Improving vaccine performance with adjuvants.

New vaccines are presently under development and in testing for the control of infectious diseases, including human immunodeficiency virus (HIV) and tuberculosis. Several of these vaccines are composed of synthetic, recombinant, or highly purified subunit antigens. Subunit vaccines are designed to include only the antigens required for protective immunization and to be safer than whole-inactivated or live-attenuated vaccines. However, the purity of the subunit antigens and the absence of the self-adjuvanting immunomodulatory components associated with attenuated or killed vaccines often result in weaker immunogenicity. Immunologic adjuvants are agents that enhance specific immune responses to vaccines. Formulation of vaccines with potent adjuvants is an attractive approach for improving the performance of vaccines composed of subunit antigens. Adjuvants have diverse mechanisms of action and should be selected for use on the basis of the route of administration and the type of immune response (antibody, cell-mediated, or mucosal immunity) that is desired for a particular vaccine.