title: Devices and formulations for pulmonary vaccination.
abstract: BACKGROUND
  Pulmonary vaccination could be a promising alternative to vaccination by injection. Administration of a vaccine to the lungs does not require the use of needles, which reduces the number of trained healthcare workers needed, the risk of needle-stick injuries and needle waste. Besides a systemic immune response, pulmonary vaccination may also induce a mucosal immune response. Such a local response may increase the effectiveness of vaccination against airborne pathogens. Although this route of administration has been studied for decades, no pulmonary vaccine is commercially available yet, due to various challenges mostly intrinsic to pulmonary drug delivery and vaccine formulation.
  
  
  METHODS
  This review discusses the inhalation devices and formulation strategies that may be suitable for the pulmonary administration of vaccines. In addition, critical parameters are addressed, such as the target population, to help assessing whether pulmonary administration of a specific vaccine may be feasible and beneficial or not.
  
  
  CONCLUSIONS
  A combined approach of inhalation device and vaccine formulation development is essential. This should result in a system that can effectively be used by the target population and can be produced at low costs. Only then, this challenging administration route can be successfully applied to large-scale vaccination programs.
authors.affiliation: University of Groningen, Department of Pharmaceutical Technology and Biopharmacy , Antonius Deusinglaan 1, 9713 AV Groningen , The Netherlands w.f.tonnis@rug.nl.
authors.forename: Wouter F
authors.initials: WF
authors.lastname: Tonnis
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Lexmond
authors.forename: Henderik W
authors.initials: HW
authors.lastname: Frijlink
authors.forename: Anne H
authors.initials: AH
authors.lastname: de Boer
authors.forename: Wouter L J
authors.initials: WL
authors.lastname: Hinrichs
mesh_terms: D000280:Administration, Inhalation; D000336:Aerosols / Q000737:chemistry*; D000818:Animals; D002626:Chemistry, Pharmaceutical; D004333:Drug Administration Routes; D016503:Drug Delivery Systems; D006801:Humans; D018928:Immunity, Mucosal / Q000276:immunology; D008168:Lung / Q000187:drug effects*; D009330:Nebulizers and Vaporizers; D020545:Respiratory Mucosa / Q000187:drug effects*; D014611:Vaccination / Q000379:methods*; D014612:Vaccines / Q000008:administration & dosage* / Q000737:chemistry
chemical_list: D000336:Aerosols; D014612:Vaccines