray showed a round collection at the right apex of the lung 3/2cm with a small hydro aerie level inside suggest an abscess of the right apex lung. The patient started therapy with Cephalosporin (Ceftriaxone 2X2gi.v/day) after the allergy test was negative and Gentamycin 2x80mg i.v./day but the fever and chills persisted a few days and for this reason was added also Metronidazol 2x500mgi.v./day but the chills and fever persisted also other few days and the case become a prolong fever syndrome. Blood cultures were performed and were negative. A thoracic CT scan was performed and showed the same collection at the right apex lung and unexpected a small hidden cavity like a possible small cavern. This wasn’t visualized on the chest X-ray. IDR test of PPD was positive and B.K. in sputum was positive. In this moment the diagnosis of pulmonary TB was evident and the cause of the prolong fever syndrome and this explain why the fever persisted under triple antibiotic therapy association, because the B.K. is sensible only at specific anti tuberculosis therapy. The patient was transferred in to the Pneumophtisiology Department and started the specific therapy and the fever stopped with good evolution of the patient. The real diagnosis was pulmonary TB - tuberculoma and small hidden cavern at the right apex of the lung. But the surprise and unexpected information of this clinical case appeared when the mother of this patient honest recognizes that she refused the BCG vaccination in the newborn stage of he’s baby and we know that this obligatory to performed.
Results and discussions: It is very difficult to accept that is possible to happen, refuse of BCG vaccination, but was a reality. Sometimes prolong fever no responded at usually triple association of antibiotics it is possible to hidden an unknown TB. Blood cultures were negative because the insemination wasn’t performed on the specific Löwenstein Jensen medium and B.K. develop only of this specific culture medium.
Conclusions: The BCG vaccination of the newborns is vital in this stage of life to prevent later the similar situations just like date. The very good information of the peoples about the protection of BCG vaccination it is vital to prevent the risk of TB

Kar Muthumani
University of Pennsylvania School of Medicine, USA
Title: Synthetic vector-mediated IgG generated in vivo confers protective immunity against viral infection
Kar Muthumani received his PhD from the Madurai Kamaraj University, India. He completed his postdoctoral training at the University of Pennsylvania School of Medicine, Philadelphia, USA. Currently he is an Assistant Professor in the Department of Pathology and Laboratory Medicine at UPenn’s School of Medicine. His research focuses on the immunopathogenesis of emerging infectious diseases including HIV-1, Chikungunya, MERS and Ebola, and the development of novel DNA vaccines and therapeutics against such infectious pathogens. His group employs an enhanced vaccine-delivery platform and a neutralizing-antibody-generating technology using DNA plasmids in order to generate passive immunity against select pathogens.He has been the recipient of several notable awards, including Young Scientist Award - Nobel Symposium on Global HIV Therapeutics (2001) and International Cytokine Society (2005). His accomplishments have been recognized at several international research groups including International AIDS Society (2007), International Society of Infectious Diseases (2008), International AIDS Vaccine societies (2011). He has published more than 57 articles in credited peer-reviewed journals, including publications in Nature Cell Biology, Blood, JBC, JI and PLoS. A large portion of his work has been in the translational realm as seen by its immediate clinical applications. Furthermore, he has 18 patents under his belts, the majority of which are licensed to and are drawing royalties to the University. Importantly, products from his translational research have been or are currently being evaluated in phase I or phase II clinical trials. He has contributed as an investigator or co-investigator to several grants such as the prestigious NIH HVDDT program grant for HIV Vaccine development, a highly selective NIH Directors Translational grant for Influenza vaccine development, a SRA for studying viral receptor interactions, and a Defense Advanced Research Projects Agency (DARPA) award. He is an active collaborator with national as well as international research groups, and mentors students and postdoctoral fellows.

There is an urgent need to develop improved vaccination techniques that provides effective and lasting protection against viral infection. It is thought that the induction of strong T cell responses and cross neutralizing monoclonal antibodies (mAbs), as well as antibodies that drive ADCC, play a key role in vaccine-induced protection. The development of vaccines against highly infectious pathogens such as Human Immunodeficiency virus (HIV-1), Influence A virus (Flu), Dengue virus (DV), Chikungunya virus (CHIKV), Respiratory Syncytial Virus (RSV) and Middle Eastern Respiratory Syndrome (MERS) has been wrought with difficulties. Recent advances in human antibody isolation have uncovered broadly neutralizing antibodies (bNAbs), which are capable of preventing infection against a wide array of viral pathogens. Yet generating and delivering biologically-relevant levels of such antibodies using conventional mAbs methodology is impractical, often requiring huge expenses and repeated administrations. Creating new methods of delivering neutralizing mAbs that eschew current constraints could drastically tip the scale in the fight against a number of devastating viral pathogens.
In the current approach, we have constructed an optimized, enhanced DNA plasmid formulation capable of expressing IgG of the neutralizing anti-viral mAbs. When delivered with in vivo electroporation, a single administration of the IgG plasmid resulted in generation of IgG molecules in mouse sera possessing specific target binding and neutralizing activity against diverse viral isolates. Importantly, this delivery method resulted in a more rapid increase compared to immunization with recombinant protein, lasted for weeks and can protects against viral challenge. This approach establishes a new platform for delivering protective mAbs safely and effectively. The study has implications for prophylactic and therapeutic strategies for viral infection and other important diseases especially in resource limited settings where antibody therapy is cost prohibitive.

Human vaccines - non-infectious diseases
Age-specific Immune Response to Vaccination
Vaccine safety

Session Introduction

Eric Thomas Harvill
The Pennsylvania State University, USA
Title: Different effects of whole cell and acellular vaccines on Bordetella transmission
Dr. Harvill completed his Ph.D in Immunology with Dr. Sherie Morrison and studied postdoctoral studies in Bacterial Pathogenesis with Dr. Jeff F. Miller, at UCLA. He has published nearly 100 articles, served on editorial boards for many journals and reviewed for a long list of national and international granting agencies, including six different NIH study sections. Dr. Harvill has served on two extended, multi-year committees of the National Academies of Science, National Research Council. He is currently Professor of Microbiology and Infectious Disease at the Pennslyvania State University and Visiting Professor at the Lee Kong Chian Medicine, Nanyang Technological University.

Background. Vaccine development has largely focused on the ability of vaccines to reduce disease within individual hosts with less attention to assessing the vaccine’s effects on transmission between hosts. Current acellular vaccines against Bordetella pertussis are effective in preventing severe disease, but have little effect on less severe coughing illness that can mediate transmission.
Methods. Using mice as a natural host of Bordetella bronchiseptica, we determined the effects of vaccination on shedding and transmission of this pathogen.
Results Vaccination with heat-killed whole-cell B. bronchiseptica or B. pertussis inhibited shedding of B. bronchiseptica. Differences in neutrophil and B cell recruitment distinguished sham-vaccine from whole-cell vaccine responses and correlated with shedding output. Both B and T cells were essential for vaccine-induced control of shedding. Adoptive transfer of antibodies was able to limit shedding, while depletion of CD4+ T cells led to increased shedding in vaccinated mice. Finally, whole-cell vaccination was able to prevent transmission, however an acellular vaccine that effectively controls disease failed to control shedding and transmission.
Conclusion. Our results highlight discrepancies between whole-cell and acellular vaccination that could contribute to the increased incidence of B. pertussis since the transition to the use of acellular vaccination.

Kathleen Hefferon
Cornell University, USA
Title: Plant virus expression vectors for biopharmaceutical production
Kathleen Hefferon received her Ph.D. from the Department of Medical Biophysics, University of Toronto and continued her post-doctoral studies at Cornell University. Dr. Hefferon has worked on faculty at the Division of Nutritional Sciences at Cornell and has written two books on biopharmaceuticals in plants. She teaches and conducts research at both the University of Toronto and Cornell University. Kathleen has 4 patents, has edited 6 books, and has multiple research publications. Kathleen currently lives with her family near Ithaca NY.

Plant made biologics have elicited much attention over recent years for their potential in assisting those in developing countries who have poor access to modern medicine. Additional applications such as the stockpiling of vaccines against pandemic infectious diseases or potential biological warfare agents are also under investigation. Plant virus expression vectors represent a technology that enables high levels of pharmaceutical proteins to be produced in a very short period of time. Recent advances in research and development have brought about the generation of superior virus expression systems which can be readily delivered to the host plant in a manner that is both efficient and cost effective. The following presentation describes recent innovations in plant virus expression systems and their uses for producing biologics from plants.

Anis Larbi
Singapore Immunology Network, Singapore
Title: Systems vaccinology applied to aging populations
Anis Larbi is a Principal Investigator at the Singapore Immunology Network (SIgN, A*STAR). He is in charge of the Aging and Immunity Program and also acts as a PI of the Immunomonitoring Platform. He is part of the Singapore Longitudinal Aging Study consortium. His research focuses on the understanding of immunosenescence in humans.In Singapore he is coordinating various clinical projects including a Phase IV clinical trial, epidemiological and longitudinal studies on aging. He graduated from the University of Sherbrooke (Canada) and worked at the University of Tubingen (Germany) before joining SIgN in 2010.

Aging is associated with the erosion of several systems including neuro-endocrine, immune, cardiovascular, hormonal, cognitive and others. This is likely to contribute and explain the age-related increased susceptibility to diseases and infections. Prophylactic interventions to reduce this burden include vaccination and campaigns have shown their beneficial effects on overall mortality during peaks (eg. influenza).However,the increased susceptibility to infections in elderly is accompanied by hypo-responsiveness to vaccination. To date, there is no answer to an important question: who is not responding and why? We have tested the hypothesis that responses to Flu vaccination were dependent on overall health of the elderly prior to vaccination using a systems approach. Combining clinical (using a holistic approach) and biological (focusing on biological reserves) measures we were able to better understand the relationship between inflammation, physical condition and response to vaccination. I will discuss the benefits of running vaccination trials in deeply stratified cohorts and the mechanisms associated with high versus low response.

Ljudmila Stojanovich
University Medical Center Bezanijska kosa, Serbia
Title: Immunization of patients with autoimmune rheumatic disease against influenza: A study of vaccine safety and immunogenicity
Ljudmila Stojanovich is Research Professor, and the scientific director in the Bezhanijska Kosa, University Medical Center of Belgrade University. Her research focuses on Systemic Lupus Erythematosus, Antiphospholipid Syndrome, and Vaccination in patients with Autoimmune Rheumatic diseases. She is an author of three monographs and of about 250 articles on various aspects of Rheumatic disorders, published in international journals and in conference proceedings. She is in Editorial Boards /Reviewer in the “Current Contents” or “Science citation index”, like LUPUS, Cellular and Molecular Neurobiology, The Journal of Vaccine, The Journal of Rheumatology, Allergologia et Immunopathologia and others. She is a member of number International Project, like of “the European Forum on Antiphospholipid Antibodies”, “Multicenter Studies Antiphospholipid Antibodies, Infections and Autoimmune Diseases”. She is the member of steering group committee (composed of experts representing 11 European countries) of European League Against Rheumatism (EULAR) for the recommendations for vaccination in patients with autoimmune inflammatory rheumatic diseases.

Objectives: Compared to the healthy population, patients suffering from autoimmune rheumatic diseases have a significantly increased risk of various infections. The issue of vaccinating against the seasonal flu in these patients is still surrounded by numerous dilemmas about its efficiency and the possible harmful effects of exacerbation of the underlying disease. We aim to assess the protective role of the influenza vaccine by analyzing the association between respiratory infections occurrence and humoral response to influenza A (H1N1) infection in patients with autoimmune rheumatic diseases.
Methods: Our study includes three groups of patients (99 in total) with stable underlying diseases status, suffering from: 30 patients with systemic lupus erythematosus (SLE), 37 with rheumatoid arthritis (RA) and 32 with Sjögren's Syndrome (SjS). In November 2011. 46 patients were immunized with an inactivated trivalent split vaccine (15 µg HA A/California/7/2009 (H1N1), 15 µg HA A/Pert/16/2009 (H3N2) and 15 µg / HA B Brisbane / 60/2008) whereas 52 patients did not accept the proposed vaccination.These three groups of patients were divided into two subgroups depending on vaccination: vaccinated - SLE1 (19), RA1 (15) and SjS1 (14), and unvaccinated - SLE2 (11), RA2 (22), SjS2 (18). During the following year disease activity parameters (SLEDAI for SLE), presence of viral and bacterial infections and concentration of A H1N1 antibodies were monitored in vaccinated and unvaccinated patients. Previous respiratory infections from 2006-2011 were regarded as a potentially significant predictor of a more frequent future onset of influenza and secondary bacterial complications.
In the following six months parameters of disease activity (from the date of vaccination until April 2013) and the titer of antibodies against influenza A H1N1 were monitored. We used hemagglutination inhibition test (according to the method of the Center for Disease Control and Prevention (CDC) with antigen A/California/7/2009 influenza virus (H1N1), and turkey erythrocytes for the detection of antibodies against the A H1N1. Value of seroprotective titer (ST) was defined as ≥ 32. Importance of predisposing factors for influenza occurrence (i.e. previous respiratory infections and vaccinations in last five years) was also analyzed.
Results: The incidence of viral and bacterial infections among vaccinated patients (primarily influenza) was significantly lower, compared to the non-vaccinated group. Influenza occurrence was significantly associated with previous respiratory infections (p=0.001). The mean titer of antibodies was highest in SLE patients and significantly higher in all vaccinated patients (p=0.018). Mid-level antibody titer was significantly related to last vaccination in all patients (p= 0.001) and has not been proven after removal of last vaccination effects (p=0.227). Similar results were obtained for patients with SLE, while in RA and SjS these correlations were not significant. ST levels for all vaccinated patients (84.17) were significantly higher than in non-vaccinated patients (8.80) (p=0.008) and were associated with last vaccination in all patients and in SLE group (p=0.012, p=0.039 respectively). Highest levels were observed in vaccinated SLE patients (141.05) and were significantly higher than in non-vaccinated patients (p=0.002). Seroprotective rate for all vaccinated patients was 48% compared to 15% in unvaccinated (p=0.014) and it was highest among SLE patients (53%) (p= 0.049). In RA and SjS groups, these differences were not statistically significant. There was no significant difference between three diseases regarding the mean ranks of antibody titer (p=0.418). Previous bronchitis and pneumonia increased influenza risk significantly.
Conclusions: Based on results to date, it is our opinion that overall, influenza vaccination for patients suffering from SLE, RA and Sjögren’s Syndrome is safe, efficient and sufficiently immunogenic. Based on several years of monitoring respiratory infections in our patients, it is clearly visible that a high risk for exacerbation of the underlying disease was linked to viral or bacterial infection, and practically never to the vaccination itself.

Farhat Afrin
Taibah University, Saudi Arabia
Title: Leishmaniasis vaccines and immunotherapeutics
Farhat Afrin received her Ph.D. in 1999 from Indian Institute of Chemical Biology, Kolkata, India where she worked on liposomal vaccines and drugs against visceral leishmaniasis. From 1998-2014, she was a Faculty member in Department of Biotechnology, Hamdard University, New Delhi, India. She is a recipient of several honors including Commonwealth Academic Staff fellowship, ICMR International fellowship for Young Indian Bio-medical Scientists and DBT Overseas Associateship and also worked at National Institutes of Health, MD, USA and Centre for Immunology and Infection, University of York, UK. Her research interest is parasite immunology with emphasis on development of vaccines and immunotherapeutics for Leishmania infection. She has published over 45 papers in Journals of International repute.

Leishmaniasis is a profound global health problem, encompassing in severity from self-healing cutaneous lesions to mucocutaneous and fatal visceral manifestations. This vector-borne neglected syndrome is ranked among the six most important tropical infectious diseases by WHO. Vaccination remains the best hope for control, and development of a safe, effective and affordable antileishmanial vaccine is a critical public-health priority. The major impediment in vaccine design is the translation of data from animal models to human disease, and transition from laboratory to the field. Furthermore, a thorough understanding of protective immune responses and generation and maintenance of the immunological memory is needed. In the absence of effective vaccines, chemotherapy has remained sole arsenal in the fight against leishmaniasis. The limited chemotherapeutics available against leishmaniasis are deplorable due to high cost, systemic toxicity, prolonged treatment regimens, emerging drug resistance, lack of efficacy in endemic areas, relapse of visceral affliction in the form of PKDL and emergence of HIV co-infection. Leishmania parasites incapacitate host macrophages and impair their functioning, eventually leading to suppression of cell-mediated immunity and resistance is associated with a T-helper-1 immune response that activates macrophages to kill the intracellular parasites. It is well documented that a fully competent immune response is required for successful cure of leishmaniasis by restoring defective host immune machinery. The recent advances in development of prophylactic and immunotherapeutic anti-leishmanial vaccines will be discussed, highlighting the potential of herbal immunomodulators alone or in nanoliposomal forms aimed to modulate and activate the immune response to obtain a therapeutic cure.

Su-Hwa Lee, Ah-Ra Kim, Dong-Hun Lee, Fu-Shi Quan
Kyung Hee University School of Medicine, South Korea
Title: Microneedle delivery of trivalent influenza vaccine to the skin induces long-term cross-protection
Fu Shi Quan received her Ph.D. degree at Korea University Seoul, Korea and had postdoctoral training in the laboratory of professor Richard W. Compans (Department of Microbiology & Immunology, School of Medicine, Emory University, GA USA). She has spent most of her scientific career in Dr. Compans’ lab studying virus-like particle vaccines. Currently, she is a Professor in Department of Medical Zoology at Kyung Hee University School of Medicine, where her focus is the development of VLP protective vaccines against influenza and a respiratory syncytial virus (RSV). She is recognized as an expert in influenza VLP vaccine research.

Microneedle vaccination has been previously demonstrated to induce protection against the homologous virus strain. In this study, we investigated the heterosubtypic protective efficacy of trivalent influenza vaccine containing A/PR/8/34 (H1N1), A/Hong Kong/68 (H3N2) and B/Lee/40 after skin vaccination using microneedle patches coated with the vaccine. Microneedle vaccination of mice in the skin induced 100% protection against lethal challenge infection with heterologous influenza A/California/04/09, A/Philippines/2/82 and B/Victoria/287 viruses at 5 month after boost. Cross-reactive serum IgG antibody responses against heterologous influenza viruses A/California/04/09, A/Philippines/2/82 and B/Victoria/287 were induced at high levels. Hemagglutination inhibition (HAI) titers against these heterogous viruses were also maintained at high levels. Microneedle vaccination induced substantial levels of lung cross-reactive IgG antibody responses and cross-reactive antibody-secreting plasma cells from spleen and bone marrow. Lung viral loads were reduced significantly and all mice were survived upon virus challenges. These results indicate that skin vaccination with trivalent vaccine using a microneedle patch provides protection against heterologous influenza viruses in mice.
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MEST) (NRF-2014R1A2A2A01004899).

Babatunde I. Omotowo
University of Nigeria, Nigeria
Title: Opportunistic Immunization as tool to address missed opportunity: Attitude and practice in a tertiary hospital

Background: Immunization is the most cost effective public health interventions a saving more lives than any other health care intervention. The prevalence of missed opportunities to immunization is 32%-34.4% in Nigeria. This creates a barrier to achieving the goals of Immunization. This study sought to ascertain the practice of opportunistic immunization as a tool to address this gap.
Method: Immunization records of pediatric in-patients in University of Nigeria Teaching Hospital were obtained from case notes of discharged patients. Self administered, structured questionnaire was used to elicit information from 197 health care providers in pediatric department/units.
Result: Of the 83.8% of respondents who have heard of missed opportunity only 62% had a correct knowledge of it. More than half of the respondents believe that missed opportunities happen in UNTH especially in pediatric medical wards. Only 60.9% took immunization history from all pediatric patients. Only 8.6% of respondents reported having practiced opportunistic immunization at one point or the other. Data from medical records showed that the practice of opportunistic immunization with in- patients was only 10.8% of the 55.4% patients with missed immuniztion documented at presentation. The most popular reported practice among our respondents when they detected cases of incomplete immunization is referral to immunization clinic (54.8%), administration of vaccines in the wards and clinics (23.9%) while 16.2% do nothing at all. Up to 73.6% of the HCPs reported that UNTH is yet to adopt opportunistic immunization policy. The Institute of Child Health in UNTH practices opportunistic immunization in her ‘Well Baby Clinic’ but do not have any written policy on opportunistic immunization. Only 65% of respondents believed opportunistic immunization policy would be very effective and would increase immunization coverage and eliminate missed opportunities.
Conclusion: The study site is yet to adopt opportunistic immunization policy with attendant low level of practice