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This report updates previous CDC guidelines and recommendations on preferred prevention and treatment regimens regarding naturally occurring anthrax. Also provided are a wide range of alternative regimens to first-line antimicrobial drugs for use if patients have contraindications or intolerances or after a wide-area aerosol release of Bacillus anthracis spores if resources become limited or a multidrug-resistant B. anthracis strain is used (Hendricks KA, Wright ME, Shadomy SV, et al.; Workgroup on Anthrax Clinical Guidelines. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis 2014;20:e130687; Meaney-Delman D, Rasmussen SA, Beigi RH, et al. Prophylaxis and treatment of anthrax in pregnant women. Obstet Gynecol 2013;122:885-900; Bradley JS, Peacock G, Krug SE, et al. Pediatric anthrax clinical management. Pediatrics 2014;133:e1411-36). Specifically, this report updates antimicrobial drug and antitoxin use for both postexposure prophylaxis (PEP) and treatment from these previous guidelines best practices and is based on systematic reviews of the literature regarding 1) in vitro antimicrobial drug activity against B. anthracis; 2) in vivo antimicrobial drug efficacy for PEP and treatment; 3) in vivo and human antitoxin efficacy for PEP, treatment, or both; and 4) human survival after antimicrobial drug PEP and treatment of localized anthrax, systemic anthrax, and anthrax meningitis. Changes from previous CDC guidelines and recommendations include an expanded list of alternative antimicrobial drugs to use when first-line antimicrobial drugs are contraindicated or not tolerated or after a bioterrorism event when first-line antimicrobial drugs are depleted or ineffective against a genetically engineered resistant B. anthracis strain. In addition, these updated guidelines include new recommendations regarding special considerations for the diagnosis and treatment of anthrax meningitis, including comorbid, social, and clinical predictors of anthrax meningitis. The previously published CDC guidelines and recommendations described potentially beneficial critical care measures and clinical assessment tools and procedures for persons with anthrax, which have not changed and are not addressed in this update. In addition, no changes were made to the Advisory Committee on Immunization Practices recommendations for use of anthrax vaccine (Bower WA, Schiffer J, Atmar RL, et al. Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices, 2019. MMWR Recomm Rep 2019;68[No. RR-4]:1-14). The updated guidelines in this report can be used by health care providers to prevent and treat anthrax and guide emergency preparedness officials and planners as they develop and update plans for a wide-area aerosol release of B. anthracis. [ABSTRACT FROM AUTHOR]

This report updates the 2009 recommendations from the CDC Advisory Committee on Immunization Practices (ACIP) regarding use of anthrax vaccine in the United States (Wright JG, Quinn CP, Shadomy S, Messonnier N. Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices [ACIP)], 2009. MMWR Recomm Rep 2010;59[No. RR-6]). The report 1) summarizes data on estimated efficacy in humans using a correlates of protection model and safety data published since the last ACIP review, 2) provides updated guidance for use of anthrax vaccine adsorbed (AVA) for preexposure prophylaxis (PrEP) and in conjunction with antimicrobials for postexposure prophylaxis (PEP), 3) provides updated guidance regarding PrEP vaccination of emergency and other responders, 4) summarizes the available data on an investigational anthrax vaccine (AV7909), and 5) discusses the use of anthrax antitoxins for PEP. Changes from previous guidance in this report include the following: 1) a booster dose of AVA for PrEP can be given every 3 years instead of annually to persons not at high risk for exposure to Bacillus anthracis who have previously received the initial AVA 3-dose priming and 2-dose booster series and want to maintain protection; 2) during a large-scale emergency response, AVA for PEP can be administered using an intramuscular route if the subcutaneous route of administration poses significant materiel, personnel, or clinical challenges that might delay or preclude vaccination; 3) recommendations on dose-sparing AVA PEP regimens if the anthrax vaccine supply is insufficient to vaccinate all potentially exposed persons; and 4) clarification on the duration of antimicrobial therapy when used in conjunction with vaccine for PEP. These updated recommendations can be used by health care providers and guide emergency preparedness officials and planners who are developing plans to provide anthrax vaccine, including preparations for a wide-area aerosol release of B. anthracis spores. The recommendations also provide guidance on dose-sparing options, if needed, to extend the supply of vaccine to increase the number of persons receiving PEP in a mass casualty event. [ABSTRACT FROM AUTHOR]

These recommendations from the Advisory Committee on Immunization Practices (ACIP) update the previous recommendations for anthrax vaccine adsorbed (AVA) (CDC. Use of anthrax vaccine in the United States: Recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2000;49:1-20; CDC. Use of anthrax vaccine in response to terrorism: supplemental recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2002;51:1024-6) and reflect the status of anthrax vaccine supplies in the United States. This statement 1) provides updated information on anthrax epidemiology; 2) summarizes the evidence regarding the effectiveness and efficacy, immunogenicity, and safety of AVA; 3) provides recommendations for pre-event and preexposure use of AVA; and 4) provides recommendations for postexposure use of AVA. In certain instances, recommendations that did not change were clarified. No new licensed anthrax vaccines are presented. Substantial changes to these recommendations include the following: 1) reducing the number of doses required to complete the pre-event and preexposure primary series from 6 doses to 5 doses, 2) recommending intramuscular rather than subcutaneous AVA administration for preexposure use, 3) recommending AVA as a component of postexposure prophylaxis in pregnant women exposed to aerosolized Bacillus anthracis spores, 4) providing guidance regarding preexposure vaccination of emergency and other responder organizations under the direction of an occupational health program, and 5) recommending 60 days of antimicrobial prophylaxis in conjunction with 3 doses of AVA for optimal protection of previously unvaccinated persons after exposure to aerosolized B. anthracis spores. [ABSTRACT FROM AUTHOR]

States that the United States Air Force will hold a nonjudicial punishment hearing for Sonnie Bates, who has refised to participate in the US Defense Department's anthrax vaccination program. Bates as a pilot at Dover Air Force Bates in Delaware; Bates' agreement to a less formal disciplinary proceeding.

Focuses on the challenges being faced by the biodefense industry in developing vaccines or therapies intended to combat potential bioweapons in the U.S. Increase in funding allocated by the government to help create such products; Value of a contract awarded to VaxGen by the Department of Health and Human Services to produce next-generation anthrax vaccine; Factors that hinder large companies to develop drugs and vaccines for infectious diseases of all types.

The article discusses a study which investigated the effectiveness of a three-dose schedule of intramuscular primary injection with triennial boosters in protecting against anthrax.

The article reports on the efforts of biotechnology company Iomai Corp. to develop a patch-based anthrax vaccine. The preclinical development of the vaccine will involve the combination of an antigen developed by Avecia Biologics Ltd. and an adjuvant on a skin patch from Iomai. The U.S. Department of Defense issued a grant to Iomai for the development of the vaccine.

The article reports that Maryland-based PharmAthene has agreed to buy Avecia Biologics' biodefense vaccines business for $20 million. The acquisition includes a second-generation recombinant protective antigen (rPA) anthrax vaccine, a recombinant dual-antigen plague vaccine and a third-generation rPA anthrax vaccine. Avecia will also receive milestone payments and royalties from the vaccines if PharmAthene wins vaccine contracts.

The article offers news briefs related to the chemical industry in the U.S. The Food and Dug Administration prohibited the human safety testing of anthrax vaccine by VaxGen Inc. The global chemical trade has exceeded $1.1 trillion for 2005. A proposal was passed by the Chemical Safety & Hazard Investigation Board for federal agencies to protect workers from industrial fires and dusts.

The article reports on the passing of a new bill creating a new agency called the Biomedical Advanced R& Authority. The agency will be a component of the U.S. Department of Health & Human Services and will coordinate all federal biodefense efforts including the discovery and production of vaccines against bioweapons such as anthrax.

Interviews Irma Anderson, mayor of Richmond, California and chair of the Children, Health and Human Services Committee of the U.S. Conference of Mayors, on the resolution passed by the Conference to stress the importance of cities and counties having enough anthrax vaccines on hand for their communities. Goal of the resolution; Explanation of how cities normally receive the vaccines; Opinion on who should be vaccinated.

Reports that a U.S. federal judge has lifted his December 2003 temporary injunction that had stopped the Pentagon's mandatory anthrax vaccination program in its tracks. Previous ruling by U.S. District Judge Emmet G. Sullivan in which he sided with six plaintiffs who had sued the Pentagon and the Food and Drug Administration challenging the legality of the anthrax vaccine; Argument that the vaccine was still investigational.

Reports on a contract awarded to Avecia in 2003 to produce doses of a new recombinant anthrax vaccine for the U.S. government's National Institute of Allergy and Infectious Diseases. Partnership of Avecia with Baxter Healthcare for the project; Basis of the active component of the developed vaccine; Functions of the vaccine.

Reports the completion of screening of molecules as potential inhibitors of the assembly of anthrax vaccine by the Oxford University's chemistry department.

Reports the effectiveness of anthrax vaccine against strains of anthrax bacteria in the U.S. Advances in genetic engineering; Natural mutations of anthrax bacteria; Adverse reactions associated with the anthrax vaccine.

Reports updates on the biological warfare and terrorism. Postponement of negotiation for the Biological Weapons Convention in Geneva; Litigation on the lawsuit filed by the State of Nevada on the Yucca Mountain nuclear waste repository; Projects on anthrax vaccines through the National Institute of Allergy & Infectious Diseases.

Focuses on the military research and development on biological terrorism in the United States. Development of bioterrorism data and response technologies for defense purposes; Focus of the Department of Health & Human Services hearing on biological terrorism; Origin of the antianthrax drug doxycycline. INSET: WHENCE COMES ANTHRAX DRUG?.

Focuses on the methods of cleaning up facilities for anthrax infection in the United States. Contributions of government and industry; Administration of gas solutions outside offices.