title: Vaccines for preventing anthrax.
abstract: BACKGROUND
  Anthrax is an acute bacterial skin disease which may be fatal. Three anthrax vaccines are commercially available but their comparative effectiveness and safety is not clear.
  
  
  OBJECTIVE
  The objective of this review was to assess the effects of human anthrax vaccines in healthy adults and children.
  
  
  METHODS
  We searched the Cochrane Controlled Trials Register, Medline, Embase and the reference lists of articles. We handsearched the journal Vaccine and contacted researchers in the field.
  
  
  METHODS
  Randomised and quasi-randomised trials comparing anthrax vaccines with placebo, vaccines for other diseases or no intervention.
  
  
  METHODS
  Trial quality assessment and data extraction was conducted independently by the six authors.
  
  
  RESULTS
  Two trials involving 16,052 people were included. Both trials had methodological limitations. Compared to placebo, vaccination was associated with a reduced risk of contracting anthrax (relative risk 0.16, 95% confidence interval 0.07 to 0.35). Compared to placebo, the killed vaccine was associated with a higher incidence and severity of adverse effects (odds ratio 5.15, 95% confidence interval 2.28 to 11.61). Just over 5% of participants in the vaccine group reported adverse effects. The effectiveness of the vaccine does not appear to be influenced by the route of inoculation.
  
  
  CONCLUSIONS
  Killed anthrax vaccines appear to be effective in reducing the risk of contracting anthrax with a relatively low rate of adverse effects. Further research should be restricted to testing new vaccines only.
authors.affiliation: Army Medical Directorate 5, Ministry of Defence, Building 21a, Keogh Barracks, Ash Vale, HANTS, UK, GU12 5RR. zorria@epinet.co.uk
authors.forename: T
authors.initials: T
authors.lastname: Jefferson
authors.forename: V
authors.initials: V
authors.lastname: Demicheli
authors.forename: J
authors.initials: J
authors.lastname: Deeks
authors.forename: P
authors.initials: P
authors.lastname: Graves
authors.forename: M
authors.initials: M
authors.lastname: Pratt
authors.forename: D
authors.initials: D
authors.lastname: Rivetti
mesh_terms: D000328:Adult; D000881:Anthrax / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D014612:Vaccines / Q000627:therapeutic use*
chemical_list: D014612:Vaccines