http://www.anthraxvaccine.org/recter.html
This webwsite
provides an enormous amount of information on anthrax vaccine. This is because,
for a very controversial and complex subject, "the devil is in the
details." Here I am just giving my brief opinion of what to do *now*.
If anthrax is used for bioterrorism, the existing vaccine may or may not be
effective. In the one human study ever done of any anthrax vacine, the vaccine
was about 70% effective at preventing anthrax infections. The current vaccine's
effectiveness has not been tested in humans. Although it was 95% effective in
monkeys, there are reasons to believe monkeys respond to it better than humans.
Antibiotics (doxycycline and ciprofloxacin) prevented anthrax in 80% and 90% of
a small number of monkeys. But both antibiotics and vaccines can be defeated
using widely known genetic engineering techniques to create resistant anthrax
strains, or specially selecting naturally occurring anthrax strains. Cipro is
the only antibiotic that has been approved by FDA for use against anthrax,
because the manufacturer applied for this indication recently.
Anthrax experts in the past have felt that antibiotics are an excellent
prophylactic measure, but that vaccines will add to their protection when given
*following* an exposure, based on animal experiments.
Anthrax does NOT spread from person to person. It ONLY affects those who
breathe in the spores when first released. There is only a tiny risk from
spores that are re-aerosolized later. Therefore, if you are not in the
immediate area of release, or in a narrow path where spores of sufficient
quantity are carried by the wind (it requires tens of thousands to millions of
spores to cause infection) you will not be affected.
The vaccine presently available has caused longlasting medical illness in a
significant proportion of those who receive it. All existing doses are
currently under quarantine by FDA for manufacturing lapses. Even if FDA decides
the bioterrorism risk is real and releases the quarantined vaccine for military
or civilian use, the manufacturing lapses and risk of chronic illness *remain*.
If the antibiotics are effective (this depends on the strain of anthrax
employed), one has time to consider use of the vaccine afterward. If
antibiotics are not effective, then the vaccine may be lifesaving, or may be
ineffective. But I suspect that 10-35% of vaccine recipients develop illnesses
resembling chronic fatigue syndrome, fibromyalgia, multiple chemical
sensitivity, autoimmune illnesses, and/or neuropathies: also known as
"Gulf War Syndrome." This is the tradeoff you are making when
receiving this vaccine.
One can, however, take antibiotics *in advance of* an attack, and still get
their benefit if an anthrax attack were to occur. Personally, I have
antibiotics handy, but will use them only if attack apears imminent or has
occurred. If vaccine is made available, you will never find me lining up for my
dose...by the way, there are six initial doses and then one-two yearly booster
shots. Protection, you see, does not come quickly, nor easily.
Although dose recommendations for antibiotic therapy exist, they are
theoretical, and do not reflect actual experience in humans. Cephalosporins are
the only antibiotic class to which anthrax is naturally resistant. So use a
high normal dose for a long duration (1-6 months because ungerminated spores
can persist in the lungs longterm and germinate following antibiotic
cessation): post exposure, when the organism can be cultured, the
recommendations can be refined.
One other theoretical consideration is that doxycycline and cipro have been the
recommended drugs for anthrax for a decade, and therefore specific resistance
to those two may have been added to enhance virulence. This might lead you to
choose a second or even third antibiotic to which the organism is less likely
to be resistant.
Meryl Nass, MD
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.