College: Medicine
Department: Pediatrics; Pathology, Immunology and Laboratory Medicine; Medicine 
Research interests: Influenza: community immunization and new vaccines that induce IgA antibody

Parker A, Small Jr. MD is a pediatrician, immunologist and educator whose current work focuses primarily on public health response to influenza. He has served on numerous advisory bodies such as the US National Vaccine Advisory Committee. Most recently, he received the CDC Childhood Immunization Champion award for his work in school based influenza vaccination. In 1993 he was named the National Medical School Basic Science Teacher of the Year by the AMA/AAMC.

He holds 12 issued patents, a 2012 provisional patent for an intranasal influenza vaccine, and a 2013 provisional patent for an intranasal respiratory allergy vaccine.

His career is best summarized by the following partial list of his more than 150 publications (5 of his first 19 were in the journal “Science”) about influenza, basic immunology, public health and medical education:

Science

Influenza

  Host Defense

 Serum antibody (IgG) prevents viral pneumonia, but does not prevent infection of the  upper respiratory tract of mice, ferrets or people:

Ramphal, R., Cogliano, R.C., Shands, J.W., Jr., and Small, P.A., Jr.  Serum antibody prevents murine influenza pneumonia but not influenza tracheitis. Infect. Immun. 25:992-997, 1979

Barber, W.H. and Small, P.A., Jr.  Local and systemic immunity to influenza infections in ferrets.  Infect. Immun. 21:221-228, 1978

Reuman, P.D., Ayoub, E.M., and Small, P.A., Jr.  The effect of passively acquired maternal antibody on influenza illness in children:  A prospective study of influenza A in mother-infant pairs.  Pediatric Inf. Dis. 6:398-403, 1987.

 

IgG does cause temporary recovery in nude mice:

Kris, R.M., Yetter, R.A., Cogliano, R., Ramphal, R., and Small, P.A., Jr.  Passive serum antibody causes temporary recovery from influenza virus infection of the nose, trachea and lung of nude mice.  Immunology 63:349-353, 1988.

 

IgA does prevent infection of the upper respiratory tract:

Renegar, Kathryn B. and Small, Parker A., Jr.  Immunoglobulin A mediation of murine nasal anti-influenza virus immunity.  J. of Virology, 65:2146-2148, 1991.

Renegar, Kathryn B. and Small, Parker A., Jr.  Passive transfer of local immunity to influenza virus infection by IgA antibody.  J. of Immunology, 146:1972-1978, 1991.

 

CMI promotes recovery:

Bender, B.S., Croghan, T., Liping, Z., and Small, P.A., Jr.  Transgenic mice lacking major histocompatibility complex-restricted class I T-cells have delayed viral clearance and increased mortality following influenza virus challenge.  J. Exp. Med., 175:1143-1145, 1992.

 

In old mice recovery is delayed and CMI is weak:

Bender, Bradley S., Johnson, Michael P. and Small, Parker A., Jr.  Influenza in senescent mice:  impaired cytotoxic T-lymphocyte activity is correlated with prolonged infection.  Immunology, 72:514-519, 1991.

 

Pathogenesis

Virus desquamates the epithelium (classic SEMs):

Ramphal, R., Fischlschweiger, W., Shands, J.W., Jr., and Small, P.A., Jr.  Murine influenzal tracheitis:  A model for the study of influenza and  tracheal epithelial repair.  Amer. Rev. Resp. Dis. 120:1313-1324, 1979.

 

Site of initial infection and prior flu infection determines life or death

Yetter, R.A., Lehrer, S., Ramphal, R., and Small, P.A., Jr. Outcome of influenza infection:  Effect of site of initial infection and heterotypic immunity.  Infect. Immun. 29:654-662, 1980.

 

Vaccinology

 Intranasal inactivated flu vaccine prevents illness in human field trials

1967 H2N2 Intranasal gave 79% protection vs 27% shots (drifted virus)

Waldman, R.H., Mann, J.J., and Small, P.A., Jr.  Immunization against influenza:  Prevention of illness in man by aerosolized inactivated vaccine.  J.A.M.A. 207(3):520-524, 1969.

 

IgA antibody is cross protective even for shifted flu virus

Waldman, R.H., Wigley, F.M., and Small, P.A., Jr.  Specificity of respiratory secretion antibody against influenza virus.  J. Immunol. 105:1477-1483, 1970.

 

1968 H3N2  Intranasal 65% vs shots 90%

Waldman, R.H., Bond, J.O., Levitt, L.P., Hartwig, E.C., Prather, E.C., Baratta, R.L., Heill, J.S., and Small, P.A., Jr.  An evaluation of influenza immunization; influence of route of administration and vaccine strain.  Bulletin of the W.H.O. 41(3.4.5):543:548, 1969.

 

Vaccinia vectored flu vaccine protects mice if given by a mucosal route:

Small, P.A., Jr., Smith, G.L., and Moss, B.  Intranasal vaccination with recombinant vaccinia containing influenza hemagglutinin prevents both influenza viral pneumonia and nasal infection:  Intradermal vaccination prevents only viral pneumonia.  In: VACCINES 85, (R. Lerner, R. Chanock, and F. Brown, eds.) Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, pp. 175-176, 1985.

Meitin, Catherine A., Bender, Bradley S., and Small, Parker A., Jr.  Influenza immunization: intranasal live vaccinia recombinant contrasted with parenteral inactivated vaccine. Vaccine 9:751-756, 1991.

Meitin, C.A., and Small, P.A., Jr.  Scarification with a vaccinia-influenza recombinant does not stimulate IgA unless the animals auto- or cross-inoculate their nasopharynxes.  Vaccines 11:1360-1361, 1993.

Meitin, C.A., Bender, B.S., and Small, P.A., Jr.  Enteric immunization of mice against influenza with recombinant vaccinia.  Proc. Natl. Acad. Sci. USA 91:11187-11191, 1994.

Community Immunization

 How to run a school located influenza vaccination (SLIV) program:

Cuc H. Tran, Josephine McElrath, Patricia Hughes, Kathleen Ryan, Jean Munden, Joan B. Castleman, Jackie Johnson, Randell Doty, Dallas R. McKay, Jim Stringfellow, Rosalee A. Holmes, Paul D. Myers, Parker A. Small, Jr., and J. Glenn Morris, Jr.  Implementing a Community-Supported School-Based Influenza Immunization Program.  Biosecurity and Bioterrorism 8: 331-341, 2010

 

School-located Influenza Vaccination Programs are Effective in Providing Community   Immunity

School-located Influenza Vaccination Programs are Effective in Providing Community Immunity(Manuscript in preparation)

Why parents like SLIV programs (telephone survey)

Cuc H Tran MPH, Michael J Scicchitano PhD, Kathleen A Ryan MD and Parker   A Small Jr MD, Parental Attitudes Towards School Located Influenza Vaccination Programs – a Two Year Cross-Sectional Telephone Survey(Manuscript in preparation)

 

Increasing influenza vaccination rates through a high school classroom intervention

Tom Benton, MD, MPH, Scott Flamand, Jarah Blackburn, Husang David Lee, Mary Peoples-Sheps, DrPH, Parker Small, Jr. MD High School Classroom Intervention That Increases Flu Vaccination Rates (Manuscript in preparation)

 

Basic Science 1960 – 1970s

Immunoglobulin structure

IgG (2H2Lchains)

Small, P.A., Jr., Kehn, J.E., and Lamm, M.E.  Polypeptide chains of rabbit gamma globulin.  Science 142:393-394, 1963.

 

IgM (pentamir of 4 chain model)

Small, P.A., Jr., Kehn, J.E., and Lamm, M.E.  Polypeptide chains of rabbit gamma globulin.  Science 142:393-394, 1963.

 

IgA (dimer of 4 chain model)

Cebra, John J. and Small, P.A., Jr.  Polypeptide chain structure of rabbit immunoglobulins.  III.  Secretory IgA from colostrum.  Biochem. 6:503-512, 1967.

IgA synthesized in mammary glands

Asofsky, R.M. and Small, P.A., Jr.  Colostral immunoglobulin A synthesis in vitro of T-chain by rabbit mammary gland.  Science 158:932-933, 1967.

 

Polypeptide chains of specific antibody far more complex than chains of myeloma proteins

Asofsky, R.M. and Small, P.A., Jr.  Colostral immunoglobulin A synthesis in vitro of T-chain by rabbit mammary gland.  Science 158:932-933, 1967.

Terry, W.P., Small, P.A., Jr., and Reisfeld, R.A.  Electrophoretic heterogeneity of the polypeptide chains of human G-myeloma proteins. Science 152:1628, 1966.

 

Structure and function of antibody from lower vertebrates

Sharks

Clem, L.W. and Small, P.A., Jr.  Phylogeny of immunoglobulin structure and function.  I. Immunoglobulins of the lemon shark.  J. Expt. Med. 125:5893, 1967.

Small, P.A., Jr., Klapper, D.G., and Clem, L.W.  Half-lives, body distribution, and lack of interconversion of serum 19S and 7S IgM of sharks. J. Immunol. 105:29, 1970.

 

Bony fish

Clem, L.W. and Small, P.A., Jr.  Phylogeny of immunoglobulin structure and function.  V.  Valencies and association constants of teleost antibodies to a haptenic determinant.  J. Expt. Med. 132:385, 1970.

 

Renal Disease

Role of complement in glomerulonephritis:

Baxter, J.H. and Small, P.A., Jr.  Antibody to rat kidney:  In vivo effects of univalent and divalent fragments.  Science 140:1406-1407, 1963.

 

IgA nephropathy – first animal model

Rifai, A., Small, P.A., Jr., Teague, P., and Ayoub, E.M.  Experimental IgA nephropathy.  I.  A laboratory model for IgA immune complex nephritis.  J. Exp.  Med. 150:1161-1173, 1979.

 

Public Health

 

Sex EducationTeam Packs – group instructional methodology (students are put in groups of 4, each given ¼ of the relevant information and expected to work together to solve the problem) for high school students used by half of Florida’s counties and beyond: AIDS, gonorrhea, herpes and pregnancy The CDC and National PTA chose the AIDS program as the best in the nation in 1987.

Dorman, Steve M., Small, Parker A., Jr. and Lee, Debra Dell.  A Cooperative Learning Technique for AIDS Education.  Journal of School Health, 59:314-315, 1989.

Small, P.A., Jr., and Small, N.S.  AIDS:  Prevention Through Education is Our Only Hope.  Florida Psychiatric Society Newsletter, Vol. XIV, No. 1 (March), 1992, pp. 8-9.

 

Partners in Prevention of Substance Abuse (PIPSA) for tobacco education

Medical, dental, nursing, pharmacy and public health students learn about tobacco together in groups of 5, and then go to middle school classrooms to teach about the effects of tobacco. The program was developed at UF, and has impacted tens of thousands of UF professional students and hundreds of thousands of north Florida middle school students.  The program has spread to other Florida Health Science Centers.

 

Celebrate Immunization

A group instructional program to educate middle school students about immunization. The 4 students “were” Jenner, Pasteur, Salk and Sabin.  The program was widely disseminated.

Small, P.A., Jr., and Small, N.S.  Celebrate Immunization, Science Scope 18:33-34, 1995.

Small, P.A., Jr.  Marking the birthday of modern vaccines, SciencePlus7 Communicator 8:7, 1995.

Small, P.A., Jr., and Small, N.S.  Mankinds magnificent milestone, The American Biology Teacher, in press, 1995.

 

Medical Education

Small, P.A., Jr., Stevens, C.B., and Duerson, M.C.  Issues in Medical Education:  Basic Problems and Potential Solutions.  Academic Medicine 68(10):S89-S98, 1993. 

 

Patient Oriented Problem Solving (POPS) is group instructional methodology for professional students.

Immunology POPS published, by the Upjohn Company, were used by more than half of US middle schools

Pharmacology POPS were also published and distributed by The Upjohn Co.

MITI bank (microbiology test item bank for medical schools)

Peer evaluation of medical students identifies caring and/or clinically competent standouts:

McCormack, WT, Lazarus C, Stern D, Stevens CB, Small Jr PA.  2007.  Peer nomination identifies medical student exemplars in clinical competence and caring at three medical schools.  Academic Medicine 82(11):1033-9.

Contact information:
Emerging Pathogens Institute
University of Florida
P.O. Box 100009
Gainesville, Florida 32610-0009
Phone: (352) 359-3163

Email: pasmall@epi.ufl.edu