Background
Plague is endemic in China, Mongolia, Burma, Vietnam, Indonesia, India, large parts of Southern Africa, the United States and South America. There are three types of vaccines (live attenuated, killed and F1 fraction) with varying means of administration.

Objectives
The objective of this review was to assess the effects of vaccines to prevent plague.

Search methods
We searched MEDLINE (1966 to February 2011), EMBASE (1985 to February 2011), CENTRAL (The Cochrane Library 2011, Issue 2) and reference lists of articles. We handsearched the journal 'Vaccine' (up to 1997) and contacted experts in the field.

Selection criteria
Randomized trials comparing live and killed plague vaccines against no intervention, placebo, other plague vaccines or vaccines against other disease (control vaccines).

Data collection and analysis
Three reviewers assessed the eligibility of trials.

Main results
No trials were included.

Authors' conclusions
There is not enough evidence to evaluate the effectiveness of any plague vaccine, or the relative effectiveness between vaccines and their tolerability. Circumstantial data from observational studies suggest that killed types may be more effective and have fewer adverse effects than attenuated types of vaccine. No evidence appears to exist on the long-term effects of any plague vaccine.

Vaccines for preventing plague.

The need for combination vaccines has been recognised for many years. Many children must have 9 or 12 injections in their first year, which places a considerable burden on the child and the health service. Combination vaccines or simultaneously administered vaccines need to generate a protective immune response to all vaccine components that is equivalent to the response when administered separately. This is not always the situation. Many vaccines should not be administered together because of adverse reactions known as vaccine-vaccine interactions, a phenomenon where one vaccine affects another vaccine, thus potentially causing loss of immunogenicity, loss of protective efficacy or induction of adverse reactions. It is important to remember that most vaccine-vaccine interactions are asymptomatic and may only be discovered when the immune status of the vaccine recipient is analysed or when the individual is challenged by the microbe. The interactions may occur because of physical or chemical interactions within the vaccine formulation, interactions between live vaccines or immunological interference. This review summarises known vaccine-vaccine interactions that have been critically analysed and categorised based on their clinical importance.

Clinically relevant vaccine-vaccine interactions: a guide for practitioners.

The cutaneous route for such variolation involved breaking the skin with a sharp instrument, and it was used in India perhaps as early as in China, but it was not documented until the 16th century. 2 Variolation was supplanted by safer cutaneous application of material from cowpox lesions, the method of “vaccination” known in the 18th century and first published by Edward Jenner. After 15th-century experiments with hypodermic injection, 3

Alternative vaccine delivery methods

Vaccines administered simultaneously: directions for new combination vaccines based on an historical review of the literature

Clinico-immunological studies on men were conducted using associated immunization by pair combinations of 8 commercial national vaccines (typhoid, plague, typhus, smallpox, tick-borne encephalitis, yellow-fever, cholera and sextaanatoxine). As for reactogenicity and immunological efficiency (serological studies), these pair associations can be subdivided into three main groups. The first group consists of pair combinations of vaccines that cannot exert any influence on immunogenicity of cause the development of frequent post-vaccination reaction or temporary disability (typhus, smallpox, tick-borne encephalitis, yellow-fever vaccines). These preparations are completely compatible in every combination. The second group includes plague and cholera vaccines that reduce its immunogenicity under the influence of more active antigens or increase its reactogenicity being associated with typhoid vaccine or sextaanatoxine. The third group is composed of typhoid vaccine and sextaanatoxine that have high reactogenicity and stable serological shifts. Associations of the first group are the most favourable for anti-epidemiological practice.

[The clinico-immunological validation of associated immunization].

The article substantiates epidemiological expediency of complex (associated) immunization of servicemen and population against typhoid, typhus and plague in polyetiological zones of these infections, and also in cases of simultaneous proliferation of these diseases. For simultaneous preventive vaccination against these infections a complex immunization scheme was experimentally substantiated and clinically approved. It is based on national commercial vaccines and ensures a simultaneous administration of 2-3 vaccine preparations by hypodermic syringe or jet injection. Typhoid and typhus vaccines are injected under one shoulder-blade, and plague vaccine is injected under another shoulder-blade. This complex vaccine is harmless, moderately reactogenic, develops expressing immunity which have the same protective features as monovaccines alone. This scheme is recommended for use in anti-epidemic practice.

[Combined (associated) immunization against typhoid, typhus and plague].

A safe, moderately reactogenic and immunologically effective scheme of complex (combined) immunization against meningitis A, diphtheria, typhoid fever, viral hepatitis A and influenza has been developed as the result of experimental and clinico-immunological studies. Depending on the epidemiological situation, the newly developed scheme can be used in two variants. According to the first variant of this scheme, the following preparations are injected subcutaneously into three different sites: a mixture of group A meningococcal vaccine and diphtheria toxoid, typhoid vaccine and influenza vaccine. The second variant of the scheme differs from its first variant in using intramuscular injection of normal human immunoglobulin instead of injection of influenza vaccine. Moreover, in practical realization these variants may be altered by excluding vaccines, unnecessary under present conditions. The newly developed scheme of vaccinal prophylaxis is recommended for practical use.

[A system for the mass combined vaccination of the adult population against influenza, viral hepatitis, typhoid, meningitis and diphtheria].

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[The clinico-immunological validation of associated immunization].

[Combined (associated) immunization against typhoid, typhus and plague].

[A system for the mass combined vaccination of the adult population against influenza, viral hepatitis, typhoid, meningitis and diphtheria].