Biologics:

I.Vaccines:
A vaccine is a biological preparation that provides active acquired immunity to a particular disease. A
vaccine typically contains an agent that resembles a disease-causing microorganism and is often made
from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. 

Mode of action of vaccines:

Vaccines induce primary active immunity. Primary active immunity from vaccination developes more
slowly than the incubation period of the most infections and must be induced prior to exposure to the
infectious agent. Therefore the general action of vaccines is considered to be prophylactic. One
exception is rabies vaccine because rabies virus has incubation time period of 35 days.

Immunization with living agents is preferred over killed vaccines because of a superior and prolonged
response. Non living vaccines provide protection only for a limited time and repeated vaccination is
required to maintain protection against typhoid, cholera etc.

Types of vaccines:

Following are different types of vaccines.

1. Live-attenuated vaccines

Live vaccines use a weakened (or attenuated) form of the germ that causes a disease.

Because these vaccines are so similar to the natural infection that they help prevent, they
create a strong and long-lasting immune response. Just 1 or 2 doses of most live vaccines can
give you a lifetime of protection against a germ and the disease it causes.

But live vaccines also have some limitations. For example:

 Because they contain a small amount of the weakened live virus, some people should
talk to their health care provider before receiving them, such as people with weakened
 immune systems, long-term health problems, or people who’ve had an organ
transplant.

 They need to be kept cool, so they don’t travel well. That means they can’t be used in
countries with limited access to refrigerators.

Live vaccines are used to protect against:

 Measles, mumps, rubella (MMR combined vaccine)

 Rotavirus

 Smallpox

 Chickenpox

 Yellow fever

2. Inactivated vaccines

Inactivated vaccines use the killed version of the germ that causes a disease.

Inactivated vaccines usually don’t provide immunity (protection) that’s as strong as live
vaccines. So you may need several doses over time (booster shots) in order to get ongoing
immunity against diseases.

Inactivated vaccines are used to protect against:

 Hepatitis A

 Flu 

 Polio

 Rabies

3. Subunit, recombinant, polysaccharide, and

conjugate vaccines

Subunit, recombinant, polysaccharide, and conjugate vaccines use specific pieces of the germ
— like its protein, sugar, or capsid (a casing around the germ).
Because these vaccines use only specific pieces of the germ, they give a very strong immune
response that’s targeted to key parts of the germ. They can also be used on almost everyone
who needs them, including people with weakened immune systems and long-term health
problems.

One limitation of these vaccines is that you may need booster shots to get ongoing protection
against diseases.

These vaccines are used to protect against:

 Hib (Haemophilus influenzae type b) disease

 Hepatitis B

 HPV (Human papillomavirus)

 Whooping cough (part of the DTP combined vaccine)

 Pneumococcal disease

 Meningococcal disease

 Shingles

4. Toxoid vaccines

Toxoid vaccines use a toxin (harmful product) made by the germ that causes a disease. They
create immunity to the parts of the germ that cause a disease instead of the germ itself. That
means the immune response is targeted to the toxin instead of the whole germ.

Like some other types of vaccines, you may need booster shots to get ongoing protection
against diseases.

Toxoid vaccines are used to protect against:

 Diphtheria

 Tetanus
II.Toxoids:

A toxoid is an inactivated toxin (usually an exotoxin) whose toxicity has been

suppressed either by chemical (formalin) or heat treatment, while other properties,
typically immunogenicity, are maintained.
Toxins are secreted by bacteria, whereas toxoids are altered form of toxins
Mode of action:
Toxoid vaccines prevent diseases caused by bacteria that produce toxins (poisons) in the
body. In the process of making these vaccines, the toxins are weakened so they cannot
cause illness. Weakened toxins are called toxoids. When the immune system receives a
vaccine containing a toxoid, it learns how to fight off the natural toxin.
To increase the immune response, the toxoid is adsorbed to aluminium or calcium salts,
which serve as adjuvants.

Examples:
Tetanus toxoid:
the tetanus toxoid is derived from the tetanospasmin produced by Clostridium tetani. The
latter causes tetanus.
Multiple doses of tetanus toxoid are used for the development of highly immune persons
for the production of human anti-tetanus immune globulin (tetanus immune globulin)
which has replaced horse serum-type tetanus antitoxin in most of the developed world..
Diphtheria toxoid:
The first vaccine against diphtheria was developed in the early 1800s and was widely used in
the United States as early as 1914. The vaccine consisted of a toxin-antitoxin formulation
and was found to be 85 percent effective in preventing diphtheria . In the 1920s, Ramon
found that by treating the toxin with formalin and creating the toxoid, the toxicity of the
preparation could be reduced while maintaining the immunogenic properties . In 1926,
Glenny and his associates discovered that alum-precipitated toxoid was even more effective,
and by the mid-1940s diphtheria toxoid was being combined with tetanus toxoid and whole-
cell pertussis vaccine to create the diphtheria-tetanus-pertussis (DTP) vaccine (. Soon after,
the DTP combination vaccine was adsorbed onto an aluminum salt and researchers noted
the enhanced immunogenicity of the diphtheria and tetanus toxoid in the presence of
pertussis vaccine and the aluminum salt.
 Safety and stability:
Toxoid vaccines are safe because they cannot cause the disease they prevent and there is
no possibility of reversion to virulence. The vaccine antigens are not actively multiplying and
do not spread to unimmunized individuals. They are stable, as they are less susceptible to
changes in temperature, humidity and light.

III. Antitoxins:
An antitoxin is an antibody with the ability to neutralize a specific toxin. Antitoxins are
produced by certain animals, plants, and bacteria in response to toxin exposure. Although
they are most effective in neutralizing toxins, they can also kill bacteria and other
microorganisms. Antitoxins are made within organisms, and can be injected into other
organisms, including humans, to treat an infectious disease. This procedure involves injecting
an animal with a safe amount of a particular toxin. The animal's body then makes the
antitoxin needed to neutralize the toxin. Later, blood is withdrawn from the animal. When the
antitoxin is obtained from the blood, it is purified and injected into a human or other animal,
inducing temporary passive immunity. To prevent serum sickness, it is often best to use an
antitoxin obtained from the same species (e.g. use human antitoxin to treat humans).

IV. Antivenoms:
Antivenom, also known as antivenin, venom antiserum and antivenom immunoglobulin, is a
medication made from antibodies which is used to treat certain venomous bites and stings.

Antivenom is made by collecting venom from the relevant animal and injecting small amounts of
it into a domestic animal The antibodies that form are then collected from the domestic animal's
blood and purified. Versions are available for spider bites, snake bites, fish stings, and scorpion

stings.

Types of antivenoms:
Antivenoms can be classified into

i. monovalent (when they are effective against a single species' venom)

 ii. polyvalent (when they are effective against a range of species, or
several different species at the same time).

Mode of administration:
The majority of antivenoms (including all snake antivenoms) are administered intravenously;
however, stonefish and redback spider antivenoms are given intramuscularly. The intramuscular
route has been questioned in some situations as not uniformly effective.

Mechanism of action:
Antivenoms bind to and neutralize the venom, halting further damage, but do not reverse
damage already done. Thus, they should be given as soon as possible after the venom has been
injected. Since the advent of antivenoms, some bites which were previously invariably fatal have
become only rarely fatal provided that the antivenom is given soon enough.

Uses of antivenoms:
Antivenom is used to treat certain venomous bites and stings. They are recommended only if
there is significant toxicity or a high risk of toxicity. The specific antivenom needed depends on
the species involved.

As an alternative when conventional antivenom is not available, hospitals sometimes use an

intravenous version of the antiparalytic drug neostigmine to delay the effects of neurotoxic
envenomation through snakebite. Some promising research results have also been reported for
administering the drug nasally as a "universal antivenom" for neurotoxic snakebite treatment.

Side effects and safety of antivenomns:

Antivenoms are purified by several processes but will still contain other serum proteins that can
act as antigens. Some individuals may react to the antivenom with an immediate hypersensitivity
reaction (anaphylaxis) or a delayed hypersensitivity (serum sickness) reaction and antivenom
should, therefore, be used with caution. Although rare, severe hypersensitivity reactions including
anaphylaxis to antivenin are possible. Despite this caution, antivenom is typically the sole
effective treatment for a life-threatening condition, and once the precautions for managing these
reactions are in place, an anaphylactoid reaction is not grounds to refuse to give antivenom if
otherwise indicated. Although it is a popular myth that a person allergic to horses "cannot" be
given antivenom, the side effects are manageable, and antivenom should be given as rapidly as
the side effects can be managed.