title: Safety of anthrax vaccine: an expanded review and evaluation of adverse events reported to the Vaccine Adverse Event Reporting System (VAERS).
abstract: OBJECTIVE
  To assess the safety of a licensed anthrax vaccine (AVA) given to more than 500,000 US military personnel, through review and medical evaluation of adverse events (AEs) reported to the Vaccine Adverse Event Reporting System (VAERS).
  
  
  METHODS
  AEs were summarized by person, vaccine lot, type, frequency and impact. A Delphic approach was used to tentatively assess causality in an effort to detect serious AEs (SAEs) or other medically important AEs (OMIAEs) possibly attributable to AVA.
  
  
  RESULTS
  The Anthrax Vaccine Expert Committee (AVEC) reviewed 1841 reports describing 3991 AEs (9.4 reports/10,000 doses of AVA) that were submitted to VAERS from 1Q1998 through 4Q2001. One hundred forty-seven reports described an SAE or OMIAE, of which 26 were tentatively rated as possible, probable or certain consequences of vaccination (injection-site reaction [12], 'anaphylactic-like reaction' [5] and eight other systemic AEs [1-2 each]).
  
  
  CONCLUSIONS
  This review produced no evidence for an unusual rate of any SAE or OMIAE attributable to AVA. It supported an earlier impression that AVA may cause significant local inflammation and should be administered over the deltoid rather than the triceps to avoid direct or compression injury to the ulnar nerve. The subjects of VAERS reports tended to be older than all recipients of AVA. Females generally had and/or reported AEs more often than males, but transient articular reactions were surprisingly more common in males. Variations in the frequency or severity (as judged by hospitalization and/or loss of duty) of reported AEs did not suggest a significant problem with (1) a particular lot of AVA, (2) recurrent AEs after multiple doses or (3) vaccination of persons with a concomitant illness or those given other vaccines or medications.
authors.affiliation: Department of Pediatrics, Obstetrics and Gynecology, The Children's National Medical Center, George Washington University, Washington, DC 20010-2970, USA. jsever@cnmc.org
authors.forename: John L
authors.initials: JL
authors.lastname: Sever
authors.forename: Alan I
authors.initials: AI
authors.lastname: Brenner
authors.forename: Arnold D
authors.initials: AD
authors.lastname: Gale
authors.forename: Jerry M
authors.initials: JM
authors.lastname: Lyle
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Moulton
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Ward
authors.forename: David J
authors.initials: DJ
authors.lastname: West
mesh_terms: D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D022122:Anthrax Vaccines / Q000009:adverse effects* / Q000276:immunology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D011358:Product Surveillance, Postmarketing; D012737:Sex Factors; D014481:United States
chemical_list: D022122:Anthrax Vaccines