http://www.nytimes.com/2001/12/16/national/16MAIL.html

 

December 16, 2001

THE HEALTH THREAT

Anthrax Shot Considered for Civilians

By WARREN E. LEARY

ASHINGTON, Dec. 15 — The government is considering making the anthrax vaccine that is now used by the military available to postal workers and others at high risk of exposure to the deadly bacteria, federal health officials said today.

Tommy G. Thompson, the secretary of the Department of Health and Human Services, could make a decision on expanded anthrax vaccinations next week, officials said after a forum, arranged by the Centers for Disease Control and Prevention, on what to do next to prevent inhalation anthrax in people who have already taken antibiotics because of possible exposure.

The Defense Department has agreed to turn over 220,000 doses of vaccine to the health department and the Food and Drug Administration has given the disease centers permission to use the vaccine in an experimental treatment program.

Since early October, more than 32,000 persons have been given initial courses of antibiotics to counteract possible infections of anthrax from contaminated mail, officials said. Of these, about 10,000 were advised to continue taking antibiotics for 60 days because they were most likely to have been exposed. Five people have died of inhalation anthrax since the outbreak began.

Dr. D. A. Henderson, director of the office of public health preparedness at Health and Human Services, said candidates for the vaccine would be those with possible exposure to large amounts of anthrax spores.

"We are concerned with people who may have had a very heavy dose," Dr. Henderson said after the meeting. This group, he said, probably numbers about 3,000.

Once in the body, the spores are believed to germinate into disease- causing bacteria within 60 days. But because antibiotics kill the bacteria, not the spores, there are concerns that some spores might remain after the 60-day treatment and turn deadly, experts said.

Dr. Anthony S. Fauci of the National Institutes of Health said that there was not yet a consensus among health experts on whether to offer an anthrax vaccine to civilians because the antibiotics treatment is considered sufficient. If the vaccine becomes available, patients will have to make their own decision about taking it, he said.

If the vaccine, which previously has been used only by the military and only for protection against a future exposure, becomes available for civilians, its use as a treatment after exposure would be considered experimental and require special informed consent agreements from the patients, said Dr. Katherine Zoon, an official at the Food and Drug Administration.

Animal-test data suggests that the vaccine should be given in three doses over a month's time, while the patients are getting an additional 30- day course of antibiotics to ward off any potential disease before the vaccine takes effect, experts said at the meeting.

About 2.1 million anthrax vaccine doses have been administered to 521,000 members of the military with few severe adverse effects, experts said. While most reactions are mild, including redness, itching and swelling at the inoculation site, severe allergic reactions have been seen in 1 in 100,000 cases, they said.

Dr. Ivan Walks, health commissioner for the District of Columbia, said any vaccine program should be accompanied by education and communication programs directed at various economic and racial groups. He reminded participants that when antibiotics were recommended early in the crisis, some postal workers voiced concerns that they were not tested and treated as quickly as workers on Capitol Hill who were exposed to anthrax from tainted mail in the offices of senators.

Al Ferranto of the National Association of Letter Carriers also cautioned the policy makers to consider how any vaccine recommendation might affect postal workers, who tend to be older than soldiers, with some having diabetes and other medical problems. He asked health authorities to look at "the big picture," including how a vaccine program might hurt confidence in the postal system.

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.