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Paper I — 2016 October (Supplementary) (2010 Scheme) — Q4

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Paper I
2016 October (Supplementary) (2010 Scheme) · 40 marks · 120 min

Question

Adjuvants

Q42 marksShort Notes

Answer

Adjuvants are substances added to a vaccine that, while not themselves immunogenic, enhance and prolong the specific immune response to the co-administered antigen — allowing a smaller antigen dose, fewer doses, and/or a stronger, longer-lasting immune response than the antigen would elicit alone.

Mechanisms of action (vary by adjuvant type):

  • Depot effect — the adjuvant forms a slow-release reservoir at the injection site, prolonging antigen exposure to immune cells and sustaining stimulation over time (e.g., aluminium salts).
  • Enhanced antigen uptake/presentation — some adjuvants improve delivery of antigen to antigen-presenting cells or promote their maturation and activation.
  • Direct immune stimulation — activation of pattern-recognition receptors (e.g., Toll-like receptors) on innate immune cells, mimicking the “danger signal” naturally provided by infection and thereby boosting the resulting adaptive response.

Examples:

  • Aluminium salts (alum — aluminium hydroxide/phosphate) — the most widely used adjuvant in human vaccines (e.g., DPT, hepatitis B); acts mainly via a depot effect and mild inflammatory stimulation.
  • Freund’s adjuvant (complete/incomplete) — used in experimental/research immunization (too reactogenic for routine human use); complete Freund’s adjuvant contains killed mycobacteria for additional immune stimulation.
  • Oil-in-water emulsions (e.g., MF59, AS03) — used in some modern influenza vaccines.
  • Toll-like receptor agonists (e.g., monophosphoryl lipid A, CpG oligonucleotides) — used in some newer subunit vaccines.
  • Virosomes and liposomes — deliver antigen in a particulate form that mimics a pathogen’s structure, enhancing uptake.

Clinical relevance: adjuvants are particularly important for killed/inactivated and subunit vaccines (which are inherently less immunogenic than live attenuated vaccines, since they do not replicate in the host), allowing these safer vaccine types to still generate adequate protective immunity.

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