Current paediatric immunization programmes include too many injections in t
he first months of life. Oral or nasal vaccine delivery eliminates the requ
irement for needles and can induce immunity at the site of infection. Howev
er, protein antigens are poorly immunogenic when so delivered and can induc
e tolerance. Novel ways to enhance immune responses to protein or polysacch
aride antigens have opened up new possibilities for the design of effective
mucosal vaccines. Here, we discuss the immunological principles underlying
mucosal vaccine development and review the application of immunomodulatory
molecules and delivery systems to the selective enhancement of protective
immune responses at mucosal surfaces.