ObjectiveTo review and update consensus-based recommendations for medical and
public health professionals following a Bacillus anthracis attack against a civilian population.ParticipantsThe working group included 23 experts from academic medical centers,
research organizations, and governmental, military, public health, and emergency
management institutions and agencies.EvidenceMEDLINE databases were searched from January 1966 to January 2002, using
the Medical Subject Headings anthrax, Bacillus anthracis, biological weapon, biological terrorism, biological warfare, and biowarfare. Reference review identified
work published before 1966. Participants identified unpublished sources.Consensus ProcessThe first draft synthesized the gathered information. Written comments
were incorporated into subsequent drafts. The final statement incorporated
all relevant evidence from the search along with consensus recommendations.ConclusionsSpecific recommendations include diagnosis of anthrax infection, indications
for vaccination, therapy, postexposure prophylaxis, decontamination of the
environment, and suggested research. This revised consensus statement presents
new information based on the analysis of the anthrax attacks of 2001, including
developments in the investigation of the anthrax attacks of 2001; important
symptoms, signs, and laboratory studies; new diagnostic clues that may help
future recognition of this disease; current anthrax vaccine information; updated
antibiotic therapeutic considerations; and judgments about environmental surveillance
and decontamination.

/pdf/anthrax-as-a-biological-weapon-2002-updated-recommendations-ebw79qjamb.pdf

Anthrax as a biological weapon, 2002: updated recommendations for management.

Objective To develop consensus-based recommendations for measures to be taken by medical and public health professionals following the use of anthrax as a biological weapon against a civilian population. Participants The working group included 21 representatives from staff of major academic medical centers and research, government, military, public health, and emergency management institutions and agencies. Evidence MEDLINE databases were searched from January 1966 to April 1998, using the Medical Subject Headings anthrax, Bacillus anthracis, biological weapon, biological terrorism, biological warfare, and biowarfare. Review of references identified by this search led to identification of relevant references published prior to 1966. In addition, participants identified other unpublished references and sources. Consensus Process The first draft of the consensus statement was a synthesis of information obtained in the formal evidence-gathering process. Members of the working group provided formal written comments which were incorporated into the second draft of the statement. The working group reviewed the second draft on June 12, 1998. No significant disagreements existed and comments were incorporated into a third draft. The fourth and final statement incorporates all relevant evidence obtained by the literature search in conjunction with final consensus recommendations supported by all working group members. Conclusions Specific consensus recommendations are made regarding the diagnosis of anthrax, indications for vaccination, therapy for those exposed, postexposure prophylaxis, decontamination of the environment, and additional research needs.

/pdf/anthrax-as-a-biological-weapon-medical-and-public-health-1tm5d8hp3e.pdf

Anthrax as a Biological Weapon Medical and Public Health Management

Tracking human antigen-specific memory B cells: a sensitive and generalized ELISPOT system.

In vitro correlate of immunity in a rabbit model of inhalational anthrax.

Comparative efficacy of experimental anthrax vaccine candidates against inhalation anthrax in rhesus macaques.

In conducting research using animals, the investigators adhered to the “Guide for the Care and Use of Laboratory Animals,” prepared by the Committee on Care and Use of Laboratory Animals of the Institute of Laboratory Animal Resources, National Research Council (NIH Publication No. 8623, revised 1985). The views, opinions and/or findings contained in this publication are those of the authors and should not be construed as an official Department of the Army position, policy or decision unless so designated by other documentation.

Efficacy of a standard human anthrax vaccine against Bacillus anthracis aerosol spore challenge in rhesus monkeys

Five unimmunized adult rhesus monkeys weighing 5.9-6.3 kg were challenged with a precalculated, inhaled dose of 20.95-41.8 &kg of aerosolized ricin. Two males and three females either died or were killed at the onset of respiratory distress between 36 and 48 hours post-ricin inhalation and were necropsied. Consistent gross and microscopic lesions were confined to the thoracic cavity. All monkeys had multifocal to coalescing fibrinopurulent pneumonia, diffuse necrosis, and acute inflammation of airways, and nearly diffuse alveolar flooding, with peribronchovascular edema. All monkeys also had purulent tracheitis, fibrinopurulent pleuritis, and purulent mediastinal lymphadenitis. One male monkey and one female monkey had bilateral adrenocortical necrosis. We attributed the cause of death to asphyxiation following massive pulmonary alveolar flooding. The lesions of acute inhaled ricin intoxication in rhesus monkeys closely resembled those lesions reported in rats with acute inhaled ricin intoxication.

https://vet.sagepub.com/content/33/3/296.full.pdf

M. L. M. Pitt

Papers

Efficacy of a standard human anthrax vaccine against Bacillus anthracis aerosol spore challenge in rhesus monkeys

EXPERIMENTAL DISEASE Lesions of Acute Inhaled Lethal Ricin Intoxication in Rhesus Monkeys