Adverse reactions to anthrax immunisation in a military field hospital.
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 reactions following 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 not affect acceptance of anthrax immunisation. Poor completion rates necessitate development of a new anthrax immunisation strategy.
Hayes
S C
SC
33 Field Hospital Fort Blockhouse, Gosport, Hants, PO12 2AB.
World
M J
MJ
D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D022122:Anthrax Vaccines / Q000009:adverse effects* / Q000276:immunology*; D000907:Antibodies, Bacterial / Q000097:blood; D001407:Bacillus / Q000276:immunology; D004342:Drug Hypersensitivity / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006772:Hospitals, Military; D006801:Humans; D007115:Immunization Schedule; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D010146:Pain / Q000209:etiology; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D015995:Prevalence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D006113:United Kingdom
D022122:Anthrax Vaccines; D000907:Antibodies, Bacterial; D007074:Immunoglobulin G