- (Reuters) - The U.S. government may offer anthrax vaccinations
to some people exposed to the biowarfare agent in mail attacks so they
would not get sick once they stop taking antibiotics, officials said on
Saturday. People exposed to high doses may still have potentially deadly
anthrax spores in their lungs after taking the recommended 60-day course
of antibiotics. As many as 3000 people are at the highest risk of having
lingering spores and might be candidates for an anthrax vaccine, officials
- The government's top experts said they would make a recommendation
early next week to Tommy Thompson, the Secretary of Health and Human Services,
on whether to make the vaccine available to some people who were exposed.
[This was approved 18 Dec 2001; see <http://www.nytimes.com/2001/12/19/national/19VACC.html
- The vaccine, which Bioport Corp. makes for the U.S. military,
is approved for preventing anthrax before exposure. Giving it after someone
comes in contact with the biological warfare agent would be done on an
experimental basis only, with patients' informed consent, officials said.
The doses of the vaccine available to health officials have not received
Food and Drug Administration clearance for use, but one top FDA official
said they would be appropriate for an emergency, stressing that patients
would be informed of their status.
- Alternatives to vaccination include advising people to
watch for symptoms and to keep in close touch with their doctors after
their 60- day course ends or extending antibiotic treatment to 90 days.
- The Atlanta-based Centers for Disease Control and Prevention
held a meeting with anthrax experts in Washington on Saturday to discuss
data and evaluate options for preventing any new illnesses in people who
inhaled anthrax bacteria spores. Experts have little experience with anthrax
to guide their decisions.
- About 10 000 people were urged to take the 60-day treatment
because they were exposed to anthrax through tainted letters sent to media
outlets and 2 US senators. Antibiotic therapy started as early as 8 Oct
2001, so many people have completed their courses. Others did not start
until 25 Nov 2001. No one who has finished the 60-day therapy has developed
anthrax, "an extremely reassuring piece of information,'' said Julie
Gerberding, acting deputy director for the CDC's infectious disease center.
- One animal study showed giving a vaccine together with
antibiotics offered no benefit over giving antibiotics alone. [But this
is because the veterinary Sterne vaccine is a "live" vaccine
derived from a culture that is deficient in the pX02 plasmid. The Russians
have successfully explored the possibility of producing STI vaccines resistant
to various antibiotics that would be given simultaneously with the vaccine.
The STI vaccine is similar to the Sterne vaccine. - Mod.MHJ]
- Vaccines ... would be given in 3 injections at 2-week
intervals. Antibiotic therapy would continue until immunity built up at
about 4 weeks after the first shot.
- People who were in the room where an anthrax-tainted
letter to Senate Majority Leader Tom Daschle was opened have been urged
to extend antibiotic treatment to 90 days, said Dr. Gregory Martin, chief
of infectious diseases at Walter Reed Army Medical Center.
- Some members of the military have alleged that the vaccine
caused chronic health problems. Health officials said on Saturday that
the vaccine had not been linked to any long-term side effects, but that
studies were continuing. The most common side effects are injection- site
reactions, such as swelling and tenderness.
- The Defense Department is transferring 10 000 doses of
the vaccine to the Department of Health and Human Services and has offered
to make more doses available, said Dr. Kathy Zoon, head of the FDA's Center
for Biologics Research and Evaluation. The 10 000 doses are from a lot
that Bioport has made at a renovated plant that is awaiting regulatory
approval. Other doses could come from another batch of 209 000 made in
1992. Preservative levels in those doses are lower than required for regulatory
approval, Zoon said, but she added that either batch would be suitable
for emergency use. ___
- ProMED-mail <firstname.lastname@example.org
- [If the USDA/APHIS or AVMA had recommended putting thousands
of cattle on cipro for 60 or 90 days, we would have been roundly criticised
by our physician brethren, and correctly so.
- If these people were vaccinated now and the antibiotics
discontinued after a week, when the antibody system had begun to be primed
[by the vaccine] -- or after 2 shots had been given, to be more cautious
-- they are then adequately protected against any late-germinating spores,
especially if they later get a third shot. The trials at USAMRIID many
years ago demonstrated the good protection provided by 2 or 3 shots of
the US human vaccine against massive exposures. Similarly, over time the
lungs clear out many if not all of the spores deposited there.
- If I were to predict anything, it would be that in future
similar exposures, the putatively exposed people would be started promptly
on a vaccination series and simultaneously be given a limited but adequate
amount of a suitable oral antibiotic. - Mod.MHJ]