Anthrax vaccination in a military population before the war in Iraq: side effects and informed choice

Anthrax: A narrative review

Bacillus anthracis is a zoonotic bacterium, majorly responsible for causing human anthrax and the possibility of the outbreak spreading globally. Herbivorous animals serve as the inherent reservoir for the disease, whereas all endothermic species are vulnerable. Humans contract the disease inadvertently by contact with diseased animals or animal products or through the consumption or handling of infected flesh. There is no such reported data indicating the transmission of anthrax from human to human, which further does not guarantee the bacterium's mutations and new transmission route. Nevertheless, it can lead to various infections, including endophthalmitis, bacteremia, cutaneous infection, central nervous system infection, and pneumonia. Therefore, it is crucial to examine the present epidemiological situation of human anthrax in densely populated nations, including the altered symptoms, indications in people, and the method of transmission. This article highlights the current diagnostic methods for human anthrax, further examines the available therapy options and future perspectives in treatment protocol. This narrative review resulted from a simple search strategy on "PubMed", "ScienceDirect", "ClinicalTrials.gov" and web reports using "AND" as Boolean operator with search keywords, i.e., "Anthrax" AND "Infection", "Anthrax" AND "Pandemic", "Anthrax" AND "Infectious disease", "Anthrax" AND "Vaccine", "Anthrax" AND "Diagnosis" shows minimal narrative literature in between 2024 and 2005. Furthermore, this narrative review highlights the potential approaches for detecting anthrax infection, establishing suitable protocols for prevention, and focusing on the current epidemiology and available therapeutics, vaccine and its future developmental strategies for the prevention of infectious disorder.

Serological responses to Anthrax Vaccine Precipitated (AVP) increase with time interval between booster doses

We undertook a Phase 4 clinical trial to assess the effect of time interval between booster doses on serological responses to AVP. The primary objective was to evaluate responses to a single booster dose in two groups of healthy adults who had previously received a complete 4-dose primary course. Group A had received doses on schedule while Group B had not had one for ≥2 years. Secondary objectives were to evaluate the safety and tolerability of AVP booster doses, and to gain information on correlates of protection to aid future anthrax vaccine development. Blood samples were taken on Day 1 before dosing, and on Days 8, 15, 29 and 120, to measure Toxin Neutralisation Assay (TNA) NF₅₀ values and concentrations of IgG antibodies against Protective Antigen (PA), Lethal Factor (LF) and Edema Factor (EF) by ELISA. For each serological parameter, fold changes from baseline following the trial AVP dose were greater in Group B than Group A at every time-point studied. Peak responses correlated positively with time since last AVP dose (highest values being observed after intervals of ≥10 years), and negatively with number of previous doses (highest values occurring in individuals who had received a primary course only). In 2017, having reviewed these results, the Joint Committee on Vaccination and Immunisation (JCVI) updated UK anthrax vaccination guidelines, extending the interval between routine AVP boosters from one to 10 years. Booster doses of AVP induce significant IgG responses against the three anthrax toxin components, particularly PA and LF. Similarly high responses were observed in TNA, a recognised surrogate for anthrax vaccine efficacy. Analysis of the 596 TNA results showed that anti-PA and anti-LF IgG make substantial independent contributions to neutralisation of anthrax lethal toxin. AVP may therefore have advantages over anthrax vaccines that depend on generating immunity to PA alone.

A longitudinal study of UK military personnel offered anthrax vaccination: informed choice, symptom reporting, uptake and pre-vaccination health

AIM

To determine longer term health outcome in a cohort of UK service personnel who received the anthrax vaccination.

METHOD

We conducted a three year follow up of UK service personnel all of whom were in the Armed Forces at the start of the Iraq War. 3206 had been offered the anthrax vaccination as part of preparations for the 2003 invasion of Iraq. A further 1190 individuals who did not deploy to Iraq in 2003 were subsequently offered the vaccination as part of later deployments, and in whom we therefore had prospective pre-exposure data.

RESULTS

There was no overall adverse health effect following receipt of the anthrax vaccination, with follow up data ranging from three to six years following vaccination. The previous retrospective association between making an uninformed choice to receive the anthrax vaccination and increased symptom reporting was replicated within a longitudinal sample where pre-vaccination health was known.

CONCLUSIONS

Anthrax vaccination was not associated with long term adverse health problems. However, symptoms were associated with making an uninformed choice to undergo the vaccination. The results are important both for the safety of the vaccine and for future policies should anthrax vaccination be required in either military or non military populations.

Production of recombinant anthrax toxin receptor (ATR/CMG2) fused with human Fc in planta

Mass vaccination against anthrax with existing vaccines is costly and unsafe due to potential side effects. For post-infection treatment, passive immunotherapy measures are currently available, most based on anthrax protective antigen (PA)-specific therapeutic antibodies. Efficient against wild-type strains, these treatment(s) might fail to protect against infections caused by genetically engineered Bacillus anthracis strains. A recent discovery revealed that the von Willebrand factor A (VWA) domain of human capillary morphogenesis protein 2 (CMG2) is an exceptionally effective anthrax toxin receptor (ATR) proficient in helping to resolve this issue. Here we describe in planta production of chimeric recombinant protein (immunoadhesin) comprised of functional ATR domain fused with the human immunoglobulin Fc fragment (pATR-Fc). The fusion design allowed us to obtain pATR-Fc in plant green tissues in a soluble form making it fairly easy to purify by Protein-A chromatography. Standardized pATR-Fc preparations (purity>90%) were shown to efficiently bind anthrax PA as demonstrated by ELISA and Western blot analysis. Recombinant pATR-Fc was also shown to protect J774A1 macrophage cells against the anthrax toxin. This study confirmed that plant-derived pATR-Fc antibody-like protein is a prospective candidate for anthrax immunotherapy.

Multiple vaccinations, health, and recall bias within UK armed forces deployed to Iraq: cohort study

OBJECTIVE

To assess the relation between self reported number of vaccinations received and health, and between numbers of vaccinations recorded from individuals' medical records and health.

DESIGN

First phase of a cohort study.

SETTING

UK armed forces personnel.

PARTICIPANTS

4882 randomly selected military personnel deployed to Iraq since 2003 and a subset of 378 whose vaccination records were accessed.

MAIN OUTCOME MEASURES

Psychological distress, fatigue, symptoms of post-traumatic stress disorder, health perception, and multiple physical symptoms.

RESULTS

Personnel who reported receiving two or more vaccinations on a single day were more likely to report symptoms of fatigue (adjusted risk ratio 1.17, 95% confidence interval 1.05 to 1.30), show caseness according to the general health questionnaire (1.31, 1.13 to 1.53), and have multiple physical symptoms (1.32, 1.08 to 1.60). These associations were no longer significant when number of vaccinations recorded in individuals' medical records was used as the independent variable.

CONCLUSIONS

Multiple vaccinations given to personnel in the UK armed forces in preparation for deployment to Iraq are not associated with adverse health consequences when vaccinations are recorded objectively from medical records. Adverse health consequences associated with self reported multiple vaccinations could be explained by recall bias.

Current awareness: Pharmacoepidemiology and drug safety

In order to keep subscribers up‐to‐date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of pharmacoepidemiology and drug safety. Each bibliography is divided into 20 sections: 1 Reviews; 2 General; 3 Anti‐infective Agents; 4 Cardiovascular System Agents; 5 CNS Depressive Agents; 6 Non‐steroidal Anti‐inflammatory Agents; 7 CNS Agents; 8 Anti‐neoplastic Agents; 9 Haematological Agents; 10 Neuroregulator‐Blocking Agents; 11 Dermatological Agents; 12 Immunosuppressive Agents; 13 Autonomic Agents; 14 Respiratory System Agents; 15 Neuromuscular Agents; 16 Reproductive System Agents; 17 Gastrointestinal System Agents; 18 Anti‐inflammatory Agents ‐ Steroidal; 19 Teratogens/fetal exposure; 20 Others. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.