Bevel-Down Superior to Bevel-Up in Intradermal Skin Testing

Howard, April; Mercer, Patricia; G, Nataraj H; Kang, Bann C.

doi:10.1016/s1081-1206(10)63222-x

Cited by 24 publications

(15 citation statements)

References 5 publications

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“…For standardization, the diameter of induration should be measured transversely to the long axis of the forearm and recorded in millimeters. [23] Reliable reading of the Mantoux skin test requires standardization of procedures, training, supervision, and practice. This may also include periodic standardized reliability testing.…”

Section: Administrationmentioning

confidence: 99%

Mantoux test and its interpretation

Nayak

Acharjya

2012

Indian Dermatol Online J

162

120

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The tuberculin skin test is one of the few investigations dating from the 19th century that are still widely used as an important test for diagnosing tuberculosis. Though very commonly used by physicians worldwide its interpretation always remains difficult and controversial. Various factors like age, immunological status coexisting illness etc influence its outcome, so also its interpretation. Utmost care is required while interpreting the result and giving an opinion. This article has been written with the purpose of elucidating the performance and interpretation of the standard tuberculin test.

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Section: Administrationmentioning

confidence: 99%

Mantoux test and its interpretation

Nayak

Acharjya

2012

Indian Dermatol Online J

162

120

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“…Intradermal vaccination has been investigated to address these limitations and shown to offer immunologic advantages, such as a reduction of dose needed for protective immunity and an elevated immune response in the elderly, which is the population most susceptible to influenza-related morbidity and mortality [5–7]. However, intradermal immunization with vaccines in solution requires needle injection by medical personnel, which is an often painful, time consuming and unreliable, as well as associated with needle injuries and pathogen transmission [8, 9]. …”

Section: Introductionmentioning

confidence: 99%

Formulation and coating of microneedles with inactivated influenza virus to improve vaccine stability and immunogenicity

Kim¹,

Quan²,

Compans³

et al. 2010

Journal of Controlled Release

221

195

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Microneedle patches coated with solid-state influenza vaccine have been developed to improve vaccine efficacy and patient coverage. However, dip coating microneedles with influenza vaccine can reduce antigen activity. In this study, we sought to determine the experimental factors and mechanistic pathways by which inactivated influenza vaccine can lose activity, as well as develop and assess improved microneedle coating formulations that protect the antigen from activity loss. After coating microneedles using a standard vaccine formulation, antigenicity was reduced to just 2%, as measured by hemagglutination activity. The presence of carboxymethylcellulose, which was added to increase viscosity of the coating formulation, was shown to contribute to vaccine activity loss. After screening a panel of candidate stabilizers, the addition of trehalose to the coating formulation was shown to protect the antigen and retain 48–82% antigen activity for all three major strains of seasonal influenza: H1N1, H3N2 and B. Influenza vaccine coated in this way also exhibited thermal stability, such that activity loss was independent of temperature over the range of 4 – 37°C for 24 h. Dynamic light scattering measurements showed that antigen activity loss was associated with virus particle aggregation, and that stabilization using trehalose largely blocked this aggregation. Finally, microneedles using an optimized vaccine coating formulation were applied to the skin to vaccinate mice. Microneedle vaccination induced robust systemic and functional antibodies and provided complete protection against lethal challenge infection similar to conventional intramuscular injection. Overall, these results show that antigen activity loss during microneedle coating can be largely prevented through optimized formulation and that stabilized microneedle patches can be used for effective vaccination.

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“…Intradermal injection requires specialized training and is often unreliable [11]. Scarification also requires training and delivers an inefficient and variable dose [2], [3].…”

Section: Introductionmentioning

confidence: 99%

Transdermal Influenza Immunization with Vaccine-Coated Microneedle Arrays

et al. 2009

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BackgroundInfluenza is a contagious disease caused by a pathogenic virus, with outbreaks all over the world and thousands of hospitalizations and deaths every year. Due to virus antigenic drift and short-lived immune responses, annual vaccination is required. However, vaccine coverage is incomplete, and improvement in immunization is needed. The objective of this study is to investigate a novel method for transdermal delivery using metal microneedle arrays (MN) coated with inactivated influenza virus to determine whether this route is a simpler and safer approach than the conventional immunization, capable to induce robust immune responses and confer protection against lethal virus challenge.Methodology/Principal FindingsInactivated A/Aichi/2/68 (H3N2) influenza virus was coated on metal microneedle arrays and applied to mice as a vaccine in the caudal dorsal skin area. Substantial antibody titers with hemagglutination inhibition activity were detected in sera collected two and four weeks after a single vaccine dose. Challenge studies in mice with 5×LD50 of mouse adapted Aichi virus demonstrated complete protection. Microneedle vaccination induced a broad spectrum of immune responses including CD4+ and CD8+ responses in the spleen and draining lymph node, a high frequency of antigen-secreting cells in the lung and induction of virus-specific memory B-cells. In addition, the use of MN showed a dose-sparing effect and a strong Th2 bias when compared to an intramuscular (IM) reference immunization.Conclusions/SignificanceThe present results show that delivery of inactivated influenza virus through the skin using metal microneedle arrays induced strong humoral and cellular immune responses capable of conferring protection against virus challenge as efficiently as intramuscular immunization, which is the standard vaccination route. In view of the convenience of delivery and the potential for self-administration, vaccine-coated metal microneedles may provide a novel and highly effective immunization method.

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Bevel-Down Superior to Bevel-Up in Intradermal Skin Testing

Cited by 24 publications

References 5 publications

Mantoux test and its interpretation

Mantoux test and its interpretation

Formulation and coating of microneedles with inactivated influenza virus to improve vaccine stability and immunogenicity

Transdermal Influenza Immunization with Vaccine-Coated Microneedle Arrays

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