Lupine Publishers | Of Syringes, Vaccines and Chemistry
Abstract
The
modern trend to avoid vaccination is based mainly on superstición and bad
science understanding and includes a bad medical practice. In this article we
talk about how vaccines were originated, if the syringe development and the
importance of materials chemistry to improve its manufacture.
Keywords: Vaccine; Syringe;
Immunization; Jenner; Wood
The
Beginnings of Immunization
Since
its appearance on the face of the planet, the human being has been accompanied
by diseases that cause infections and that are easily transmitted from person
to person. This is logical if we think that the first living beings were the
unicellular ones; thus, it is not surprising that epidemics were already
mentioned before our era and, in addition, possible ways of surviving the
infection. It is possible that in India, 1,500 B. C., epidemics and forms of a
very early vaccination were documented. It is mentioned that the Egyptians
sought some form of inoculation with microorganisms, while Thucydides refers to
some plague saying: “... this disease is not suffered twice and if it were to
suffer again, it would not be with deadly results ...”, which leads to think
that non-fatal infected people were immunized, similar to what happens with
vaccines. From shortly before the beginning of the Christian era and until the
twelfth century, the Chinese used to dry the pustules of both humans and cows
infected with smallpox. Once dry, they sprayed them and made people, especially
those who had daily contact with cattle, inhale the dust through their noses to
try to get immunized, which was achieved in a huge number of cases. This
technique was called scarification. Another practice that was developed in the
search for control of these pests was the use of material infected with
smallpox among humans: food was prepared, for example, and the sickest person
was the first one to eat it, to later pass it in the same recipient among all
the members of the family or community [1].
Many
of these customs persisted in the Middle East and were introduced in Europe
mainly by the Ottoman invasions; but in the eighteenth century the wife of the
English ambassador in Turkey (who had applied the technique to her own
six-year-old son) proposed the use of scarification to deal with the smallpox
epidemic that struck London in 1721. Applied experimentally about some inmates
and in view of the positive results, the princesses Amelia and Carolina,
daughters of the Prince of Wales and future King George II were subjected to
this treatment; they suffered the disease very slightly and had no sequelae or
the horrible marks left on the faces of the survivors. The scarification gained
ground until Edward Jenner, an English physician, developed a different and
properly protocolized method. A milkmaid who had lesions with pus on her hands
(presumably cowpox), named Sarah Nelmes, allowed Jenner to take that pus and
with it she inoculated a child, James Phipps. The inoculation was usually done
with a metal lancet that was put in contact with the infected material, to then
produce pickets or small cuts in the skin of the people to whom it was wished
to infect. We must emphasize that before experimenting with the child Phipps,
Jenner had inoculated his own son of 18 months of age. Six weeks after this
inoculation James was inoculated again, now with pus from active lesions of
human pox. The child Phipps did not get infected and Jenner waited a month to
try again to infect him with human smallpox. Excited by this success, Jenner
repeated the experiment with 32 more people, achieving the immunity of all of
them [2]. Despite all the setbacks that occurred, Jenner went ahead and in 1803
the entire royal family was vaccinated with his technique, which began to be
used in Europe and then around the world. Perhaps the memory that George
Washington was a survivor of smallpox, led to the acceptance of the method in
the United States. It is said that the first Russian child vaccinated was
called Vaccinov (because of the vaccine). On the other hand, Napoleón I in 1812
decreed obligatory the vaccination against the smallpox in the army and tried to
take it to all the French society [3].
The
Beginning of the Injection
Ovid
tells that Medea helped Jason get the golden fleece in exchange for his promise
of marriage. Medea was a powerful priestess and sorceress who returned youth to
Jason’s father, Esón, cutting his throat and then filling his body with a magic
potion. He did this with a double purpose: to get well with Jason and
demonstrate his power. There are many researchers who assume that the act
performed by Medea to rejuvenate Esón was simply a blood transfusion. We would
be talking about introducing a foreign substance to the body, more than two
thousand years ago. The next historical reference to a blood transfusion is
available until the fifteenth century, when blood was taken from three young men
-who died for it- for a Jewish doctor to carry out a transfusion to Pope
Innocent VIII. However, we do not know anything about the way in which these
transfusions were carried out. In the midseventeenth century Christofer Wren,
assisted among others by Robert Boyle (the alchemist and scientist who
enunciated Boyle’s law for gases, among other principles) administered
intravenous drugs to patients. A cut was made in the vein, a silver or gold
tube was inserted, and the liquid was introduced by pumping it through a
leather bladder (like an enema, an enema) or by simple gravity. The medications
used were water, opium or purgatives; many of these procedures were aimed at
treating syphilis. Towards the nineteenth century an instrument was developed
that allowed to pump liquids in small quantities with greater comfort; these
were hand-held devices (not as large as enema bladders), which fit in one hand.
They consisted of a hollow tube in which a plunger was inserted to push the
contents of the tube towards the end; This was also hollow and was introduced
in various parts of the body for the administration of substances [4,5].
The
wife of the Scottish scientist Alexander Wood suffered from very intense
neuralgia and that motivated Word to find a way to alleviate his pain more
quickly and effectively. To make the opium action faster and more effective,
Wood used some device designs that allowed him to “push” a drug through a kind
of pump and managed to improve this design (simultaneously with the work of the
French Charles Gabriel Pravaz) by using a needle with a hollow body and tip;
with this the medicine could be introduced in the skin of the patient, looking
for the rapidity in the administration. Wood argued that, at least in the case
of analgesics such as morphine (opium), it should be deposited in a nerve very
close to the site in which the pain was located. He published an article about
these studies entitled A new method to treat neuralgia through the direct
application of opioids in pain points. A legend says that Wood’s excitement at
experimenting on how to cure pain caused him to administer too many injections
in a short time, until his wife died, but without pain. This has not been
proven historically, but it is still a curious detail, not forgetting the fact
that what Wood’s wife really had was a kind of arthritis. Another form of this
legend says that it was about migraines, but the article written by Wood is
quite clear and points out the application in painful joints. The important
thing of this matter is that a way of depositing the opiates was found in such
a way that if they caused side effects on the digestive system (esophagus,
stomach or intestines), they no longer appeared. Obviously, the first deduction
was that if they were deposited near the affected sites, the opioids would work
better. For five years this was applied by those doctors who believed in this
novel technique, until Dr. Charles Hunter was presented with a complication:
two of his patients developed local abscesses precisely at the sites where they
received injections. This caused Hunter to experiment to see if the same
response could be obtained by depositing the analgesics away from the directly
affected sites and the results were positive. Hunter coined the term hypodermic
(under the skin) but had to face a demand established by Wood accusing him of
plagiarism and malpractice. The medical journals became battlefields until a
committee of the Surgical Medical Society of London was formed, which two years
later ruled in favor of Hunter: the new technique would be called hypodermic
and it was concluded that it was possible that the injection of opiates will be
successfully managed away from the site of pain. The most curious of all this
is that no one, neither the doctors involved with Wood nor those who were in
favor of Hunter, nor the Medical Society itself thought about the problems that
were causing the patients: tolerance, addiction and over demand, among others,
for how lucrative it was to have so many patients and so much opium to
administer. Be that as it may, the hollow needle and the hypodermic syringe,
the predecessor of the one we use today to administer medicines and vaccines or
to draw blood, for example, were invented and perfected. Or to fill ink
cartridges for printer.
Materials
of Construction of Syringes
Initially
the plunger or piston of the syringes had cotton on the tip so that there was a
good fit between the body of the syringe and the piston, which allowed the
liquid to be driven. The end of the syringe was conical in shape and the hollow
needle was adapted at the end. It was initially worked with metals but soon
changed to glass, because of its quality of not reacting with the substances
that were injected. For example, morphine is obtained from opium using hydrochloric
acid and consequently the liquid that was injected to the patients had acidic
characteristics, which could react with the metal. To not break the glass
easily and give greater security to those who used these syringes, the body of
these was inserted into a metal support spice that allowed rapid handling while
showing the amount of substance that was injected. The twentieth century
brought several changes in the design and construction of syringes. The common
glass is known as alkaline glass and, over time, becomes opaque by washing and
contact with water and other materials. To eliminate this problem, we began to
use alkali-free glass (Pyrex type); later, a stainless-steel tip attached to
the glass, which allowed to secure the needle so that it would not slip and
accidentally separate when applying the injection was designed. Thus, the
syringes came in stainless steel cases that were also used to sterilize the
syringe boiling water in the case itself, which closed hermetically to maintain
the sterility of the instrument. The Second World War allowed the development
of an auto injection device that would allow the soldiers to inject analgesics
or specific antidotes while they were attended by doctors. The innovation was
that the needle remained hidden from view by the user, reducing the anxiety
that causes most people to know that they are going to inject it. The syringe
consisted of a tube filled with the specific medication to be used and a spring
that, when hit against a member of the soldier, pushed the needle towards the
site of the blow, causing it to penetrate under the skin and release its
contents. Towards the middle of the century, the first fully disposable glass
syringes were produced with two different purposes and designs: one to collect
blood in donation campaigns and the other for polio vaccination campaigns.
Meanwhile the steel for the needles and the specific cut for each application
were perfected: it was no longer just a question of perforating the skin, but
the angle determined whether it was a subcutaneous, intramuscular or
intravenous injection. They also worked on finding a way to make disposable
needles. The 1960’s decade not only brought the Beatles to the world; they also
brought the completely disposable syringes made of plastic and that were
marketed in previously sterilized packages.
Encounter
between Hypodermal Syringes and Vaccines
From
the development of the hypodermic syringe and the hollow needle, the
application of the vaccines could be carried out more efficiently, measuring
the quantities that were introduced to the body with greater precision.
Pasteur’s experiment to find a vaccine against anthrax in cattle is famous, but
in the field of human vaccines it is also at least remarkably successful. In 5,
without being a doctor and therefore not authorized to give any treatment to
any person, Pasteur decided to use the vaccine against rabies developed by his
colleague Emile Roux drying the spinal cord of rabbits infected with the
disease to treat the child Joseph Meister, who had been attacked by a rabid
dog. The child did not develop the disease and Pasteur remained a hero,
although if the vaccine had failed, he might have been condemned for his
audacity. The important part is that this vaccine was not inoculated but
injected. From then on, most vaccines are applied by injection, although many
are already ingested.
Vaccine
Production
There
are several different types of vaccines, depending on how the antigens are
produced, that is, the microorganisms or chemicals responsible for unleashing
the body’s immune response. Let’s see them quickly.
Living Attenuated Microorganisms
They
consist of using the weakened (attenuated) microorganism, which is the closest
thing to a real infection. The advantage is that it is the infectious agent
itself that provides the immunity; The disadvantages are the need for
refrigeration and the possibility of mutations, among others. This form of
vaccine is very suitable for the case of viruses. The vaccines against rubella,
varicella and some types of influenza, among others, correspond to this kind of
preparation.
Inactivated Microorganisms
Dead
microorganisms are used; This procedure is better for bacteria. In the case of
using this type of vaccines, we have the disadvantage that, as the bodys immune
response is slower and slower, it requires the use of reinforcements, that is,
new applications of the vaccine. Among the advantages of this kind of vaccine
are its stability and its ease of transport and storage, since they do not
require refrigeration. Some of the vaccines in this class are rabies, hepatitis
A, some types of influenza and polio.
Vaccines in Subunits (Parts of Viruses)
Instead
of using the entire microorganism, only the parts that the antibodies recognize
to affect their immunizing action are used. This technique greatly reduces the
possibility of adverse side reactions occurring in vaccinated persons. Usually
cultures of the microorganism are prepared to then use chemical techniques to
separate the specific part that leads to obtain the vaccine. Genetic
engineering techniques such as recombinant DNA technology can also be used to
produce this vaccine. This is how some vaccines against hepatitis B and human
papillomavirus are prepared and research is under way to reach the hepatitis C
vaccine. They have the advantage that they target a part of the microorganism
specifically, and that there are less chances of adverse reactions, but in
counterpart its development is more difficult and takes more time.
Toxoids
When
a microorganism secretes a toxin (toxic chemical compound in extremely low
doses) that causes the disease, the microorganism is cultured to obtain
appreciable amounts of the toxin. The microorganism is separated, the toxin is
purified and rendered inactive, usually by using a solution of formaldehyde in
sterilized water. These detoxified toxins are used as vaccines; When the human
body receives this chemical compound deactivated, it learns to fight it and
prepares itself for an eventual confrontation with the original toxin. Examples
of this class of vaccine are diphtheria and tetanus. Vaccines also contain
other chemical compounds as ingredients to make them safer and more effective.
Among the most important we have the following.
Preservatives
Prevent
the contamination of containers, bottles or culture media with pathogenic germs
that could cause other diseases than those prevented by the vaccine. One of the
most used preservatives in the past was the so-called thimerosal, a compound
that contains mercury. Its use was restricted to the production steps and was
eliminated when the vaccine was packaged for storage and transport. Currently,
most of the vaccines have been eliminated, but they are still used in some
processes, such as some influenza vaccines.
Additives
They
help the vaccine retain its potency during storage time; Among other chemical
substances used for this purpose, we have gelatin, albumin, sucrose and
lactose.
Adjuvants
They
help the body to have a better immune response and are usually aluminum salts.
These salts help the antigens remain in the injection site and then be
transported directly to the lymph nodes, which is where the immune response to
the presence of the aggressors begins.
Antibiotics
Sometimes
antibiotics can be used to prevent contamination of vaccines. In very isolated
cases traces of antibiotics present in vaccines can trigger allergic reactions
in vaccinated subjects. Some vaccines are produced in chicken eggs, so that
some proteins from the same egg may be present in the vaccine and cause
allergic reactions; vaccines against influenza and against yellow fever are
produced in this way. Each vaccine requires very specific and controlled
conditions for its production: the mixtures of compounds that will serve to
cultivate the microorganism, those of the substances that will allow its
isolation and conservation; in short, without the achievements of chemistry, we
would not have the spectacular advances that allow a huge number of diseases
that were deadly a few decades ago can now be prevented. As we can see,
chemistry has provided materials so that we can prevent or cure diseases,
making our life longer and more pleasant.
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