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 Participants identified unpublished sources.Consensus ProcessThe first draft synthesized the gathered information.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.

Tick-borne encephalitis

Note: This article was originally published with an incorrect version of the Acknowledgments, which appeared on p. 218 of the print version. The correct version of the Acknowledgments appeared on pp. 1–2. The corrected article is available below.

/pdf/human-health-risk-assessment-for-aluminium-aluminium-oxide-5dfetd69xm.pdf

Human Health Risk Assessment for Aluminium, Aluminium Oxide, and Aluminium Hydroxide

ObjectiveTo develop consensus-based recommendations for measures to be taken
by medical and public health professionals if hemorrhagic fever viruses (HFVs)
are used as biological weapons against a civilian populationParticipantsThe Working Group on Civilian Biodefense included 26 representatives
from academic medical centers, public health, military services, governmental
agencies, and other emergency management institutionsEvidenceMEDLINE was searched from January 1966 to January 2002 Retrieved references,
relevant material published prior to 1966, and additional sources identified
by participants were reviewedConsensus ProcessThree formal drafts of the statement that synthesized information obtained
in the evidence-gathering process were reviewed by the working group Each
draft incorporated comments and judgments of the members All members approved
the final draftConclusionsWeapons disseminating a number of HFVs could cause an outbreak of an
undifferentiated febrile illness 2 to 21 days later, associated with clinical
manifestations that could include rash, hemorrhagic diathesis, and shock
The mode of transmission and clinical course would vary depending on the specific
pathogen Diagnosis may be delayed given clinicians' unfamiliarity with these
diseases, heterogeneous clinical presentation within an infected cohort, and
lack of widely available diagnostic tests Initiation of ribavirin therapy
in the early phases of illness may be useful in treatment of some of these
viruses, although extensive experience is lacking There are no licensed vaccines
to treat the diseases caused by HFVs

https://jamanetwork.com/journals/jama/articlepdf/194908/JST20006.pdf

Hemorrhagic Fever Viruses as Biological Weapons: Medical and Public Health Management

The biological differences associated with the sex of an individual are a major source of variation, affecting immune responses to vaccination. Compelling clinical data illustrate that men and women differ in their innate, humoral, and cell-mediated responses to viral vaccines. Sex affects the frequency and severity of adverse effects of vaccination, including fever, pain, and inflammation. Pregnancy can also substantially alter immune responses to vaccines. Data from clinical trials and animal models of vaccine efficacy lay the groundwork for future studies aimed at identifying the biological mechanisms that underlie sex-specific responses to vaccines, including genetic and hormonal factors. An understanding and appreciation of the effect of sex and pregnancy on immune responses might change the strategies used by public health officials to start efficient vaccination programmes (optimising the timing and dose of the vaccine so that the maximum number of people are immunised), ensure sufficient levels of immune responses, minimise adverse effects, and allow for more efficient protection of populations that are high priority (eg, pregnant women and individuals with comorbid conditions).

/pdf/the-xs-and-y-of-immune-responses-to-viral-vaccines-2olfe786kn.pdf

The Xs and Y of immune responses to viral vaccines

Long-term duration of detectable neutralizing antibodies after administration of live-attenuated VEE vaccine and following booster vaccination with inactivated VEE vaccine

Anthrax Vaccine: Evidence for Safety and Efficacy Against Inhalational Anthrax

Immunogenicity of an inactivated Rift Valley fever vaccine in humans : a 12-year experience

Anthrax vaccine: immunogenicity and safety of a dose-reduction, route-change comparison study in humans.

Background Many countries have stockpiled vaccines because of concerns about the reemergence of smallpox. Traditional smallpox vaccines are based on replicating vaccinia viruses; these vac...

https://www.nejm.org/doi/suppl/10.1056/NEJMoa1817307/suppl_file/nejmoa1817307_data-sharing.pdf

Phillip R. Pittman

Papers

Long-term duration of detectable neutralizing antibodies after administration of live-attenuated VEE vaccine and following booster vaccination with inactivated VEE vaccine

Anthrax Vaccine: Evidence for Safety and Efficacy Against Inhalational Anthrax

Immunogenicity of an inactivated Rift Valley fever vaccine in humans : a 12-year experience

Anthrax vaccine: immunogenicity and safety of a dose-reduction, route-change comparison study in humans.

Phase 3 Efficacy Trial of Modified Vaccinia Ankara as a Vaccine against Smallpox