Because of the threat of biological warfare, the U.S. military plans to vaccinate 2.4 million personnel against anthrax. A number of soldiers are risking court martial rather than accept the vaccine because of concerns about safety. Some believe it may be related to the Gulf War Syndrome (USA Today 1/26/99).

On the other hand, some civilians are asking questions about how to obtain the vaccine because they wish to protect themselves against a highly fatal disease, which has unquestionably been weaponized by many possible antagonists.

The anthrax vaccine was licensed in 1970 on the basis of one published study, with only five inhalation cases. Animal studies have shown survival rates as low as 4% and as high as 100% after anthrax challenge. A 1994 Staff Report for the Committee on Veterans Affairs is quoted as saying that ``its [the vaccine's] safety, particularly when given to thousands of soldiers in conjunction with other vaccines, is not well established'' (Lancet 351:657, 1998, quoting a ProMED-mail posting). The one U.S. producer, Michigan Biologic Products Institute (now Bioport Corp.), would have closed last year except for a last-minute plea by the Pentagon.

Textbooks of military medicine and The Medical Letter (40:52-53, 1998) state that the anthrax vaccine is ``safe and effective.'' The British secretary of state for defence was vaccinated on camera in an effort to convince service personnel and the public of the vaccine's safety. However, several epidemiologists at the University of Bristol described the state of current thinking as one of ``clinical equipoise'' and recommended randomizing troops to receive or not receive vaccine (Br Med J 316:1322, 1998). Certainly, there is a need to develop a better vaccine. Harrison's Principles of Internal Medicine states: ``The current vaccines are impure and chemically complex, elicit only slow-onset protective immunity, provide incomplete protection, and cause significant adverse reactions.''

The vaccine is not completely protective against all natural strains of Bacillus anthracis. An additional threat in the context of biological warfare is the potential use of genetically engineered strains, against which both vaccine and antibiotics may be ineffective (CMAJ 158:633, 1998). Thus, prevention of exposure (as with shelters and protective gear) remains indispensable.

It is hypothesized that multiple vaccinations may cause complex interactions and a large change in the immune response, causing symptoms like those observed in Gulf War veterans. Also, there is a report that the anthrax-pertussis combination induced ``severe loss of condition and weight'' in animals (Nature 390:3, 1997).

The British defence ministry has also admitted that ``medical record-keeping in the Gulf was not satisfactory,'' according to researcher Alan Silman of the University of Manchester (Nature 384:604, 1996). Moreover, ``the MOD [ministry of defence] suffers from an excessive culture of secrecy'' (Nature 390:3-4, 1997).

Circumstantial evidence pointing to vaccines as a cause for the Gulf War syndrome also comes from the fact that no symptoms have been reported in French forces, who were not given the vaccines used by British and American troops (ibid.)

The questions raised about adverse reactions due to vaccine cocktails are highly pertinent in the civilian sector, now that such a large number of vaccines are mandated for administration to children, with exclusion from school and even charges of child neglect or abuse as penalties for noncompliance.

Late last year, the CDC received reports of a series of bioterroristic threats of anthrax exposure, in letters purportedly contaminated with the bacillus, or as telephone threats about contaminated ventilation systems. To date, all have been hoaxes. Decontamination was carried out with soap, copious quantities of water, and 0.5% hypochlorite bleach (standard household bleach diluted 1:10 with water).

Chemoprophylaxis may be recommended until B. anthracis is ruled out. For adults, the CDC recommends ciprofloxacin 500 mg bid OR levofloxacin 500 mg qd OR ofloxacin 400 mg bid OR (if a fluorquinolone is unavailable or contraindicated) doxycycline 100 mg bid. For children, both drugs have adverse consequences. Ciprofloxacin 20-30 mg per kg per day, divided every 12 hours (but NOT other fluoroquinolones) or doxycycline 5 mg per kg of body mass per day divided every 12 hours, may be used, weighing the risk of the drugs against the risk of life-threatening infection. Amoxicillin 40 mg per kg per day, divided every 8 hours, up to 500 mg tid, should be substituted as soon as possible if the organism is determined to be penicillin sensitive. If anthrax exposure is confirmed, the immunizations should begin as soon as possible, along with the antibiotics. Vaccine can be obtained through the CDC in Atlanta (MMWR 48:69-74, 1999).

Laboratory mice and rats thrive when fed the material.

``Rapid inactivation of anthrax bacteria and spores combined with low toxicity makes BCTP a promising candidate for use as a broad-spectrum, post-exposure decontamination agent,'' Baker said.

A detailed draft program for the 17th annual meeting in Seattle is enclosed.

Special tours have been arranged before and after the meeting, of the Boeing plant and the Bangor Trident Nuclear Submarine Base. The number of attendees at these events is strictly limited, and the submarine base needs a list at least a month in advance. Call now to reserve a place!