title: Vaccines: countering anthrax: vaccines and immunoglobulins.
abstract: Anthrax spores rank as the leading threat among bioweapons. This article reviews the accumulated evidence for immunization, either active or passive, to counter the malicious release of anthrax spores. The key protective factor in current anthrax vaccines for humans is a protein called protective antigen, which allows ingress of toxins into cells. The US vaccine is licensed to prevent anthrax, regardless of the route of exposure. Its dosing schedule is cumbersome and somewhat painful (shortcomings that may be resolved by ongoing clinical studies). It can be prescribed with the confidence commensurate with dozens of human safety studies and experience in 1.8 million recent vaccinees. For post-exposure prophylaxis, combining antibiotic prophylaxis and active immunization before illness onset may offer the best combination of prompt and sustained protection, especially for people who inhale large doses of spores. To treat anthrax infection, passive immunization using a polyclonal or monoclonal antibody product may offer important clinical benefit, especially if the anthrax bacteria are resistant to multiple antibiotics.
authors.affiliation: Merck Vaccines and Infectious Diseases, West Point, Pennsylvania 19486-0004, USA. john_grabenstein@merck.com
authors.forename: John D
authors.initials: JD
authors.lastname: Grabenstein
mesh_terms: D000881:Anthrax / Q000276:immunology / Q000517:prevention & control*; D022122:Anthrax Vaccines / Q000276:immunology / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001408:Bacillus anthracis / Q000276:immunology*; D023482:Bioterrorism; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D007116:Immunization, Passive / Q000379:methods; D007136:Immunoglobulins / Q000276:immunology / Q000627:therapeutic use*; D013171:Spores, Bacterial / Q000276:immunology; D014611:Vaccination / Q000379:methods
chemical_list: D022122:Anthrax Vaccines; D007136:Immunoglobulins