Chng 22

SN XUT V S DNG VACXIN

Bin son: L Vn Hip, Nguyn Ln Dng

22.1. LCH S
Antoni van Leeuwenhock pht minh ra knh hin vi v nhn thy vi
khun vo nm 1684. Hn 100 nm sau Edward Jenner l ngi u tin tr
thnh phng php chng u phng nga bnh u ma. Trong giai on
t 1857 n 1885 Louis Pasteur tr thnh ng t ca ngnh Vi sinh vt v
cng l ngi u tin ch to ra vacxin phng bnh than v bnh di.















Hnh 22.1: Edward Jenner


Bng 22.1: Nin biu pht hin mm bnh v sn xut vacxin
a- Qu trnh pht hin mm bnh
Nm Mm bnh Ngi pht hin
1863
1873

1878
1879
1880
1882
1883

1884
1885
1886
1887
1891
1894
1896
1901
1905
1906
1908
1909
1911
1933
1934

1938
1940
1953
Vi khun than
Vi khun hi (phong)
Vi khun st hi quy
Vi khun t cu
Vi khun lu
Vi khun thng hn
Vi khun lao
Vi khun t
Vi khun lin cu
Vi khun bch hu, un vn
Vi khun E.coli
Vi khun Bruccela
Vi khun no m cu
Vi khun l
Vi khun dch hch
Vi khun gy ng c tht
Virut st vng
Vi khun giang mai
Vi khun ho g
Virut gy ung th
Virut bi lit
Virut Thy u
Virut cm
Virut quai b v virut vim
no Nht Bn
Virut si
Virut st xut huyt Dengue
L.Pasteur
H.Hansen
O.Obermeier
L.Pasteur
A.Neisser
K.Eberth. G.Gaffky
R.Koch
R.Koch
T.Bilroth , L.Pasteur
E.Klebs, F.Loffler,A.Nicolaev
T.Escherichi
D.Bruce,B.Bang, G.Traum
A.Weichselbaum
K.Shiga
A.Yersin
E.Van Ermengen
W.Reed
E.Schaudina, E.Holiman
Bordet-Gengou
Ellerman-Bang

Aragao-E.Paschen
U.Smith-H.ADNewes
C.Johnson-E.Goodpasture

H.Plotz
A.Smorodissev-A.Chumacov
1964
1967
1969
1970
1973
1976
1977
1983
1989
1990
1884

Virut Adeno
Virut vim gan B
Marburg
Lazza
Dengue
Virut vim gan A
Virut Ebola
Virut vim gan D
Virut HIV
Virut Vim gan C
Virut vim gan E
Virut vim gan G

W.Row
Blumberg
Fill


Frinston

Rizzetto
Montagnier
Choo
Reyes
Simons

b- Sn xut vacxin
Nm Loi vacxin Ngi xut
1796
1880
1885
1892
1896
1898
1915
1921
1923
1926
1927
1932
Vacxin u ma
Vacxin bnh than
Vacxin di bt hot
Vacxin t
Vacxin t
Vacxin thng hn
Vacxin chng hoi th
Vacxin BCG phng lao
Vacxin ho g
Vacxin bch hu
Vacxin un vn
Vacxin sng st vng
E.Jenner
Louis Pasteur
Louis Pasteur
Haffkine
Kolle
Raita
Weinberg
L.C.A.Calmette-A.F.Mguerin
Blum-Madsen
G.Ramon-Glenny
Ramon-Zoeller
M.Theiler
1933
1937
1938
1940
1943
1949
1953
1957
1960
1967
1968
1969
1971
1974
1978

1979
1980
1981
1983
1983

1986
1988
1992
1993

1996
1998
Vacxin Weils
Vacxin cm bt hot
Vacxin vim no
Vacxin di bt hot
Vacxin cm sng
Vacxin Lepto
Vacxin bi lit cht (Salk)
Vacxin bi lit sng ung
Vacxin si sng
Vacxin quai b bt hot
Vacxin vim no m C
Vacxin Rubella sng
Vacxin vim no m A
Vacxin Rubella sng
Vacxin vim gan B huyt
tng
Vacxin Vim ph cu
Vacxin di nui cy t bo
Vacxin ho g v bo
Vacxin thy u
Vacxin vim gan B ti t hp
Vacxin si+quai b+Rubella
Vacxin Hib
Vacxinvim gan A
Vacxin cng hp 5 thnh
phn DTP-IPV-Hib
Vacxin DPT-Hib-HepB
Vacxin Rota v Lyme
Wani
Salk
A.Cmorodinsov-E.Levkovich
D.Semple
Francis
A. Varpholomeev-G.Kovalxkii
Salk
Sabin
J.F.Enders,Yokuno,A.A.Smordints
ev
(Hoa K)
Gotschlich
(Hoa K-B)
Gotschlich
Takahashi

Maufas
Austrian
(Php Nht)
Sato
Takahshi
MerkCo.Ltd (Hoa K), Myanohara
(Nht)
Merieux


22.2. VACXIN
22.2.1. S pht trin ca vacxin
Vacxin hc (Vacxinology) c m u thnh cng vo cui th k 18
bi bc s th y E.Jenner (Anh) vi vacxin lm t chng gy bnh u b,
tim cho cu b 13 tui J.Philip. Hin nay, T chc Y t Th gii (WHO)
cng nhn tim vacxin l phng cch bo v hiu qu, gip nhn loi trnh
c cc bnh truyn nhim. T 1880, Louis Pasteur (Php) sng ch
thnh cng vacxin chng bnh Than v nhiu loi vacxin khc trn tng
ca Jenner, to ra mt trng phi ring tn ti cho n ngy nay. Sang na
th k 20, mc d cng ngh vacxin c nhng bc tin vt bc v t
nhiu thnh tch ng k, nhng cng ny sinh nhiu thch thc, nhiu
bnh dch nguy him ti pht v mi xut hin.
Tnh trng min dch m c th c c sau khi s dng vacxin l kt
qu ca s p ng min dch i vi cc thnh phn khng nguyn c trong
vacxin. Ty tng loi vacxin, hiu lc bo v c th do min dch dch th,
min dch qua trung gian t bo hoc phi hp c hai loi. Ngoi min dch
c hiu, vacxin cn c kh nng tng cng c min dch khng c hiu
nh lm tng qu trnh thc bo nh khng th ng vai tr l yu t opsonin
c hiu v nh lymphokin hot ha i thc bo
22.2.2. Nguyn tc s dng vacxin
Vic s dng vacxin phi m bo cc nguyn tc sau y:
- Tim chng trn phm vi rng, t t l cao.
- Tim chng ng i tng.
- Bt u tim chng ng lc; bo m ng khong cch gia cc
ln tim chng; tim chng nhc li ng thi gian.
- Tim chng ng ng v ng liu lng.
- Nm vng phng php phng v x tr cc phn ng khng mong
mun do tim chng.
- Bo qun vacxin ng quy nh.
22.2.2.1. Phm vi v t l tim chng
- V phm vi tim chng:
Phm vi tim chng c quy nh theo tnh hnh dch t ca tng
bnh. Phm vi tim chng ng nhin khng ging nhau gia cc nc.
Ngay c cc khu vc trong mt nc cng c th c s khc nhau. Nhng
quy nh ny li c th thay i theo thi gian do s thay i v dch t dch
t hc ca bnh nhim khun. V l thuyt, ngi ta thng ni tim chng
cng rng cng tt. Thc t th khng th thc hin c iu v nhng l
do sau y: Th nht, s rt tn km (chi ph cho vic mua hoc sn xut
vacxin v cho vic t chc tim chng); th hai, tuy cc phn ng khng
mong mun do vacxin gy ra rt t nhng khng phi l khng c.
- V t l tim chng:
Nhng khu vc c lu hnh bnh truyn nhim, tim chng phi t
trn 80% i tng cha c min dch mi c kh nng ngn nga c dch.
Nu t l tim chng ch t trong khong t 50% n 80%, nguy c xy ra
dch ch gim bt. Nu t l tim chng di 50% dch vn d dng xy ra.
22.2.2.2. i tng tim chng
i tng cn c tim chng mt loi vacxin no l tt c nhng
ngi c nguy c nhim vi sinh vt gy bnh m cha c min dch.
Tr em l i tng cn c c bit quan tm. Sau khi ht min dch th
ng do m truyn (trong thi gian khong 6 thng) nguy c mc bnh ca
tr rt ln. Mt khc min dch th ng nh khng th truyn qua rau thai
hoc qua sa ch c i vi nhng bnh m c ch bo v ch yu do min
dch dch th. i vi nhng bnh m c ch bo v l min dch qua trung
gian t bo th tr c th b bnh ngay t nhng thng u tin sau khi sinh.
Nhng hiu bit ny l c s cho vic quy nh thi im bt u tim chng
cho tr em. Tr nhng i tng chng ch nh, tt c tr em u phi c
tim chng.
i vi ngi ln, i tng tim chng thu hp hn. Thng ch tin
hnh tim chng cho nhng nhm ngi c nguy c cao. Trong thi k m
ca, s lng ngi i du lch gia cc nc ngy cng ln, tim chng cho
ngi du lch tr thnh yu cu bt buc i vi c nc c cng dn i
du lch v c nc n khch du lch.
Trong nhng nm gn y, phng bnh un vn s sinh, ph n
la tui sinh c tim phng un vn.












Hnh 22.2: Tim chng vacxin
Din chng ch nh tim chng (khng c tim chng) c hng
dn ring i vi mi vacxin. Ni chung khng c tim chng cho cc i
tng sau y:
- Nhng ngi ang b st cao. Nhng trng hp ang b nhim
khun nh khng st hoc ch st nh th khng cn phi hon tim chng.
- Nhng ngi ang trong tnh trng d ng. Nhng ngi c c a
d ng hoc c lch s gia nh b d ng vn tim chng c, nhng cn
phi theo di cn thn hn.
- Vacxin sng gim c lc khng c tim chng cho nhng ngi
b thiu ht min dch, nhng ngi ang dng thuc n p min dch hoc
nhng ngi mc bnh c tnh.
- Tt c cc loi vacxin virut sng gim c lc khng c tim
chng cho ph n ang mang thai.
22.2.2.3. Thi gian tim chng
Vic tim chng c tin hnh thng xuyn hoc tp trung tim
chng hng lot ty thuc vo yu cu ca mi loi vacxin v cc iu kin
c th khc.
- Thi im t chc tim chng: Khi xc nh c quy lut xut
hin dch, cn phi tin hnh tim chng n trc ma dch, c th c
thi gian hnh thnh min dch. i vi vacxin c tim chng ln u, thi
gian tim tng ko di t 24 gi n 2 tun (trung bnh khong 1 tun), ty
thuc vo bn cht vacxin v tnh phn ng ca c th. Hiu gi khng th
t c nh cao nht sau khong 4 ngy n 4 tun (trung bnh 2 tun).
l kt qu ca p ng min dch tin pht. Khi tim chng nhc li, thi gian
tim tng s rt ngn, hiu gi khng th t c nh cao nht ch sau mt
s ngy nh nhng t bo lympho c tr nh min dch. l kt qu ca p
ng min dch th pht.
- Khong cch gia cc ln tim chng: i vi nhng vacxin phi
tim chng nhiu ln (khi to min dch c bn), khong cch hp l gia cc
ln tim chng l 1 thng. Nu khong cch ny ngn hn, mc d tim
chng ln sau nhng kt qu p ng ca c th vn ch nh tin pht, p
ng min dch th pht s khng c hoc b hn ch. Ngc li, v mt l do
no phi tim chng ln tip theo sau hn 1 thng, hiu qu min dch vn
c m bo, v vy ln tim chng trc vn c tnh. Tuy nhin, khng
nn ko di vic tim chng nu khng c nhng l do bt buc, v tr c th
b mc bnh trc khi c tim chng y .
- Thi gian tim chng nhc li: Ty thuc vo thi gian duy tr c
tnh trng min dch c hiu lc bo v ca mi loi vacxin. Thi gian ny
khc nhau i vi cc loi vacxin khc nhau. Khi tim chng nhc li thng
ch cn 1 ln. Vi ln tng cng ny, c th s p ng min dch nhanh v
mnh hn, cho d khng th ca ln tim chng trc ch cn li rt t.

22.2.2.4. Liu lng v ng a vacxin vo c th
a- Liu lng
Liu lng vacxin ty thuc vo loi vacxin v ng a vo c th.
Liu lng qu thp s khng kh nng kch thch c th p ng min
dch. Ngc li, liu lng qu ln s dn n tnh trng dung np c hiu
i vi ln tim chng tip theo.
b- ng tim chng
- Chng (rch da): y l ng c in nht, c thc hin ngay t
lc Jenner sng ch ra vacxin phng bnh u ma. i vi vacxin ny,
ng chng vn c dng cho ti khi bnh u ma b tiu dit hon ton
trn hnh tinh ca chng ta (1979), khng cn phi chng u na. Ngy nay
ng chng vn cn c s dng cho mt s t vacxin.
- ng tim: C th tim trong da, tim di da hoc tim bp, khng
bao gi tim vacxin vo ng tnh mch. Tim trong da c th c thc
hin bng bm kim tim hoc bng bm nn p lc khng kim.
- ng ung: ng ung l ng a vacxin vo c th d thc
hin nht. Tuy nhin ch thc hin c i vi vacxin khng b dch ng
tiu ha ph hy. Cng vi tin b trong s hiu bit v vai tr ca min dch
ti ch do IgA tit, nhng vacxin phng bnh ng tiu ha (hoc bnh
ni khc nhng vi sinh vt xm nhp vo c th theo ng tiu ha)
c s dng hoc ang c nghin cu a vo c th bng cch ung.
ng ung kch thch min dch tit ti ch mnh hn nhiu so vi ng
tim.
Ngoi 3 ng ni trn, vacxin cn c vo c th theo mt s ng
khc nh kh dung, t di li, tht vo i trng, nhng ng ny t
c s dng.
22.2.2.5. Cc phn ng ph do tim chng
V nguyn tc, vacxin phi m bo an ton. Song trn thc t
khng th t c mc an ton tuyt i. Tt c cc vacxin u c th
gy ra phn ng ph mt s ngi.
- Phn ng ti ch: Nhng phn ng nh thng gp sau tim chng l
ni tim c th hi au, mn , hi sng hoc ni cc nh. Nhng phn ng
ny s mt i nhanh chng sau mt vi ngy, khng cn phi can thip g.
Nu tim chng khng m bo v khun, ni tim c th b vim nhim,
mng m.
- Phn ng ton thn: Trong cc phn ng ton thn, st hay gp hn
c (10% n 20%). St thng ht nhanh sau mt vi ngy. Co git c th
gp nhng vi t l rt thp (1/10.000), hu ht khi khng li di chng g.
Mt s vacxin c th gy ra phn ng nguy him hn, trong c sc phn
v, tuy nhin t l rt thp.
Khi bn v nhng phn ng do vacxin, rt cn phi nhn mnh rng
mc nguy him do vacxin nh hn rt nhiu so vi mc nguy him do
bnh nhim khun tng ng gy ra. Th d, t l bin chng nguy him do
bnh ho g gp hng trm n hng nghn ln phn ng nguy him do vacxin
bch hu ho g un vn (vacxin DPT) gy ra.
22.2.2.6. Bo qun vacxin
Vacxin rt d b hng nu khng c bo qun ng. Cht lng
vacxin nh hng trc tip n hiu lc to min dch, v vy cc vacxin cn
phi c bo qun tt ngay t lc n c sn xut cho ti khi c tim
chng vo c th. Thng quy trnh bo qun cc vacxin khng ging nhau,
nhng ni chung cc vacxin u cn c bo qun trong iu kin kh, ti
v lnh.
Nhit v nh sng ph hy tt c cc loi vacxin, nht l nhng vacxin
sng nh vacxin si, bi lit v vacxin BCG sng. Ngc li, ng lnh ph
hy nhanh cc vacxin gii c t (nh vacxin phng un vn v bch hu).
Trong qu trnh s dng cng ng, cc vacxin cn c bo qun nhit
trong khong t 2
o
C n 8
o
C.
Mt trong nhng cng vic quan trng nht trong vic t chc tim
chng l to lp c dy chuyn lnh. Dy chuyn lnh khng n thun l
c cc nh lnh, t lnh, cc phch hoc cc hp cch nhit m cn phi
lu c nhng khu trung gian trong qu trnh vn chuyn vacxin v tin
hnh tim chng. Vacxin nu b ph hy d c c bo qun lai iu
kin thch hp cng khng th c hiu lc tr li, cng khng c tc dng
na, phi loi b.
Mt im cng cn c lu l cc ha cht ty u, st trng u c
th ph hy vacxin. Nu cc dng c tim chng c kh trng bng ha
cht th ch cn mt lng rt t dnh li cng c th lm hng vacxin. V vy
cc dng c tim chng trc khi dng phi c ra sch sau kh trng
nhit cao bng cch luc hoc hp.
22.3. TIU CHUN CA VACXIN
Hai tiu chun c bn nht ca vacxin l an ton v hiu lc.
22.3.1. An ton
Mt vacxin l tng khi s dng s khng gy bnh, khng gy c v
khng gy phn ng. Sau khi sn xut vacxin phi c c quan kim nh
nh nc kim tra cht ch v mt v khun, thun khit v khng c.
- V khun: Vacxin khng c nhim cc vi sinh vt khc, nht l cc
vi sinh vt gy bnh.
- Thun khit: Ngoi khng nguyn a vo kch thch c th p
ng min dch chng vi sinh vt gy bnh, khng c ln cc thnh phn
khng nguyn khc c th gy ra cc phn ng ph bt li.
- Khng c: Liu s dng phi thp hn rt nhiu so vi liu gy c.
Tuy nhin, nh nu phn 2.5., khng c vacxin no t c
an ton tuyt i. Khi cn nhc quyt nh xem mt vacxin no c
c a vo s dng hay khng, cn phi so sch gia mc phn ng do
vacxin v tnh nguy him ca bnh nhim khun tng ng.
22.3.2. Hiu lc
Vacxin c hiu lc ln l vacxin gy c min dch mc cao v
tn ti trong mt thi gian di. Hiu lc gy min dch ca vacxin trc ht
c nh gi trn ng vt th nghim, sau trn thc a.
Trn ng vt th nghim: Cch th nht, nh gi mc p ng
min dch thng qua vic xc nh hiu gi khng th hoc xc nh mc
dng tnh ca phn ng da. Cch nh gi ny khng cho bit hiu lc bo
v. Cch th hai, xc nh t l ng vt c tim chng sng st sau khi
th thch bng vi sinh vt gy bnh.
D c c quan kim nh nh nc kim tra v c nh gi
trn ng vt, trc khi a ra tim chng rng ri, vacxin u phi c th
nghim trn thc a (field test): Vacxin c tim chng cho mt cng
ng, theo di thng k tt c cc phn ng ph v nh gi kh nng bo v
khi ma dch ti.
Ngoi 2 tiu chun trn, chn mt vacxin tim chng, ngi ta cn
quan tm n gi thnh v tnh thun li cho vic tin hnh tim chng.
22.3.3. Cc nhn t nh hng n hiu lc ca vacxin
22.3.3.1. Bn cht v liu lng ca vacxin
Hiu lc ca vacxin s cao nu cha cc khng nguyn c tnh sinh
min dch mnh. Mt khc vacxin phi c sn xut t cc chng vi sinh vt
t cch i din cho tc nhn gy bnh.
22.3.3.2. ng a vacxin vo c th
22.3.3.3. Cc cht ph gia min dch
Cc cht ph gia min dch c dng rng ri nht l cc hp cht
ca nhm (aluminum hydroxit hoc aluminum photphat). Cht ph gia min
dch c tc dng lm cho vacxin chm ging ha, v vy c th gim c
liu lng v s ln tim chng. Cht ph gia cn c tc dng kch thch c
th p ng min dch mnh hn. Nh vy cht ph gia min dch va c tc
dng lm tng hiu qu kinh t, va c tc dng lm tng hiu qu min dch.
22.3.3.4. Tnh trng dinh dng
Nhng nh hng ca tnh trng dinh dng n p ng min dch
c xc nh. Nhng kt qu nghin cu cho thy, suy dinh dng lm
gim p ng min dch qua trung gian t bo r hn min dch dch th. Tuy
nhin cc tr suy dinh dng vn cn c tim chng v 2 l do: Th nht,
chng vn c kh nng p ng min dch; th hai, chng rt d b mc cc
bnh truyn nhim.
22.3.3.5. Khng th do m truyn
Khng th do m truyn c kh nng c ch p ng min dch ca
loi vacxin tng ng. V vy hiu lc min dch ca mt s vacxin s b hn
ch nu tim chng qu sm khi hiu gi khng th do m truyn cn tng
i cao. Nhng bnh nh lao, bi lit c c ch khng ch yu l min
dch qua trung gian t bo, a tr khng c m truyn, v vy phi c
tim vacxin phng lao v ung vacxin phng bi lit t rt sm ngay nhng
ngy u tin sau khi sinh.
22.4. PHN LOI VACXIN
Vacxin c th chia thnh 3 loi:
1) Vacxin gii c t,
2) Vacxin cht ton th hoc khng nguyn tinh ch, v
3) Vacxin sng gim c lc.
22.4.1. Vacxin gii c t
Loi vacxin ny c sn xut t ngoi c t ca vi khun c
lm mt tnh c nhng vn gi c tnh khng nguyn. Vacxin gii c t
kch thch c th sn xut ra khng c t, l loi khng th c kh nng
trung ha ngoi c t. Vacxin ny nhm phng chng cc bnh nhim trung
do vi khun gy bnh ch yu bng ngoi c t.
22.4.2. Vacxin cht ton th hoc khng nguyn tinh ch
Loi vacxin ny sn xut t cc vi sinh vt gy bnh. Sau khi vi sinh
vt b git cht c th ly ton b huyn dch lm vacxin (vacxin ton th),
hoc tinh ch ly cc thnh phn khng nguyn quan trng, l cc khng
nguyn bo v (protective antigens).
Cc khng nguyn ny ch yu kch thch p ng min dch dch th.
Cc khng th c hnh thnh c th trc tip git cht vi sinh vt, ngn cn
s bm dnh ca chng vo t bo c th vt ch, lm tng kh nng thc bo
, hoc phi hp cc c ch trn.
22.4.3. Vacxin sng gim c lc
Loi vacxin ny sn xut t vi sinh vt gy bnh hoc vi sinh vt ging
vi sinh vt gy bnh v cu trc khng nguyn, c lm gim c lc
khng cn kh nng gy bnh. Vacxin sng to ra trong c th mt qu trnh
nhim khun t nhin, kch thch c th p ng c min dch ton th v
min dch ti ch, c min dch dch th v min dch qua trung gian t bo.
Tuy nhin iu phi quan tm c bit l tnh an ton ca vacxin sng,
phi m bo khng cn kh nng gy bnh hoc ch gy bnh rt nh, v vi
sinh vt phi c tnh di truyn n nh khng tr li c lc ban u.
22.5. PHI HP VACXIN
Mc ch chnh ca vic phi hp vacxin l m gim bt s mi tim
chng hoc lm gim bt s ln t chc tim chng. C 2 loi phi hp
vacxin:
1) Tim chng vacxin phi hp (trn cc vacxin vi nhau, tim chng
cng mt ln, cng mt ng)
2) Tim chng nhiu vacxin ring bit trong cng mt thi gian, c th
cc v tr khc nhau hoc theo nhng ng khc nhau.








Hnh 22.4: Tim vacxin cho tr em
Phi hp vacxin phi m bo gi c hiu lc to min dch v
khng gy ra tc hi g. Hiu lc to min dch i vi mi thnh phn
vacxin t nht phi bng khi chng c tim chng ring r. Mt s trng
hp khi phi hp vacxin to ra c p ng min dch mnh hn. Ngc li
c nhng trng hp phi hp khng hp l lm gim hiu lc to min
dch. S phi hp vacxin hp l s khng lm tng t l phn ng ph. Ngha
l an ton vn c m bo nh khi chng c tim chng ring r
nhng thi gian khc nhau.
22.6. PHT TRIN VACXIN
22.6.1. Tiu chun chp nhn
- Tuyt i v khun v an ton khi s dng vi s lng ln.
- Hiu qu bo v cng ng tng i cao v phi ko di (c th sut
i ngi).
- Thch ng vi tnh hnh dch t a phng.
- c dung np tt, d s dng, n nh cht lng k c cc nc
vng nhit i nng m v gi c c chp nhn.
22.6.2. Thi k s khai
u ma, sau bnh s khng mc li, bin php min dch ch ng do
Jenner (1796) xut vi chng u B. Kapikian v cng s ngh tim
vacxin cho tr chng bnh vim d dy rut qua ng ung Rotavirut t kh
theo phng php Jenner.


Hnh 22.4:Vacxin phng chng di Hnh 22.5: Vacxin BCG phng lao



Hnh 22.6: Phn lp mm bnh Hnh 22.7: Nui cy mm bnh trn phi g







Hnh 22.8: Nui cy t bo ng vt trong ni ln men
Nm 1985 Pasteur dng vacxin lm yu qua cy truyn trn th phng
di pht sinh t vacxin. T to nguyn l lm yu mm bnh bng cy
truyn sang c cht khng thch hp cn gi l phng php c nh.
22.6.3. Thi k gii c t v vacxin bt hot
- 1884 Laffler pht hin vi khun bch hu v Roux Yersin pht hin
c t bch hu gy bnh.
- Sau khi Behring Kitasato pht hin khng huyt thanh th Gleumy
Ramon gii c c t bng formalin ra i vacxin gii c t bch hu
1923.
- Tin n pht minh vacxin ton thn t bo bt hot chng vi khun
thng hn, t, ho g, vacxin virut bt hot khc nh: Bi lit Salk, vim no
Nht Bn, cm.
22.6.4. Thi k vacxin sng
Nui cy virut trong phng th nghim thnh cng vo gia th k
20 nh vic sn xut vacxin pht trin. Enders to mi trng nui virut t
1948. Nm 1954 Sabin pht trin vacxin bi lit bt hot bng k thut nui
cy t bo thn kh ng thi Sabin v cng s lm vacxin bi lit sng gm
3 typ, thc a Rumani thnh cng. Tip l cc vacxin sng nh: St
vng, si, quai b, rubella (thp k 60), Rota, Bi lit Sabin.
22.6.5. Thi k cng ngh gen
Virut hc v nui cy m pht trin l tin cho pht trin vacxin.
c bit khi min dch hc hin i v cng ngh gen ti t hp ra i
kch thch mnh m nghin cu sn xut vacxin cng ngh cao. Trc y
ch c cc bc s nhn y v th y quan tm n vacxin. n nay, nhiu nh
khoa hc thuc cc lnh vc sinh, ha, l v cng ngh kt hp vi nhau
nghin cu ng dng cng ngh gen v protein trong pht trin vacxin.
u tin l vi vacxin vim gan B: Tc nhn gy bnh l virut nhm
ADN m tiu phn HBs c trong mu bnh nhn l khng nguyn chnh. V
cha c th sn xut ln, vic thu nhm HBs lc u da vo ngun mu
bnh nhn nn d ly nhim, s lng c hn v khng an ton. Khc phc
iu ny c hai nh sn xut Merck (M) v Matsubaz (Nht) ng thi tm
ra phng php ti t hp dng nm men sn xut khng nguyn HBs. ADN
ca virut vim gan B c gn vo nm men thng qua plasmid v nui cy
nm men ti t hp s sn sinh s lng ln khng nguyn dng pha ch
vacxin. Phng php mi thay th hon ton cng ngh c in v a
ngnh sn xut vacxin bc vo k nguyn mi.











Hnh 22.9: Vacxin phng trnh mt s ung th
22.6.6. Nm hng pht trin trong tng lai
- S dng cc ph gia (adjuvant) mi, nhm gy ra loi p ng min
dch mong mun. Th d, cht nhm photphat v cc oligonucleotit cha
CpG demetyl ha a vo vacxin khin p ng min dch pht trin theo
hng dch th (to khng th) thay v t bo.
- Vacxin polypeptit: tng cng tnh sinh min dch nh lin kt tt
hn vi cc phn t MHC: peptit nhn to ging virut, kia gn MHC;
on peptit m phng mt quyt nh khng nguyn (epitop).
- Anti-idiotyp: idiotyp l cu trc khng gian ca khng th ti v tr
gn khng nguyn, c hiu vi khng nguyn tng ng. Anti-idiotyp l cc
khng th c hiu i vi idiotyp, do anti-idiotyp xt v mt c hiu li
tng t vi khng nguyn. Vy, thay v dng khng nguyn X lm vacxin,
ngi ta dng idiotyp anti-anti-X.
- Vacxin ADN: ADN ca tc nhn gy bnh s c biu hin bi t
bo ngi c chng nga. Li th ca ADN l r, bn, d sn xut ra s
lng ln nn thch hp cho nhng chng trnh tim chng rng ri. Ngoi
ra, vacxin ADN cn gip nh hng p ng min dch: tc nhn gy bnh
ngoi bo c trnh din qua MHC loi II, dn n p ng CD4 (dch th
v t bo). Khi khng nguyn ca tc nhn c chnh c th ngi biu
hin, n s c trnh din qua MHC loi I, lc ny p ng min dch t bo
qua CD8 c kch thch. Tuy nhin phng php ny l con dao hai li bi
l t bo mang ADN l c nguy c b nhn din l khng ta, sinh ra bnh t
min.
- S dng vc-t - dng cc virut hoc Protein ti v cng hp
khng nguyn.

















Hnh 22.10: nh hng sn xut vacxin chng HIV/AIDS
22.6.7. Cng ngh mi trong sn xut vacxin
22.6.7.1. i cng
Cc cng ngh mi trong sn xut vacxin gp phn quan trng
trong qu trnh phng chng bnh tt cho con ngi. S bng n v s lng
cc cng ngh nh ti t hp ADN, tinh khit i phn t, sinh ho hc
Protein to ra nhiu ng dng trong sn xut cc loi vacxin c hiu
cho nhiu loi bnh m y hc tng nh b tay (Vim gan B, vim no Nht
Bn, ). Trong khong hai thp k cui ca thin nin k th 2 c s
bng n v s lng nhng vn k thut trong sn xut vacxin mi. C
c s pht trin ny l do nhng tin b nhanh chng trong nhiu lnh vc,
bao gm sinh hc phn t, cng ngh ti t hp ADN (rADN), sinh ho hc
protein, ho hc polysaccharit, sinh ho hc phn tch, tinh khit i phn t,
virut hc, vi khun hc, huyt thanh hc v min dch hc. Mt vi ng dng
sm nht ca nhng cng ngh mi hn dnh cho nhng vacxin c, vi
mc ch l tng s lng sn xut (nh vacxin vim gan B) hoc c s
an ton hn (nh vacxin ho g). Tuy nhin, phn ln nhng ng dng u
hng vo vic pht trin nhng vacxin mi m t trc n nay cha lm
c. Cc cng ngh mi cn c m rng sang nhng lnh vc khc nh
thay i sinh l hc (th tinh), d ng, ung th, iu tr min dch v hi
chng suy gim min dch mc phi.
Mc tiu ca mt vacxin ch ng l kch thch c th to ra mt trng
thi min dch bo v ngi c tim. C hai loi vacxin ch ng:
Vacxin sng l mt vi sinh vt hot ng nh mt tc nhn gy min dch,
c kh nng gy nhim cho cc t bo v nhn ln tc ch m khng gy ra
bnh; Vacxin cht hay bt hot l mt khng nguyn gy min dch,
khng c kh nng gy bnh truyn nhim tc ch.
Bng 22.2: Cng ngh mi trong vacxin hc
Lnh vc Cng ngh p dng
Di truyn




ADN ti t hp
(rADN)



- Nhn bit khng nguyn
- Tch khng nguyn
- Tng hp khng nguyn
- Loi tr t bin
- Loi tr c lc
Ha sinh

Tng hp peptid

- Nhn bit cc biu v peptid
- Tng hp biu v peptid






Cu trc protein v
cacbonhydrat




- D on bng vi tnh v cc biu v t bo
T
- Nhn bit khng nguyn
- Tch khng nguyn
- Xc nh dao ng ca biu b
- T cht mi
Min dch Khng th n
dng



- Nhn dng khng nguyn
- Tch khng nguyn
- Xc nh s bin i ca biu v
- Kch hot biu v khng l protein
- Tim nng ca t cht mi
iu ha min
dch
- Tnh min dch phn t
- Khm ph min dch nim mc i vi
bnh ng rut

22.6.7.2. Vacxin sng
Mt vi vacxin sng p ng v c bn nhng tiu chun cho mt
vacxin l tng. l: C kh nng to ra mt s bo v sut i vi mt
phn ng ti thiu gn nh ton th nhng ngi nhn mt hoc hai liu
vacxin. Nhng vacxin loi ny cha cc vi sinh vt thng l cc virut;
chng gy nhim cc t bo v nhn ln tc ch, ging nh s nhn ln ca
vi sinh vt hoang di gy ra nhim khun t nhin. Nh vy, vi sinh vt c
trong vacxin s gy ra mt p ng min dch ca c th ging nh p ng
vi vi sinh vt hoang di. Vacxin sng c gim c lc, tc l kh nng
gy bnh ca vi sinh vt hu nh c loi b bng cc th thut sinh hc
hay k thut. Cc vacxin sng thng to ra c hai loi min dch, l min
dch dch th (khng th) v min dch t bo (t bo Limpho T).
Vacxin sng gm c 2 loi sau:
a/ Vacxin c in
Thut ng c in cp ti nhng chin lc vacxin khng dng
ti cng ngh rADN. Chin lc vacxin c in u tin lm gim c lc
trong nui t bo tr nn hin thc trong cc thp k 40 v 50 vi nui t
bo hin i invitro (trong phng th nghim) v kh nng nui virut trong
cc nui t bo , to ra vacxin ung poliovirut, cc vacxin tim nh si,
quai b, thu u, rubella. Mt cch ch to vacxin c in th hai l phn lp
v nui virut ng vt, gy ra mt bnh ng vt tng t nh bnh ngi.
Virut ng vt ny to ra c min dch ngi nhng khng gy bnh cho
ngi. l trng hp Jenner dng virut Vacxina (u b) lm
vacxin phng bnh u ma ngi (Variola virut) 200 nm v trc. Chnh
vacxin ny dn n vic thanh ton bnh u ma trn phm vi ton th
gii vo gia thp k 70, y cng chnh l cn bnh u tin c thanh
ton bng vacxin.










Hnh 22.11: Kim tra di knh hin vi in t
b/ Vacxin ti t hp
C 2 hng trong cng ngh rADN c ng dng pht trin
nhng vacxin virut sng mi: ng dng th nht l to ra nhng bin i c
hiu hoc nhng xo b gen ca virut, iu s lm cho virut c gim
c lc mt cch vng bn. Nh vy, chng s khng cn c kh nng quay
tr li c lc. y l hng i to vacxin H5N1 ca Vin V sinh dch t
T (H Ni). ng dng th hai ca cng ngh ADN cho vic pht trin
nhng vacxin sng mi l lm cho nhng virut tr thnh cc vecto ca nhng
Polypeptit ngoi lai hay nhng Epitop peptit t nhng tc nhn gy bnh
khc ca ngi. Mc ch to ra nhng vecto nh vy l gii thiu
Polypeptit hay peptit ngoi lai cho h thng min dch, trong khun kh ca
mt virut sng, lm sao cho h thng min dch p ng vi Polypeptit ngoi
lai nh mt khng nguyn min dch sng. Nh vy s pht trin c mt
min dch rng ri hn (dch th, t bo hay c hai). L mt phn ca mt
virut sng, Polypeptit ngoi lai c biu th bn trong bo tng ca t bo
b nhim, c lm gy thnh nhng on peptit, ri c chuyn vn ti b
mt ca t bo. T , chng s kch thch s p ng ca t bo Limpho T
c vi t bo. Vecto virut mu thng c dng rng ri trong vic to ra
vacxin sng mi l virut u ma. lm cho virut ny tr thnh mt vecto,
phi to ra mt plasmid c cha gen cho polypeptit ngoi lai, vi nhng trnh
t ni tip hng s biu th ca n vo trong cc t bo, s kt hp c
gi l mt ct xt biu th. Virut Vaccinia v ct xt biu th c a cng
vo nui t bo, cc t bo c th tip nhn c hai cng mt lc vo trong bo
tng. xy ra qu trnh ti t hp, sn xut ra mt virut Vaccinia ti t
hp biu th ra Polypeptit ngoi lai.











Hnh 22.12: Sn xut vacxin ADN
22.6.7.3. Vacxin bt hot
So vi vacxin sng th cc vacxin bt hot d sn xut hn. Theo nh
ngha, cc vacxin bt hot khng th nhn ln hoc lan ta c th gy ra
bnh. Ni chung, chng c dung np tt hn, c bit phn ln cc vacxin
bt hot qua x l tinh khit loi b cc i phn t khc. Ngoi ra, do
cng ngh pht trin hin nay, c th d thc hin c vic sn xut cc
vacxin bt hot. Kh nng to min dch ca mt vacxin bt hot thng
c nng cao nh thm t dc. T dc duy nht c cp giy php dng
cho ngi l mui nhm hydroxit hay photphat, c dng tim cho hn 1
t ngi trn ton cu. Khng nguyn ca vacxin gn mt cch vng bn vo
mui nhm nh tc ng tng h in v lm thnh mt hn dch. Cc
vacxin cht thng c chc nng kch thch cc p ng min dch dch th,
cng nh khi ng cho min dch t bo.
a/ Vacxin bt hot nguyn t bo
Sn xut vacxin bt hot nguyn t bo vi khun hay ton ht nh
virut, vi mc ch kch thch vic hnh thnh cc khng th i vi nhiu
khng nguyn; mt vi vacxin cn c tc dng trung ho tc nhn gy bnh.
Trong trng hp vacxin vim gan A chng hn, cc t bo b nhim virut
vim gan A c lm dung gii bi cc ht virut tinh khit bng phng
php sinh ho hc, bt hot bng Formalin, ri sau hp ph vo mt mui
nhm.Chin lc c in ny dn n vic sn xut ra nhng vacxin c hiu
lc, n nay vn cn l mt cng ngh la chn cho nhiu vacxin virut.
b/ Vacxin bt hot protein
i vi nhiu tc nhn gy bnh th vic pht trin mt vacxin da trn
Protein l chin lc c la chn. Phng php ch to ra mt vacxin da
trn Protein bng cc k thut min dch, di truyn v sinh ho hc xc nh
tnh c hiu khng nguyn. K thut ni trn cho php cc biu v bo v v
nhng Polypeptit c xc nh rt c hiu. Vacxin vim gan B lm t
ngun huyt tng ngi l vacxin u tin trong th loi ny. Protein b mt
ca virut vim gan B (HBsAg), c xc nh l mt Lipoprotein, mt khng
nguyn c nhng biu v bo v trn b mt. HBsAg ly t huyt tng ca
nhng ngi mang virut vim gan B mn c tinh khit ri bt hot lm
vacxin. Vacxin vim gan B ti t hp l ng dng u tin ca cng ngh
rADN cho vic sn xut vacxin dng cho ngi.
22.6.8. nh hng pht trin vacxin mi
pht trin 1 vacxin mi c nhiu tr ngi thng lm nn lng cc
nh nghin cu v u t:
- Cn thi gian lu 10-20 nm
- Ri ro cao: Khong 80% gp tht bi trong nghin cu lm sng
- Khng ngc nhin khi cc doanh nghip nh nc cc nc t bn
khng tip tc pht trin sn xut vacxin na.
- Bo trc/tn ti mt h su ngn cch gia cam kt ca cng ng
quc t, quc gia v nhu cu sc khe cng ng vi vn thng mi.
- Cc t chc thng mi lun cn nhc v kh nng thu hi vn, gi
c v th trng.
Ni chung, pht trin vacxin mi cn xem xt cc vn cng ngh
sau:
So snh cng ngh bo ch C in:
- Vacxin sng gim c lc hay c bt hot.
- Vacxin nguyn t bo hay vacxin tiu n v Mi:
- Nhng vecto sng, vt ly truyn khc.
- Nhng mm bnh c bin i v di truyn.
- Cng hp.
- T dc.
- Hp thu qua nim mc.
- Ti t hp ADN.
- Nhng k thut pht hin khng nguyn.
- Cc thit b chit tch.
Vi cc t bo vi khun hoc nm men c lp ghp thm cc
gen mi, ngi ta c th nui cy quy m ln sn xut cc loi protein
khng nguyn ch to ra cc loi vacxin th h mi. u im ca cc loi
vacxin ny l:
- Rt an ton v khng s dng cc tc nhn gy bnh.
- Gi thnh h v khng phi nui cy trn phi g hoc trn cc t
chc ng vt, trong cc thit b t tin.
- Hn ch c kinh ph kim nh.
- H thp gi thnh trong bo qun v vn chuyn.
Thuc v cc loi vacxin th h mi c th k n vacxin khng
nguyn nhn to, vacxin riboxom, vacxin cc mnh ca virut, vacxin cng
ngh ADN.
Cc vacxin chng ung th gan nguyn pht, chng ung th c t cung ,
chng ung th bch cu Burkih l nhng bc tin quan trng u tin ca
con ngi trong vic tm kim bin php min dch chng him ho ung th.
Nh ghp c ADN ca vi khun Hansen vo vi khun E.coli m ngi ta
hy vng lm ra c vacxin chng phong th h hai nga mt bnh nan y
ang lm kh s 15 triu ngi trn th gii. Theo Vane v Cuatrecasas
(1984) c th tm tt cc tin b lai ca vacxin tng lai nh sau:
a. Vacxin thng thng: Vacxin sng gim c v vacxin bt hot m
vic sn xut ch yu da trn kin thc kinh nghim.
b. Vacxin ci tin: vic sn xut da trn nui cy invitro (k c t bo
ng vt c v), nm chc tnh cht cc khng nguyn hiu bit r cc v tr
sinh min dch v ADN ca chng.
c. Vacxin protein n: bao gm vic phn lp khng nguyn tinh khit
sao nhn m ho cc khng nguyn , phn tch cu trc bc nht a vo
s dng cng ngh khng th n dng v t dc ci tin.
d. Vacxin peptit tng hp: vic ch to da trn ho min dch, nghin
cu cu trc peptit trn my tnh v hiu bit c ch ca hin tng cng
hp.
e. Vacxin qua ng ung, kh dung v thc phm.
22.6.8. Cc dng trnh by mi ca vacxin tng lai
l cc loi: ADN ti t hp di truyn, vacxin n qua ming, vacxin
tinh th Trehaloz, vacxin dn trn da.Mt gen khng nguyn c ghp vo
h gen ca mt vi khun hay virut (vecto) di s iu ho ca mt
promoter, ri gy nhim cho c th, kch thch to min dch. Vacxin ti t
hp c vecto dn truyn ny, cng nh loi hnh vacxin sng gim c, cn
nhiu hn ch. Trc ht n kh cng knh do phi duy tr ngun virut hay vi
khun sng. Do vy, ngi ta phi tm kim mt phng thc khc, a gen
khng nguyn vo mt vecto n gin l plasmid. Thc nghim cho thy, khi
a ADN ca mt loi plasmid ti t hp mang gen khng nguyn ngoi lai
vo c th th c th li to min dch chng li. Vic nghin cu th
nghim ny v cn tip tc trong nhng nm ti y.
Vacxin nucleic bao gm vacxin ADN v vacxin ARN. l cc ADN
hoc ARN ca mt loi plasmid ti t hp mang gen khng nguyn ngoi lai
v promoter.
22.6.8.1. Vacxin ti t hp dng tim
Loi vacxin ny ang to mt cuc cch mng trong cng ngh sn
xut vacxin. Nm 1989, Gustav (USA) tnh c pht hin ra liu php gen
trong phng th nghim dng t bo ng vt c v sn xut mt loi protein
m ho trong gen. Ba nm sau, S. Johnston i hc Texas pht minh k
thut nhn chui ADN to sn phm protein ngoi lai trn t bo ng vt.
T protein n vacxin phi ch n bc t ph tip theo ca cc nh bc
hc M Harriet Robinson, David Weiner v nhm S.Johnstons tin hnh
thnh cng vo nm 1991.
Vacxin ADN c tc dng chng ung th, cha bnh t min dch v d
ng. Vacxin ADN c kh nng dung np cao, an ton, n nh v hiu qu
ko di so vi vacxin c in. Ngoi ra, vic d dng sn xut ln, gi thnh
chp nhn c rt c li cho cc nc ang pht trin.
22.6.8.2. Vacxin n qua ming (thc phm)
Gia nhng nm 80, RoyCutiss III v Guy Gardinau (USA) xut
tng cy gen ADN ngoi lai ca virut, vi khun vo thc vt. Nm 1992 nh
thc vt hc Boyce Thompson New-York c tng lm vacxin t nhin
cho ngi qua vic n cc thc phm cy gen trn. Hin c t nht 5 cng
ty cng ngh sinh hc ln ang nghin cu pht trin vacxin n c kiu
ny.
22.6.8.3. Vacxin ha hc dng tinh th Trehaloz lm vt mang
L loi ng i c nhiu trong cc m sinh hc, c kh nng tch tr
nng lng duy tr s sng khi gp iu kin bt li. Nm 1990 B.Roz
Anh xut vic gn cc khng nguyn vi tinh th ny v xoa trn da, d
dng xm nhp vo m sng phng thch khng nguyn nh kiu tim chng
c in. Trehaloz cn l t dc ng kh vacxin, dng kh dung dng qua
ng th (vacxin cm). Nh kh nng bt gi v thi chm, vacxin Trehaloz
rt n nh lun gi c cng hiu cao trong thi gian di bt k nhit
bo qun no (60oC/1 thng khng mt cng hiu).
22.6.8.4. Vacxin dn trn da
Ngi M cho rng vic thm qua da cng l mt cch a vacxin vo
tip cn h thng min dch ca c th ngi. Nhm nghin cu ca
G.Glenm th dn ming giy thm cha c t t CT. CT l cht kch
thch min dch mnh nhng nu c lm gim c tnh (cc tiu phn) th
chnh n tr thnh mt t dc chun cho nhiu loi vacxin khc, vic a
CT qua da rt an ton sau khi th trn mt s ngi tnh nguyn. Th vi LT
ca E.coli trn chut cng cho kt qu tt. c 30 loi khng nguyn lm
vacxin th dng ny (bch hu, un vn, cm, di ) thm ch khng gy
min dch cho vi CT. Min dch qua da bc u c th trn 18
ngi tnh nguyn vi hai khng nguyn CT v LT dn trn cnh tay trong 6
gi. Sau 3 tun o hiu gi khng th thy rt cao, khng gy phn ng ph
so vi chng. C th vacxin ny s phi ci tin bng vic thay dng trc tip
cc c t vi khun bng cc vector plasmid ADN.
22.6.8.5. Vacxin kh dung: Phun xt qua ng ht th (Vacxin cm)
22.7. TIM CHNG V NHNG S C SAU TIM CHNG
22.7.1. Li ch v thch thc
Trong 2 th k qua vacxin gp phn rt ln y li nhiu bnh tt v
gim t l t vong cho con ngi. Trc khi b khai t bi vacxin bnh u
ma tng l ni kinh hong ca c Chu u trong th k 18, cp i sinh
mng ca hng triu ngi. Vacxin cng l v kh hu hiu chng li cc
bnh truyn nhim nguy him nh Bi lit, Si, Vim no gp phn quan
trng hn ch nhng di chng gy tn ph cho bnh nhn, tit kim c
nhiu chi ph cho gia nh v x hi.
Trung bnh hng nm, tim chng cu sng c khong 3 triu
ngi trn ton th gii, khng ch v loi tr c nhiu cn bnh mi ny
sinh nhng con ngi cha c vacxin phng chng.










Hnh 22.13: Bit bao tr em cn cha c tim chng vacxin hng nm
Vi mt s bnh c th sau, nu c min dch bng vacxin, s ngi
trn ton th gii s c cu sng hng nm s l:
- T bnh u ma: (5 triu ngi). Thc t bnh chm dt t nm
1997 n nay.
- T bnh tiu chy (3 triu ngi), ring Rotavirut l 0,9 triu ngi.
- Nhim khun h hp: (3,7 triu ngi), trong do ph cu l 1,2
triu do virut 0,5 triu.
- T lao (3,2 triu ngi), si (2,7 triu ngi), st rt (2,1 triu
ngi).
- Un vn (2 triu ngi), vim gan siu vi B (1,2 triu ngi),
HIV/AIDS (1 triu ngi), ho g (1 triu ngi), bi lit (0,6 triu ngi),
bch hu (0,3 triu ngi), st xut huyt (0,03 triu ngi).
Tng cng: 24.395.000 ngi (ngun CVI/GPV1-1997).
Li ch ca tim chng vacxin cho cng ng trong nhiu thp k qua
c th gii cng nhn. Thnh tu ni bt nht l vic thanh ton vnh
vin bnh u ma trn phm vi ton cu t nhng nm 1980. nhiu quc
gia trong c Vit Nam cng b xa b bnh bi lit vo nm 2000.
Trong vng 10 nm ti, c th chng ta s y li bnh un vn s sinh bng
vacxin. Vit Nam d n tim chng m rng quc gia trin khai 10 loi
vacxin, hai thp k qua gim ng k t l mc v t vong do cc bnh
truyn nhim nh ho g, bch hu, t, thng hn, lao.
Tim vacxin si c th gim 80% nguy c mc v t vong do bnh si
gy ra tr em, song trong s tr c tim c mt t l nh b phn ng.
Khoa hc ngy cng pht trin trong cc lnh vc vi sinh vt hc, min
dch hc, sinh hc phn t, di truyn hc, ha hc, vt l, tin hc v cng
ngh nano h tr c lc cho cng cuc tm kim nhng vacxin an ton,
cng hiu hn. Vacxin hc tip cn sang nhiu lnh vc mi nh bnh d
ng, bnh x hi hc, cc bnh nan y (ung th, HIV/ADIS), bnh k sinh
trng st rt v t nhiu thnh qu ng k. Gi vacxin cng tng bc c
tho g bng nhng bin php h tr ca cc t chc Quc t (UNICEF tha
thun vi cc nh sn xut gim gi cc vacxin thit yu cho tr em) v chnh
ph cc nc (tr gi cc vacxin chng trnh, gim thu, xa b s rng
buc ca lut c quyn s hu tr tu). Nhiu nm qua, Vit Nam mnh
dn thc hin chin lc t tc vacxin, Nh nc h tr sn xut vacxin
trong nc v vn ng nhn dn s dng vacxin ni a, gi c gi
vacxin mc hp l. Vic ci tin phng thc sn xut theo li cng hp
c vacxin a gi (1 mi tim phng c nhiu bnh) v thay vacxin th
h mi nhm gim au n v lo lng cho ngi dng (nht l vi tr em)
to iu kin thun li cho vic trin khai cc chin dich tim chng. Cc t
chc phi chnh ph nh GAVI, qu Bill Gates cng to nhiu ngun ti tr
mi cho vic nghin cu v pht trin vacxin.
Nhng thch thc:
a/ Tnh an ton: Nhng phn ng ph khng an ton ca vacxin cho
ngi c tim ang l mt tri, gy cn tr ln cho cng tc vn ng tim
chng. Mc d t l xut hin nhng phn ng ph nghim trng do vacxin
rt thp, nhng vn xc nh ng nguyn nhn v cch khc phc vn l
nhng thch thc khng nh i vi mi quc gia.
b/ Chi ph: Vic u t sn xut vacxin rt tn km. Chi ph t giai
on nghin cu u tin n vic sn xut th, trang thit b v cui cng l
nh gi lm sng hiu qu ca mt vacxin mi ra i c tnh t 200 400
triu USD. y qu l mc chi khng tng cho cc nc ngho.
c/ Nhiu bnh mi xut hin cha c vacxin: T 3 thp k qua xut
hin nhiu bnh truyn nhim mi nh: HIV/AIDS, b in, st xut huyt,
SARS, cm g l thch thc ln cho gii khoa hc v cc nh qun l y t
ca cc nc. Trc ht nhn loi ang tp trung tm hiu nguyn nhn gy
dch, ch ng phng v dp tt cc v dch bng nhiu bin php tng hp,
song khng th b qua gii php ton din v trit nht l s dng vacxin.
Mt khc, vn phi tip tc tm kim cc vacxin hu hiu phng chng cc
bnh khc nh: st rt, phong ci, tim mch, ung th, d ng cng nhiu bnh
nhim khun v khng nhim khun khc.











Hnh 22.14: Vng dch St vng Chu Phi v Nam M
Mi nm c 130 triu tr em c sinh ra nhng vn c 30 triu tr
trong s ny khng c tim phng, t l tim phng cho tr di 5 tui
gim t 80% (nm 1990) xung 74% (nm 1999) s tr mi sinh ra khng
c hng vacxin min ph ca chng trnh tim chng m rng phng 6
bnh c bn si, bi lit, un vn, bch hu, ho g v lao. Tr em cc nc
ang pht trin vn c nguy c cht v nhng bnh c vacxin phng nga cao
gp 10 ln so vi tr cc nc pht trin. Tim chng l s la chn ng
n, cn min dch bo v c cng ng, tim chng tiu dit mm bnh,
bo v khng ch mt th h m cn cho cc th h tip ni. u t cho tim
chng vn l gii php r nht trong cc bin php phng chng dch bnh:
50 USD cho tim chng c th tit kim hng chc ngn USD cho vic cu
sng mt sinh mng do bnh tt cp i.
22.7.2. Chng trnh tim chng m rng (TCMR)
Chng trnh TCMR hnh thnh khi nim t u nhng nm 1974
ra mc tiu nm 1990 chng 6 bnh nguy him.
c im 6 bnh:
- Si git 2 triu tr/nm.
- Un vn git 800.000 tr/nm (2 mi bo v c m v con 80% trong
3 nm).
- Ho g git 600.000 tr/nm (cng hiu bo v 62 80% nu tim
3 liu t 6 tun tui/cch 1 thng).
- Lao: 2 triu tr di 5 tui mc/nm (60.000 s lao mng no, t
vong 50 100%). BCG gi 2 nm <80C.
Bng 22.3: Nhn bit v chng trnh TCMR
Ni dung Th gii Vit Nam
Khi ng WHO 1974 1984
Loi vacxin 6 loi (Bch hu, ho g,
un vn, lao, bi lit,
6 loi (Bch hu, ho g, un
vn, lao, bi lit, si)
si)
B sung loi vacxin
(1997)
Vim gan B, thng
hnVi, st vng (ty
dch t tng nc).
1997/ Vim gan B, thng
hn Vi, vim no, t (4 loi).
i tng mc tiu < 5 tui < 5 tui

ln v th trng
130 triu tr s
sinh/nm (cc nc
AZAN 26 triu), 65%
s tr cc nc ang
pht trin
1,6 triu tr s sinh/nm

- Bch hu: 10 18% t vong trong cc bnh bch hu (25.000 trng
hp/nm tr em) hiu qu bo v 100% DTP nu bo qun tt.
T nm 1997 TCMR ca Vit Nam b sung thm 4 loi vacxin: T
ung, vim gan virut B, vim no Nht Bn B v Thng hn.
Trong TCMR t l sau 20 nm thc hin Vit Nam gim 100 ln
t l mc cc bnh trn tr em.
Chng trnh tim chng Vit Nam:
- i tng tim chng gm tr em, ph n c thai, ph n tui sinh
.
- Khong 17 triu lt i tng tim chng trong 1 nm trong TCMR.
- Hn 50% nhu cu vacxin s dng trong TCMR c sn xut trong
nc.








Hnh 22.17: Chng trnh Tim chng m rng
22.8.3. Mt s lu v ch nh tim chng
Khng c nhiu chng ch nh trong tim chng. Tt c tr em cn
c tim chng, tr mt s trng hp sau:
a) Nhng liu tim tip theo i vi nhng trng hp c phn ng
qu mn vi liu tim trc hoc nhng ngi c tin s d ng vi cc thnh
phn ca vacxin.
b) Khng nn tim vacxin BCG cho tr em b bnh AIDS.
Ch : Tr b nghi ng nhim HIV hoc c du hiu ca bnh AIDS nn
tim vacxin si cho tr khi c 6 thng tui v nhc li khi tr c 9 thng.
c) Trong trng hp tr b m nu b m tr khng ng tim, khng
tim cho tr, cn b y t cn ngh b m mang tr tr li khi khi m.
Nhng tr c phn ng qu mn vi ln tim trc th khng nn
tim tip. Nu tr b tiu chy khi ung OPV, cn cho tr ung 1 liu b sung
cch liu th 3 t nht 4 tun.



Lu khi tim vacxin:
* Nu tim hn 1 loi vacxin trong cng mt thi im, hy s dng mt
bm kin tim cho mi loi vacxin v khng c tim cng mt ch a
hoc tay. Mi loi vacxin cn c tim nhng v tr khc nhau.
* Khng tim hn mt liu cng mt loi vacxin cho ph n hoc tr em
trong mt ln tim chng.
* Tim ng khong cch gia cc mi tim theo hng dn. (V d: phi i
ti thiu 4 tun gia cc liu i vi Bi lit, DTP v vim gan B)
* Nhng trng hp sau khng chng ch nh:
- C tin s d ng hoc hen (tr trng hp bn bit r d ng vi thnh
phn no ca vacxin).
- Cc trng hp m nh, nh vim nhim ng h hp hoc tiu chy c
thn nhit di 38,50C.
- Tin s gia nh co git, ng kinh hoc ngt.
- ang iu tr cc thuc khng sinh.
- Nhim hoc nghi ng nhim HIV nhng cha biu hin triu chng AIDS.
- Du hiu v triu chng ca AIDS, ngoi tr vacxin BCG.
- Bnh mn tnh nh cc bnh v tim, phi, thn hoc bnh gan.
- Cc bnh thn kinh bm sinh: Bi no hoc hi chng Down.
- non hoc nh cn (khng nn tr hon tim vacxin).
- hoc sp phu thut.
- Suy dinh dng.
- C tin s vng da khi .







22.8.3. Lch tim chng
Bng 22.4: Lch tim chng min dch c bn cho tr em Vit Nam.
Thng tui Vacxin cn tim Mi tim
S sinh (cng sm
cng tt)
BCG (phng lao)
Vim gan B
1 mi
Vacxin vim gan B mi 1
2 thng tui Bi lit
Bch hu, ho g, un vn
Vim gan B
Bi lit ln 1
Bch hu, ho g, un vn,
mi 1
Vacxin vim gan B mi 2
3 thng tui Bi lit
Bch hu, ho g, un vn
Bi lit ln 2
Bch hu, ho g, un vn,
mi 2
4 thng tui Bi lit
Bch hu, ho g, un vn
Vim gan B
Bi lit ln 3
Bch hu, ho g, un vn,
mi 3
Vacxin vim gan B mi 3
9 thng tui Vacxin si Mi 1 khi tr 9 thng tui
V a tr i tim trong chin
dch tim nhc vacxin si
T 1-5 tui Vim no Nht Bn* Vacxin vim no mi 1
Vacxin vim no mi 2 (Hai
tun sau mi 1)
Vacxin vim no mi 3 (mt
nm sau mi 2)
T 2 5 tui Vacxin t* 2 ln ung (ln 2 sau ln 1 hai
tun)
T 3 5 tui Vacxin thng hn* Tim 1 mi duy nht
* Ch tim chng cc vng c nguy c bnh
22.8.4. Nhng s c sau tim chng
Li ch ca tim chng cho sc khe cng ng ai cng r v l iu
khng th ph nhn. Song, nhng s c hay nhng phn ng c hi cho sc
khe tng c nhn trong cng ng th cn nhn nhn ng. Cng nh thuc,
vacxin dng trong tim chng lun t yu cu v tnh an ton v hiu lc
bo v mi c lu hnh. Nhng khng th c mt lai vacxin no hon
ton an ton v vn cn nhng t l nht nh nhng s c xy ra sau tim
chng. Thm vo nguyn nhn do chnh bn cht vacxin th qu trnh tim
chng cng l mt nguyn nhn gy s c .
Vic gim st hn ch tc dng ca cc s c ang l yu cu bc
thit trong chin lc tim chng nc ta hin nay. Cn c h thng t
Trung ng n c s thng k cc bo co trung thc v nhng phn ng
c hi ch thc do vacxin, do tim chng hay do tc ng ngu nhin trng
hp khi tim chng. c ci nhn trung thc y, cn phn loi nhng phn
ng sau tim nh trong bng di y.
Bng 22.5. Nm loi s c sau tim chng
Loi phn ng Nguyn nhn
Phn ng ca vacxin Do bn cht vacxin gy ra vi t l vt qu gii
han cho php v mc v phm vi
Sai st trong tim
chng
Sai st trong sn xut, bo qun vacxin hay khi
tim vacxin.
Ngu nhin Do tnh c kt hp nguyn nhn khc khng phi
do vacxin v tim chng.
Phn ng tm l Do lo u, s hi lm tng au n v phn ng ph
Khng r Khng xc nh c nguyn nhn
Chong phn v d c kh nng gy t vong nhng vn c th iu tr
c m khng li hu qu lu di. Cc phn ng nng khc do tc ng
ngu nhin trng hp nhiu hn do phn ng ch thc ca vacxin. Trong
chin dch tim chng, cn nm vng cc thng tin d on t l v loi
phn ng sau tim chng, phi tin hnh iu tra ngay nu thy t l xy ra
cao hn v phn ng nng hn. Ngt xu thng xy ra tr trn 5 tui
(khng i hi phi x l g ngoi vic t bnh nhn t th nm nghing).
C th ngn nga trc bng cch rt ngn thi gian ch i, gi nhit
phng mc va phi d chu, khi chun b vacxin ng cho tr thy v tim
ring r tng tr mt. Khng tr c tim b ng v phi tr t th
ngi khi tim. Cm gic trng gi l kt qu ca s lo s khi i tim chng
vi nhng triu chng c bit nh nhc u nh, chng mt, t xung quanh
ming v cc bn tay, hn na hay gp cc tr nh, thm ch ngng th, c
khi ht trn chy. Lo s c th dn n mt vi trng hp co git. C tnh
hung gy hysteria hng lot (khi u thng ngt xu t mt tr).
Gii hn nhng tc ng c hi ca tim chng v cch iu tr th
hin trong bng sau y.
Bng 22.6: Triu chng, cch iu tr v loi vacxin gy ra.
VACXIN PHN NG
GIAI ON
BC PHT
T L TRONG 1
TRIU LIU
BCG - Vim hch m 2-6 thng 100-1000
- Vim tai
- Vim nhim lan ta 2-6
thng

1-12 thng
1-12 thng
1-700
2
Vim gan B - Chong phn v
- Hi chng Guilain-
Barre
1-6 tun 1-2
5
Si - St co git
- Gim tiu cu
- Chong phn v
5-12 ngy
15-35 ngy
0-1 gi
333
33
1-50
OPV - Lit lin quan n
vacxin bi lit (VAPP).
- Nguy c cao hn vi
liu u tin
4-30 ngy 0,76-1,3 (liu u)
0,17 (liu tip
theo)
0,15 (ngi tip
xc)
Un vn - Vim dy thn kinh
cnh tay.
- Chong phn v
- p xe
2-28 ngy
0-1 Gi
1-6 tun
1-6
6-10
DTP - Khc tht dai dng >3
gi
- Cn co git
- Gim trng lc, gim
phn x (HHE).
- Chong phn v
- Hi chng no
0-24 gi
0-2 ngy
0-24 gi
0-1 gi
0-3 ngy
1000-6000

570
570

20
0-1
Vim no
Nht Bn B
- Phn ng d ng nng
- Triu chng lin quan
10-1000
1-2.3
n h thn kinh
St vng -Vim no ty
- D ng, chong phn v
7-21 ngy
0-1 gi

500-4000 tr s
sinh di 6 thng
tui
5-20
gim thiu tc hi ca s c sau tim cn c h thng gim st, bo
co thng k, hnh ng x l kp thi t cp c s n Trung ng. Ngoi
ra, vic iu tra sau tm ng nguyn nhn sai st cn c lm minh
bch, trung thc. Vic tuyn truyn trn an d lun vi cha m v qun chng
nhn dn cn c lm nghim tc trn c s khoa hc c tnh, c l. Vic
x l v thng tin qua cc c quan truyn thng l cng vic ht sc t nh
nhy cm cn thn trng v ng hng nhm to nim tin lu di ca cng
ng vi cng tc tim chng.


22.9. TRIN VNG CA CNG NGH SN XUT VACXIN
Vacxin l sn phm c ch to t cc vi sinh vt (virut, vi khun,
nm men) hoc cc khng nguyn c hiu, c a vo c th ngi gy
min dch ch ng nhm phng nhim khun do cc vi sinh vt tng ng
gy ra. Thut ng vacxin E.Jenner dng u tin bt ngun t ch Latinh
vacca (con b) ch cht ch t vy u b dng chng cho ngi nhm
phng bnh u ma. Sau ny, L.Pasteur dng thut ng vacxin rng ri
ghi nh cng trnh c ngha lch s ca E.Jenner.
Nhn chung cc vacxin hin ny thuc hai nhm chnh: Vacxin bt
hot (cn gi l vacxin cht) cha cc vi sinh vt b dit hoc cc ngoi
c t ca chng c gim c khng cn kh nng gy bnh (tc nhn
bt hot nhit, bc x, siu m, ho cht nh formalin, phenol, beta
probiolactol, merthiolate). Nhng tc nhn ny phi c tc dng lm gim
c v bo v khng nguyn.
Vacxin gim c lc (Vacxin sng) cha vi khun hoc virut c
gim c bng cch cy chuyn hoc x l sao cho mt kh nng gy c
hoc b bin chng khng cn kh nng gy c na nhng cn kh nng
min dch.
Khi u 200 nm trc y l s ra i ca vacxin u ma. Ri gn
100 nm sau vacxin di ln u tin c chng nga cho ngi, n nhng
nm 1890 ln lt ra i vacxin t, thng hn, dch hch Thp k u th k
l vacxin ho g, lao. n nhng nm 80 ca th k 20, hn 20 loi vacxin
khc c a vo sn xut.
Trong 27 loi vacxin, tt c u c tim tr 3 loi c vacxin ung
l bi lit, t, thng hn. Khng phi tt c cc tr em trn th gii u c
th c dng vacxin v nh vacxin t, thng hn, st vng ch cn cho
ngi sng trong mt vng dch hoc c gh qua vng . Trong s min
dch chun ang dng cc nc ang pht trin cng c ti t ra t 5-6 mi
tim. M tr em c tim chng vi 14 loi (11 loi trc 8 thng tui)
nhiu gp i s lng yu cu 10 nm trc.
Vi hn 200 loi vacxin ang nghin cu v pht trin, k c vacxin
phng bnh do ph cu khun v no cu khun gy ra, s ln tim s khng
gim i. ng Walter-vADNermissen ca hng SB pht biu trong cuc hp
ca CVI gn y cho rng t nht s c 25 loi vacxin cho tr em vo nm
2010. Nh vy tr em ang qu ti v nhng mi tim ! V nhng thy thuc
y hc d phng c lin quan n s qu ti ny hn chnh cha m ca nhng
a tr khe mnh phi tim vacxin. Vn ny phc tp hn nhng nc
pht trin v c nhng mi tim khng an ton na.
Vic phi hp hu ht cc vacxin vo mt mi tim l mt cch hn
ch s ln tim vacxin. Cc tin b k thut trong tng lai d nhin s sn
xut c nhiu loi khc nh vacxin ung nhng trc mt cn Mt hn
hp khng nguyn trn vo mt sn phm n thch hp vn l mt gii php
hp l trnh qu ti cho tr.
22.9.1. Thnh tu (1949 - 1983)
1949: Vacxin a gi u tin, lin kt cc khng nguyn bch hu v
ho g, bch hu v ung vn, bch hu ho g un vn (DTP: Diphteria-
Pertussis-Tetanus).
1955: Vacxin n gi (1 bnh) a chng u tin vacxin bi lit bt
hot (IPV: Inactivated Polio Vacxine) lin kt 3 tp virut polio c dng
tim v vacxin thng hn, ph thng hn A v B/
1957: Phi hp aenovirut, cm (c chp nhn s dng nm 1980)/
1958: Vacxin bi lit 3 tp theo ng ung (OPV) sabin c s
dng rng ri Lin bang X Vit t nm 1958 v c ng k M nm
1963.
1967: Phi hp si u ma (c chp nhn nm 1985 sau khi
thanh ton bnh u ma).
1970: Phi hp si c (rubella) quai b.
1971: Phi hp si rubella v si quai b Si c.
1973: Phi hp si quai b.
1975: Vacxin cng hp 2 chng (A-C) ca no cu khun s dng
khng nguyn v vi khun polyxacarit (MenPS)
1977: Vacxin ph cu polyxacarit (PnPS) cng hp 14 chng ca ph
cu khun
1981: Vacxin vim mng no th h 2 phi hp 4 chng ca no cu
khun (A, C, Dch v v W 135).
1983: Vacxin ph cu 23 chng thay th loi 14 chng.
Vi t chc CVI khuyn khch dng vacxin a gi v n gin ha
vic tim chng nhm tng s lng tr min dch vi khng nguyn mi
cng sm cng tt.
Nhng li im ca vacxin
- V thc tin:
+ Ngi c chng nga v gia nh: gim au v lo lng v b tim t
hn, gim s ln i tim. Nm 2001, ti Php, nh s dng vacxin lin hp,
tr < 2 tui, ch phi tim 7 mi, thay v phi tim 88 mi; tr < 18 tui, ch
phi tim 11 mi, thay v phi tim tng cng 55 mi.
+ Nhn vin chng nga: tit kim thi gian, gim nguy c b kim
chm.
- V y t cng ng:
+ Tng t l chng nga.
+ Cc khng nguyn mi d c chp nhn hn.
+ Li im v lch chng nga.
- V kinh t:
Tit kim trong cc khu
+ Sn xut: th tc xut l, bao b, kho cha, chuyn ch, kim k.
+ a thuc v c th: ng tim, kim tim, nhn vin tim.
a, Cc kh khn khi pht trin mt vacxin phi hp
Phi bo m s tng thch gia cc loi thnh phn ca cc vacxin c
lin hp vi nhau (khng th, cht bo qun, cht ph gia, t dc, cht n
nh)
Phi bo m c bn vng ca cc vacxin thnh phn.
Phi bo m tnh gy min dch v hiu qu bo v ca tng khng nguyn.
Phi bo m phi hp khng lm tng tc dng ph ca cc vacxin c
phi hp.
b. Nguyn l phi hp
Khi cng ngh vacxin pht trin, nh Ph tng Gim c hng SB
Francis ADNres nh gi, vacxin phi hp 10 loi khng nguyn l k thut
c th thc hin c. Ngi ta cho rng vacxin DTP s l b khung ch cn
p thm cc khng nguyn khc s c tc dng hiu qu ton cu. S la
chn ny c 2 l do chnh: DTP c s dng rng ri, ng thi DTP cn
c xem l mt vacxin n nh v vn gi vai tr chnh ca cc chng
trnh tim chng quc gia trn ton th gii (nhng chng trnh ny
chng nga c khong 75-80% tr em trn th gii di 2 tui). Vo nm
1991, mt loi vacxin DTP mi thnh phn khng nguyn ho g v bo
(DPaT) c ng k M. Vacxin ho g v bo ny c pht trin u
tin Nht gn 20 nm trc, s dng mt hoc nhiu khng nguyn tinh
khit ca vi khun ho g thay cho vacxin ho g ton t bo c in (wP)
DtaP cng hiu nh DTwP nhng t c phn ng ph hn. Song loi ny t
gi, cao gp ri so vi DTwP trn th trng nc M.









Hnh 22.16: Sn xut vacxin t quy m ln
S xut hin cc khng nguyn ha hc mi nh Hep B (Vim gan B)
hoc Hib (Haemophilus influenza typ b) gy vim mng no v vim ph
qun to thm cc dng phi hp mi, DTwP vi HepB hoc Hib hoc vi
Hib v IPV, cng c khi ngi ta dng ca vacxin DTwP-HepB dng nc
tim cng vacxin Hib ng kh. Bn cng c th phi hp Hib v HepB vi
HepA. Cho n nay, c 17 kiu phi hp vacxin theo nhiu phng php
thch hp. V s khng c l do g chng ta khng thy c 17 loi
vacxin phi hp khc thnh 34 loi.
phi hp tt ra i k cng hp. Cc vn ny sinh cn gii
quyt vacxin l gi c, liu lng thch hp, quy thnh sn xut, nhu cu bo
qun lnh, tui th vacxin, phn ng ph, hiu qu bo v v nhiu iu
khc. Nh my tnh vi vacxin phng 5 bnh (bch hu, un vn, ho g, Hib
v vim gan B), c 16.000 kiu phi hp khc nhau, v th phi hp l
mt s thay th hp l tit kim mi tim. D th no, cn loi tr cc
khng nguyn tha khi phi vacxin.
cc nc ang pht trin cn cn nhc khi phi a HepB hoc Hib
vo chng trnh tim chng m rng. C tht s cn phi hp vacxin, liu
c tha khi ghp thm c khng nguyn mi cha gy dch cng nh
vn gi c v h thng dy chuyn lnh. Trng hp t sn xut DTP th
c nn nhp DTP-HepB-HiB hay ch nhp n l cc khng nguyn dng bn
thnh phm? Mun vy, vacxin DTP t sn xut phi t cht lng cao ca
quc t quy nh. Vi cc nc cn ang t sn xut DTwP th c nn nhp
DtaP ? Ni chung cc nc ang pht trin vn thch dng DTwP hn v r
tin, v cn nghi ng cng hiu ca Pa v cn duy tr nn sn xut ang c
ca chnh cc nc .
Gi cn t l cn tr trc nht cho vic s dng vacxin phi hp
cc nc ang pht trin. Cc vacxin phi hp bn M (14-20 USD/liu)
nu mua s lng ln c UNICEF tr gi vi cc nc ngho c th thp hn
10 USD nhng chc khng di 2 USD/liu. Trong khi cc nc ngho cn
phi lo bao cp cc vacxin cn thit hn nh DTP, BCG, bi lit, si th cc
vacxin phi hp qu l kh bn c rng ri cc nc ny. gim gi
cn tng cng tip th mi ngi dn thy c ci li ca con em h khi
dng vacxin phi hp, tng s lng bn ra song song vi vic gim bt cc
chi ph trung gian nh cng tim chch v o to cc nhn vin y t, cc chi
ph do dng c tim, ph vn chuyn v bo qun, gim t l hao ht vacxin
nh ng l liu ph hp ty loi, ty th trng.
Tr ngi cui cng ph cp vacxin phi hp l vn thng tin
tuyn truyn v cng thc phi hp, hiu qu phng bnh cao v cc phn
ng ph t ca vacxin mi cha k nhng thng tin cng ngh phi hp
vacxin cho cc nc ang pht trin.
22.9.2. Nhng vn cng ngh
Bn cht khng nguyn, s tng tc trong hn hp, cng hp v dung
np, nh lng khng nguyn.
Tnh hiu qu v an ton so snh gia phi hp vi tng thnh phn
n.
Cng thc v nh hng ca cht m, pH, bo qun trong vacxin a
gi.
Chi ph cho kim nh in vitro v in vitro kt qu thc a theo tng
vng dn c v dch t khc nhau.
S tng ng gia hiu qu huyt thanh hc vi dch t hc (nht l cc
thnh phn n nguyn tng t nh khng nguyn vi khun ho g).
Thc a vi vacxin hn hp kh nh gi ht hiu qu ca tng hp
phn nu dng ring. Tng chi ph cho ra i mt loi vacxin phi hp
mi cn u t 100-200 triu USD.
22.9.3. Vn th trng
Phi hp vacxin cho ph hp nhu cu ca khi cc nc pht trin v
ngho hay cho c hai. Liu c thu ht tham gia chung ca tt c cc nh sn
xut vacxin hay ch khu tr 5 cng ty ln. Liu c c quyn cng thc phi
hp v c quyn phn phi vacxin ha hn u t ? Tui th vacxin phi
hp liu c di nh vacxin n hay d b thay th trong thi i pht trin
cng ngh nh hin nay. Nu tui th ngn, cn cn nhc u t sao cho gi
c phi chng nu khng s kh tiu th vacxin phi hp.
Cui cng l thi quen v tiu th v chnh sch t lc sn xut vacxin
cc nc ang pht trin cng nh hng n kh nng u t pht trin
cc vacxin phi hp mi. D sao cng c nhng s liu kh quan v th
trng tiu th cc vacxin phi hp v d th trng Anh quc t 1,2t USD
nm 1992 tng dn 1,7 t USD nm 1997 v nm 2002 s l 3,8 t USD (trong
10 nm qua vacxin phi hp chim 40-50 th phn vacxin).
Phi hp vacxin cn m ng pht trin cho cc nh sn xut khi cn y
mnh s lng bn ra bng cch ph cp vacxin n gi thp vo mt loi a
gi v ngc li. Phi nm bt yu cu ca th trng ring mi nc theo
kiu bnh tng a phng kp a vo nhng vacxin ph hp l chin
lc pht trin ca cc nh sn xut ln hin nay. C nhng bnh cha phi
ti nguy him nh thy u hoc quai b nhng nu c thm vacxin ny trong
vacxin phi hp a gi s hp dn cng ng trnh hi chng lm dng
vacxin v nh vic phi hp mt s khng nguyn nht nh trong nhiu
nguyn nhn tiu chy ch nh rch ri cho ngi du lch hay ch dng
cho dn c nhng ni c cc bnh a phng. Cc t chc quc t WHO,
CVI s nh hng pht trin vacxin phi hp chung ton cu trong mt ngy
gn y pht huy sc mnh ca dng vacxin phi hp mi nhm tng hiu
qu an ton cho ngi s dng.