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1: J R Army Med Corps 2000 Oct;146(3):191-5

Adverse reactions to anthrax immunisation in a
military field hospital.

Hayes SC, World MJ.
33 Field Hospital Fort Blockhouse, Gosport,
Hants, PO12 2AB.

OBJECTIVE: To determine the outcome of anthrax immunisation. METHODS: Adverse reactions (occurrence, nature, severity and incapacity) and immune responses to a voluntary programme of anthrax immunisation at 0, 3, 6, and 24 weeks were monitored by questionnaire and voluntary blood sampling in 129
members, including 24 immunised 7 years previously (immunes), of a military field hospital alerted for possible deployment. 

RESULTS: Follow-up was complete in 85%. Ninety-eight (76%) received the first anthrax immunisation. Uptake was greater (p = 0.015) in immunes. Initial prevalence of adverse reaction was 63%. Subsequent uptake and adverse reaction dwindled significantly (p < 0.001). Only 28 (22%) were immunised at 24 weeks. Proportions reporting adverse reactionsfollowing the initial immunisation were greater in immunes (p = 0.046) and officers (p = 0.02). There was no significant(p = 0.36) correlation between uptake of immunisation and prevalence of adverse reaction. Antecedent adverse reaction did not reduce the proportion of participants accepting immunisation subsequently. The nature of adverse reactions (47% local, 24% systemic and 27% both) and severity were the same throughout. Forty-five percent of adverse reactions caused incapacity. Seventy-four percent of these had pain in the injected arm (+/- systemic symptoms) which prevented lifting or driving for 48 hours in 63%. Immune responses were greater in immunes.

CONCLUSIONS: It was concluded that anthrax immunisation results in a higher than expected prevalence of adverse reaction with initial incapacity of military significance affecting 18%. Greater immune responses may increase adverse reaction but this does notaffect acceptance of anthrax immunisation. Poor
completion rates necessitate development of a new anthrax immunisation strategy.
 PMID: 11143687 [PubMed - indexed for MEDLINE]

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