title: Evaluation of body mass index, pre-vaccination serum progesterone levels and anti-anthrax protective antigen immunoglobulin G on injection site adverse events following anthrax vaccination in women.
abstract: BACKGROUND
  In 2002, CDC initiated the Anthrax Vaccination Program (AVP) to provide voluntary pre-exposure anthrax vaccination for individuals at high risk for exposure to Bacillus anthracis spores. The AVP offered an opportunity to investigate hypothesized reasons for a reported gender difference in injection site adverse events (AEs) following anthrax vaccine adsorbed (AVA).
  
  
  OBJECTIVE
  To evaluate in women the impact of body mass index (BMI), pre-vaccination serum progesterone levels, and pre-vaccination anti-anthrax protective antigen immunoglobulin G concentrations (anti-PA IgG) on the occurrence of AEs following subcutaneous AVA vaccination.
  
  
  METHODS
  Participants' BMI was determined at enrollment. Also, pre-vaccination blood samples were assayed for serum progesterone and anti-PA IgG. Post-vaccination solicited AEs were recorded by participants using a 4-day diary card.
  
  
  RESULTS
  Obese group had an elevated risk for arm soreness. Decreased pre-vaccination serum progesterone level was associated with arm swelling. Increased pre-vaccination anti-PA IgG was associated with itching on the arm; and within the obese group, was associated with arm swelling, lump or knot, redness, soreness, and warmth.
  
  
  CONCLUSIONS
  In AVA vaccinated women, obesity was associated with arm soreness and decreased pre-vaccination serum progesterone levels were associated with increased rate of arm swelling. Increased pre-vaccination anti-PA IgG may be associated with an increased frequency of itching on the arm, and in obese women, may increase the occurrence of arm swelling, lump or knot, redness, and warmth. Administering AVA according to a woman's menstrual phase may reduce the occurrence of certain injection site reactions.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Yujia
authors.initials: Y
authors.lastname: Zhang
authors.forename: Stacey W
authors.initials: SW
authors.lastname: Martin
authors.forename: Charles E
authors.initials: CE
authors.lastname: Rose
authors.forename: Raymond E
authors.initials: RE
authors.lastname: Biagini
authors.forename: Laura H
authors.initials: LH
authors.lastname: Franzke
authors.forename: Jerry P
authors.initials: JP
authors.lastname: Smith
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Sammons
authors.forename: Shirley A
authors.initials: SA
authors.lastname: Robertson
authors.forename: Michael M
authors.initials: MM
authors.lastname: McNeil
mesh_terms: D000293:Adolescent; D000328:Adult; D000881:Anthrax / Q000276:immunology*; D022122:Anthrax Vaccines / Q000008:administration & dosage / Q000009:adverse effects*; D000907:Antibodies, Bacterial / Q000097:blood*; D001132:Arm; D015992:Body Mass Index; D004487:Edema / Q000209:etiology* / Q000276:immunology / Q000378:metabolism; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007267:Injections; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000276:immunology; D016017:Odds Ratio; D011374:Progesterone / Q000097:blood*; D011537:Pruritus / Q000209:etiology* / Q000276:immunology / Q000378:metabolism; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult
chemical_list: D022122:Anthrax Vaccines; D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D011374:Progesterone