Anthrax vaccines

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Anthrax vaccines
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Vaccine description
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Anthrax vaccines are vaccines to prevent the livestock and human disease anthrax, caused by the bacterium Bacillus anthracis . [1]

Contents

They have had a prominent place in the history of medicine, from Pasteur's pioneering 19th-century work with cattle (the first effective bacterial vaccine and the second effective vaccine ever) to the controversial late 20th century use of a modern product to protect American troops against the use of anthrax in biological warfare. Human anthrax vaccines were developed by the Soviet Union in the late 1930s and in the US and UK in the 1950s. The current vaccine approved by the U.S. Food and Drug Administration (FDA) was formulated in the 1960s.  

Currently administered human anthrax vaccines include acellular (USA, UK) and live spore (Russia) varieties. All currently used anthrax vaccines show considerable local and general reactogenicity (erythema, induration, soreness, fever) and serious adverse reactions occur in about 1% of recipients. [2] New third-generation vaccines being researched include recombinant live vaccines and recombinant sub-unit vaccines.

Pasteur's vaccine

In the 1870s, the French chemist Louis Pasteur (1822–1895) applied his previous method of immunising chickens against chicken cholera to anthrax, which affected cattle, and thereby aroused widespread interest in combating other diseases with the same approach. In May 1881, Pasteur performed a famous public experiment at Pouilly-le-Fort to demonstrate his concept of vaccination. He prepared two groups of 25 sheep, one goat and several cows. The animals of one group were twice injected, with an interval of 15 days, with an anthrax vaccine prepared by Pasteur; a control group was left unvaccinated. Thirty days after the first injection, both groups were injected with a culture of live anthrax bacteria. All the animals in the non-vaccinated group died, while all of the animals in the vaccinated group survived. [3] The public reception was sensational.

Pasteur publicly claimed he had made the anthrax vaccine by exposing the bacilli to oxygen. His laboratory notebooks, now in the Bibliothèque Nationale in Paris, in fact show Pasteur used the method of rival Jean-Joseph-Henri Toussaint (1847–1890), a Toulouse veterinary surgeon, to create the anthrax vaccine. [4] [5] This method used the oxidizing agent potassium dichromate. Pasteur's oxygen method did eventually produce a vaccine but only after he had been awarded a patent on the production of an anthrax vaccine.

The notion of a weak form of a disease causing immunity to the virulent version was not new; this had been known for a long time for smallpox. Inoculation with smallpox (variolation) was known to result in far less scarring, and greatly reduced mortality, in comparison with the naturally acquired disease. The English physician Edward Jenner (1749–1823) had also discovered (1796) the process of vaccination by using cowpox to give cross-immunity to smallpox and by Pasteur's time this had generally replaced the use of actual smallpox material in inoculation. The difference between smallpox vaccination and anthrax or chicken cholera vaccination was that the weakened form of the latter two disease organisms had been "generated artificially", so a naturally weak form of the disease organism did not need to be found. This discovery revolutionized work in infectious diseases and Pasteur gave these artificially weakened diseases the generic name "vaccines", in honor of Jenner's groundbreaking discovery. In 1885, Pasteur produced his celebrated first vaccine for rabies by growing the virus in rabbits and then weakening it by drying the affected nerve tissue.

In 1995, the centennial of Pasteur's death, The New York Times ran an article titled "Pasteur's Deception". After having thoroughly read Pasteur's lab notes, the science historian Gerald L. Geison declared Pasteur had given a misleading account of the preparation of the anthrax vaccine used in the experiment at Pouilly-le-Fort. [6] The same year, Max Perutz published a vigorous defense of Pasteur in The New York Review of Books . [7]

Sterne's vaccine

The Austrian-South African immunologist Max Sterne (1905–1997) developed an attenuated live animal vaccine in 1935 that is still employed and derivatives of his strain account for almost all veterinary anthrax vaccines used in the world today. [8] Beginning in 1934 at the Onderstepoort Veterinary Research Institute, north of Pretoria, he prepared an attenuated anthrax vaccine, using the method developed by Pasteur. A persistent problem with Pasteur's vaccine was achieving the correct balance between virulence and immunogenicity during preparation. This notoriously difficult procedure regularly produced casualties among vaccinated animals. With little help from colleagues, Sterne performed small-scale experiments which isolated the "Sterne strain" (34F2) of anthrax which became, and remains today, the basis of most of the improved livestock anthrax vaccines throughout the world. [9]

Russian anthrax vaccines

Anthrax vaccines were developed in the Soviet Union in the 1930s and available for use in humans by 1940. [10] [11] A live attenuated, unencapsulated spore vaccine became widely used for humans. It was given either by scarification or subcutaneously and its developers claimed that it was reasonably well tolerated and showed some degree of protective efficacy against cutaneous anthrax in clinical field trials. [12] The efficacy of the live Russian vaccine was reported to have been greater than that of either of the killed British or US anthrax vaccines (AVP and AVA, respectively) [13] [14] [15] [16] during the 1970s and '80s. Today both Russia and China use live attenuated strains for their human vaccines. [17] These vaccines may be given by aerosol, scarification, or subcutaneous injection. [18] [19] A Georgian/Russian live anthrax spore vaccine (called STI) was based on spores from the Sterne strain of B. anthracis. It was given in a two-dose schedule, but serious side-effects restricted its use to healthy adults. [20] It was reportedly manufactured at the George Eliava Institute of Bacteriophage, Microbiology and Virology in Tbilisi, Georgia, until 1991. [21]

British anthrax vaccines

British biochemist Harry Smith (1921–2011), working for the UK bio-weapons program at Porton Down, discovered the three anthrax toxins in 1948. This discovery was the basis of the next generation of antigenic anthrax vaccines and for modern antitoxins to anthrax. [22] The widely used British anthrax vaccine—sometimes called Anthrax Vaccine Precipitated (AVP) to distinguish it from the similar AVA (see below)—became available for human use in 1954. This was a cell-free vaccine in distinction to the live-cell Pasteur-style vaccine previously used for veterinary purposes. [23] It is now manufactured by Porton Biopharma Ltd, a Company owned by the UK Department of Health.

AVP is administered at primovaccination in three doses with a booster dose after six months. The active ingredient is a sterile filtrate of an alum-precipitated anthrax antigen from the Sterne strain in a solution for injection. The other ingredients are aluminium potassium sulphate, sodium chloride and purified water. The preservative is thiomersal (0.005%). The vaccine is given by intramuscular injection and the primary course of four single injections (3 injections 3 weeks apart, followed by a 6-month dose) is followed by a single booster dose given once a year. During the Gulf War (1990–1991), UK military personnel were given AVP concomitantly with the pertussis vaccine as an adjuvant to improve overall immune response and efficacy.

American anthrax vaccines

The United States undertook basic research directed at producing a new anthrax vaccine during the 1950s and '60s. The product known as Anthrax Vaccine Adsorbed (AVA)—trade name BioThrax—was licensed in 1970 by the U.S. National Institutes of Health (NIH) and in 1972 the Food and Drug Administration (FDA) took over responsibility for vaccine licensure and oversight. AVA is produced from culture filtrates of an avirulent, nonencapsulated mutant of the B. anthracis Vollum strain known as V770-NP1-R. [24] No living organisms are present in the vaccine which results in protective immunity after 3 to 6 doses. [24] AVA remains the only FDA-licensed human anthrax vaccine in the United States and is produced by Emergent BioSolutions, formerly known as BioPort Corporation in Lansing, Michigan. The principal purchasers of the vaccine in the United States are the Department of Defense and Department of Health and Human Services. Ten million doses of AVA have been purchased for the U.S. Strategic National Stockpile for use in the event of a mass bioterrorist anthrax attack.

In 1997, the Clinton administration initiated the Anthrax Vaccine Immunization Program (AVIP), under which active U.S. service personnel were to be immunized with the vaccine. Controversy ensued since vaccination was mandatory and GAO published reports that questioned the safety and efficacy of AVA, causing sometimes serious side effects. [25] A Congressional report also questioned the safety and efficacy of the vaccine and challenged the legality of mandatory inoculations. [26] Mandatory vaccinations were halted in 2004 by a formal legal injunction which made numerous substantive challenges regarding the vaccine and its safety. [27] After reviewing extensive scientific evidence, the FDA determined in 2005 that AVA is safe and effective as licensed for the prevention of anthrax, regardless of the route of exposure. In 2006, the Defense Department announced the reinstatement of mandatory anthrax vaccinations for more than 200,000 troops and defense contractors. The vaccinations are required for most U.S. military units and civilian contractors assigned to homeland bioterrorism defense or deployed in Iraq, Afghanistan or South Korea. [28]

Investigational anthrax vaccines

Anthrax toxin protective antigen (fragment) heptamer, Bacillus anthracis. 1tzo.jpg
Anthrax toxin protective antigen (fragment) heptamer, Bacillus anthracis.

A number of experimental anthrax vaccines are undergoing pre-clinical testing, notably the Bacillus anthracis protective antigen—known as PA (see Anthrax toxin—combined with various adjuvants such as aluminum hydroxide (Alhydrogel), saponin QS-21, and monophosphoryl lipid A (MPL) in squalene/lecithin/Tween 80 emulsion (SLT). One dose of each formulation has provided significant protection (> 90%) against inhalational anthrax in rhesus macaques.

Related Research Articles

BCG vaccine Vaccine primarily used against tuberculosis

Bacillus Calmette–Guérin (BCG) vaccine is a vaccine primarily used against tuberculosis (TB). It is named after its inventors Albert Calmette and Camille Guérin. In countries where tuberculosis or leprosy is common, one dose is recommended in healthy babies as soon after birth as possible. In areas where tuberculosis is not common, only children at high risk are typically immunized, while suspected cases of tuberculosis are individually tested for and treated. Adults who do not have tuberculosis and have not been previously immunized, but are frequently exposed, may be immunized, as well. BCG also has some effectiveness against Buruli ulcer infection and other nontuberculous mycobacterial infections. Additionally, it is sometimes used as part of the treatment of bladder cancer.

Vaccination Administration of a vaccine to protect against disease

Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating the body's adaptive immunity, they help prevent sickness from an infectious disease. When a sufficiently large percentage of a population has been vaccinated, herd immunity results. Herd immunity protects those who may be immunocompromised and cannot get a vaccine because even a weakened version would harm them. The effectiveness of vaccination has been widely studied and verified. Vaccination is the most effective method of preventing infectious diseases; widespread immunity due to vaccination is largely responsible for the worldwide eradication of smallpox and the elimination of diseases such as polio and tetanus from much of the world. However, some diseases, such as measles outbreaks in America, have seen rising cases due to relatively low vaccination rates in the 2010s – attributed, in part, to vaccine hesitancy.

Vaccine Pathogen-derived preparation that provides acquired immunity to an infectious disease

A vaccine is a biological preparation that provides active acquired immunity to a particular infectious disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and to further recognize and destroy any of the microorganisms associated with that agent that it may encounter in the future. Vaccines can be prophylactic, or therapeutic. Some vaccines offer full sterilizing immunity, in which infection is prevented completely.

Anthrax Infection caused by Bacillus anthracis bacteria

Anthrax is an infection caused by the bacterium Bacillus anthracis. It can occur in four forms: skin, lungs, intestinal and injection. Symptom onset occurs between one day and more than two months after the infection is contracted. The skin form presents with a small blister with surrounding swelling that often turns into a painless ulcer with a black center. The inhalation form presents with fever, chest pain and shortness of breath. The intestinal form presents with diarrhea, abdominal pains, nausea and vomiting. The injection form presents with fever and an abscess at the site of drug injection.

Smallpox vaccine Vaccine against Variola virus

The smallpox vaccine is the first vaccine to be developed against a contagious disease. In 1796, the British doctor Edward Jenner demonstrated that an infection with the relatively mild cowpox virus conferred immunity against the deadly smallpox virus. Cowpox served as a natural vaccine until the modern smallpox vaccine emerged in the 20th century. From 1958 to 1977, the World Health Organization (WHO) conducted a global vaccination campaign that eradicated smallpox, making it the only human disease to be eradicated. Although routine smallpox vaccination is no longer performed on the general public, the vaccine is still being produced to guard against bioterrorism, biological warfare, and monkeypox.

Polio vaccine Vaccine to prevent poliomyelitis

Polio vaccines are vaccines used to prevent poliomyelitis (polio). Two types are used: an inactivated poliovirus given by injection (IPV) and a weakened poliovirus given by mouth (OPV). The World Health Organization (WHO) recommends all children be fully vaccinated against polio. The two vaccines have eliminated polio from most of the world, and reduced the number of cases reported each year from an estimated 350,000 in 1988 to 33 in 2018.

Immunization Process by which an individuals immune system becomes fortified against an infectious agent

Immunization, or immunisation, is the process by which an individual's immune system becomes fortified against an infectious agent.

In biology, immunity is the capability of multicellular organisms to resist harmful microorganisms. Immunity involves both specific and nonspecific components. The nonspecific components act as barriers or eliminators of a wide range of pathogens irrespective of their antigenic make-up. Other components of the immune system adapt themselves to each new disease encountered and can generate pathogen-specific immunity.

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Artificial induction of immunity is immunization achieved by human efforts in preventive healthcare, as opposed to natural immunity as produced by organisms' immune systems. It makes people immune to specific diseases by means other than waiting for them to catch the disease. The purpose is to reduce the risk of death and suffering, that is, the disease burden, even when eradication of the disease is not possible. Vaccination is the chief type of such immunization, greatly reducing the burden of vaccine-preventable diseases.

Mumps vaccine Vaccine which prevents mumps

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The Anthrax Vaccine Immunization Program (AVIP), is the name of the policy set forth by the U.S. federal government to immunize its military and certain civilian personnel with the BioThrax anthrax vaccine. It began in earnest in 1997 by the Clinton administration. Thereafter it ran into Food and Drug Administration (FDA) and judicial obstacles. Over 8 million doses of BioThrax were administered to over 2 million U.S. military personnel as part of the program between March 1998 and June 2008.

Zoster vaccine Vaccine to prevent shingles

A zoster vaccine is a vaccine that reduces the incidence of herpes zoster (shingles), a disease caused by reactivation of the varicella zoster virus, which is also responsible for chickenpox. Shingles provokes a painful rash with blisters, and can be followed by chronic pain, as well as other complications. Older people are more often affected, as are people with weakened immune systems (immunosuppression). Both shingles and postherpetic neuralgia can be prevented by vaccination.

Varicella vaccine Vaccine to prevent chickenpox

Varicella vaccine, also known as chickenpox vaccine, is a vaccine that protects against chickenpox. One dose of vaccine prevents 95% of moderate disease and 100% of severe disease. Two doses of vaccine are more effective than one. If given to those who are not immune within five days of exposure to chickenpox it prevents most cases of disease. Vaccinating a large portion of the population also protects those who are not vaccinated. It is given by injection just under the skin. Another vaccine, known as zoster vaccine, is used to prevent diseases caused by the same virus - the varicella zoster virus.

An attenuated vaccine is a vaccine created by reducing the virulence of a pathogen, but still keeping it viable. Attenuation takes an infectious agent and alters it so that it becomes harmless or less virulent. These vaccines contrast to those produced by "killing" the virus.

Hepatitis A vaccine Vaccine to prevent hepatitis A

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Rabies vaccine Vaccines to prevent rabies in humans and animals

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<i>Bacillus anthracis</i> Species of bacterium

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Dengue vaccine is a vaccine used to prevent dengue fever in humans. Development of dengue vaccines began in the 1920s, but was hindered by the need to create immunity against all four dengue serotypes.

References

  1. ↑ Bonville, Cynthia; Domachowske, Joseph (2020). "7. Anthrax". In Domachowske, Joseph; Suryadevara, Manika (eds.). Vaccines: A Clinical Overview and Practical Guide. Switzerland: Springer. pp. 99–110. ISBN   978-3-030-58413-9.
  2. ↑ Splino M, et al (2005), "Anthrax vaccines", Ann Saudi Med ; 2005 Mar–Apr;25(2):143–9.
  3. ↑ Decker, Janet (2003). Deadly Diseases and Epidemics, Anthrax . Chelesa House Publishers. pp.  27–28. ISBN   978-0-7910-7302-5.
  4. ↑ David V. Cohn (December 18, 2006). "Pasteur". University of Louisville. Archived from the original on 2013-04-17. Retrieved 2007-12-02. Fortunately, Pasteur's colleagues Chamberlain [ sic ] and Roux followed up the results of a research physician Jean-Joseph-Henri Toussaint, who had reported a year earlier that carbolic-acid/heated anthrax serum would immunize against anthrax. These results were difficult to reproduce and discarded although, as it turned out, Toussaint had been on the right track. This led Pasteur and his assistants to substitute an anthrax vaccine prepared by a method similar to that of Toussaint and different from what Pasteur had announced.
  5. ↑ Adrien Loir (1938). "A l'ombre de Pasteur". Le mouvement sanitaire. pp. 18, 160.
  6. ↑ See Gerald Geison, The Private Science of Louis Pasteur, Princeton University Press, 1995. ISBN   0-691-01552-X. May 1995 NY Times
  7. ↑ The Pioneer Defended, , The New York Review of Books , Dec. 21, 1995
  8. ↑ Turnbull PCB (1991). "Anthrax vaccines: past, present and future". Vaccine. 9 (8): 533–9. doi:10.1016/0264-410x(91)90237-z. PMID   1771966.
  9. ↑ Turnbull, Peter, "Obituary: Max Sterne"; The Independent @ independent.co.uk. (Tuesday, 4 March 1997).
  10. ↑ Anaisimova, TI, Pimenov TV, Kozhukhov VV, et al: "Development of method for preparation and maintenance of the anthrax strain STI-1 and test strain Zenkovsky" In Salisbury Medical Bulletin, Special Supplement #87, June 1996, pg 122.
  11. ↑ Shlyakov EN, Rubinstein E. "Human live anthrax vaccine in the former USSR". Vaccine . 12 (727): 1994.
  12. ↑ Shlyakhov (1994), Op. cit.
  13. ↑ Hambleton P, Turnbull (1990). "Anthrax vaccine development: a continuing story". Adv Biotechnol Processes. 13: 105–22. PMID   1692223.
  14. ↑ Lesnyak OT, Saltykov RA (1970). "Comparative assessment of anthrax vaccine strains'". Zh Mikrobiol Epidemiol Immunobiol. 47: 32.
  15. ↑ Shlyakhov (1994), Op. cit.
  16. ↑ Turnbull PCB, Quinn CP, Hewson R et al: "Protection conferred by microbially-supplemented UK and purified PA vaccines", Salisbury Medical Bulletin, Special Supplement #68, January 1990, pg 89.
  17. ↑ Nass, Meryl, "Anthrax Vaccine: Model of a Response to the Biologic Warfare Threat" Archived 2013-01-09 at the Wayback Machine , Infectious Disease Clinics of North America , Volume 13, Number 1 (March 1999).
  18. ↑ Shlyakhov (1994), Op. cit.
  19. ↑ Shlyakov E, Rubinstein E, Novikov I (1997). "Anthrax post-vaccinal cell-mediated immunity in humans: kinetics pattern". Vaccine. 15 (6–7): 631–636. doi:10.1016/s0264-410x(96)00286-1. PMID   9178463.
  20. ↑ Guillemin, Jeanne (1999). ANTHRAX, the investigation of a Deadly Outbreak . The New England Journal of Medicine. Vol. 343. University of California Press. pp.  34. doi:10.1056/NEJM200010193431615. ISBN   978-0-520-22917-4. PMID   11041763.
  21. ↑ Nass, Op.cit.
  22. ↑ Guillemin, Jeanne (2005), Biological Weapons: From the Invention of State-sponsored Programs to Contemporary Bioterrorism, Columbia University Press, pg 98.
  23. ↑ "Anthrax and Anthrax Vaccine—Epidemiology and Prevention of Vaccine-Preventable Diseases Archived August 24, 2012, at the Wayback Machine ", National Immunization Program, Centers for Disease Control and Prevention, January 2006. (PPT format)
  24. 1 2 BioThrax Package Insert
  25. ↑ "GAO Anthrax Vaccine Report Search" (PDF). U.S. Government Accountability Office. Retrieved 2018-04-14.
  26. ↑ "House Report 106-556 - THE DEPARTMENT OF DEFENSE ANTHRAX VACCINE IMMUNIZATION PROGRAM: UNPROVEN FORCE PROTECTION". U.S. Government Publishing Office. 2000-04-03. Retrieved 2018-04-14.
  27. ↑ "John Doe #1 v. Donald H. Rumsfeld, et al" (PDF). Military Vaccine (MILVAX) Agency. 2004-10-27. Archived from the original (PDF) on August 25, 2009. Retrieved 2009-05-06.
  28. ↑ Mandatory Vaccine Article—'Mandatory Anthrax Shots to Return', Christopher Lee, Washington Post (October 17, 2006)
  29. ↑ Yossi Melman (27 January 2009). "Defense attempting to block report about anthrax trial". Haaretz Newspaper.
  30. ↑ Chun, J.-H.; Hong, K.-J.; Cha, S. H.; Cho, M.-H.; Lee, K. J.; Jeong, D. H.; Yoo, C.-K.; Rhie, G.-e. (18 July 2012). "Complete Genome Sequence of Bacillus anthracis H9401, an Isolate from a Korean Patient with Anthrax". Journal of Bacteriology. 194 (15): 4116–4117. doi:10.1128/JB.00159-12. PMC   3416559 . PMID   22815438.

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