The Anthrax Vaccine Is It Safe? Does It Work? (2002) / Chapter Skim
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2 Background
2 Background
Pages 40-55
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From page 40... ...
By 2001 a limited vaccine supply, the result of delays in federal approval for release of newly manufactured vaccine lots, had significantly slowed plans to vaccinate all military personnel. After the deliberate distribution of anthrax spores in bioterrorist incidents in the autumn of 2001, the vaccine was offered as part of the treatment for as many as 10,000 of the civilians who had been exposed.
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From page 41... ...
Approximately 200 cases were reported in the United States before 1900 (Plotkin et al., 1960~. Only 18 cases of inhalational anthrax were reported in the United States in the 20th century, despite evidence of extensive exposure of workers in goat hair-processing mills to aerosolized spores (Inglesby et al., 1999~.
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From page 42... ...
In 1979 in Sverdiovsk, Russia, an apparently accidental release of aerosolized spores from a military facility resulted in 68 deaths among 79 individuals with reported cases of inhalational anthrax (Meselson et al., 1994~. Clinical Features The outbreak of inhalational and cutaneous anthrax in the United States during the autumn of 2001 produced far more clinical and public health experience with the disease than had occurred in many decades.
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From page 43... ...
Other symptoms including malaise, low-grade fever, and swelling of adjacent lymph glands may occur, but anthrax lesions are generally painless unless a secondary infection is present. Without antibiotic treatment, up to 20 percent of cutaneous anthrax infections are fatal, but with treatment the fatality rate is less than 1 percent (CDC, 2000c)
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From page 44... ...
The initial symptoms of inhalational anthrax, which resemble those of influenza and other common upper respiratory infections, include malaise, fatigue, and cough. In days, severe respiratory distress develops, with dyspnea, cyanosis, and strident cough.
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From page 45... ...
BACKGROUND FIGURE 2-2 Chest radiograph characteristic of inhalational anthrax. SOURCE: Public Health Image Library, CDC.
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From page 46... ...
A review of the first 10 reported patients with inhalational anthrax resulting from the bioterrorism release of anthrax spores in the autumn of 2001 indicated that all 10 had abnormal chest X rays (Ternigan et al., 2001~. Abnormalities included infiltrates, pleural effusion, and mediastinal widening.
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From page 47... ...
The effects of edema toxin appear to result from EF, an adenylate cyclase that increases intracellular levels of cyclic adenosine monophosphate, which upsets water homeostasis (Dixon et al., 1999~. Edema toxin may also impair neutrophil function.
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From page 48... ...
Live spore vaccines, such as the Sterne vaccine, have been associated with residual virulence that leads to occasional casualties in livestock and thus have not been considered appropriate for human use in the West. Therefore, when interest in the potential use of anthrax as a biological warfare agent arose after World War II, work to develop inactivated vaccines began in both the United States, at Fort Detrick, Maryland, and the United Kingdom, at Porton Down (Turnbull, 2000~.
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From page 49... ...
At the time of the Gulf War, there were fears that Iraq had produced weapons containing anthrax spores. More than 300,000 doses of AVA were distributed during Operation Desert Storm, probably to more than 150,000 service members (Army Information Paper, 1991)
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From page 50... ...
In Tuly 2000, in November 2000, and again in Tune 2001, DoD slowed the anthrax immunization program, focusing only on troops thought to be at greatest potential risk (http://www.anthrax.osd.mil, accessed September 5, 2000; Marshall, 2000~. In the autumn of 2001, more than 30,000 civilians were potentially exposed to anthrax in bioterrorist incidents involving the distribution of highly infectious spores through the U.S.
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From page 51... ...
AVAILABLE DATA ON AVA In its letter report of March 2000, An Assessment of the Safety of the Anthrax Vaccine, the IOM Committee on Health Effects Associated with Exposures During the Gulf War expressed regret over the lack of information about the vaccine in the peer-reviewed published literature (IOM, 3 Christopher Shays, chair of the Subcommittee on National security, Veterans Affairs, and International Relations of the committee on Government Reform and Oversight convened a series of hearings in 1999 and 2000 on AVIP and on allegations that adverse event reporting to the vaccine Adverse Event Reporting System does not adequately reflect the actual rate of adverse events. congressman Steve Buyer' chair of the Subcommittee on Military Personnel of the House committee on Armed services, also held a hearing on AVIP, and the committee on Appropriations chaired by Ted Stevens held a hearing on Gulf war illnesses, as had congressman Shays.
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From page 52... ...
. Their findings placed associations between the exposure of interest and the health outcome into categories such as sufficient evidence of a causal relationship, sufficient evidence of an association, limited or suggestive evidence of an association, inadequate or insufficient evidence to determine whether an association does or does not exist, and limited or suggestive evidence of no association.
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From page 53... ...
2002. Fatal inhalational anthrax in a 94-year-old Connecticut woman.
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From page 54... ...
2001. Macrophagederived cell lines do not express proinflammatory cytokines after exposure to Bacillus anthracis lethal toxin.
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From page 55... ...
2001. Cutaneous anthrax infection.
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