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Health
& Medicine
Vital Signs
. Vital
Signs: Anthrax in the News
New Vaccine, Free
Antibiotics? ... and more
With anthrax in the news these days, it seemed like a good idea
to provide some info on anthrax that might not be the stuff making the
headlines. ...
 New
Anthrax Vaccine Being Developed.
Questions have
been raised over the safety of current anthrax
vaccines. But that concern may become an
historical footnote. According to a Reuters'
Health release earlier this month, a new human anthrax
vaccine being developed in India is ready to go to
clinical trials.
.
The new vaccine was
developed over the last 7 years with a grant of
$250,000 from the Government of India's Department of
Biotechnology (DBT) to the Center for Biotechnology (CBT)
at the Jawaharlal Nehru University in New Delhi.
According to Dr. Rakesh Bhatnagar, chairman of the CBT,
the team genetically engineered Escherichia coli
to produce harmless mutations of the three key
proteins -- the lethal factor, the edema factor and
the protective antigen -- found in the bacteria
responsible for anthrax, Bacillus anthracis
. "We have so optimized this technology
that 30% of the protein that is expressed from the
recombined E. coli genome is the protective
antigen of anthrax, whereas its expression has been
negligible in the past," Dr. Bhatnagar said.
.
"This
work is very important for India," said Dr. V. K.
Vinayak, an advisor at India's Department of
Biotechnology (DBT). "Not just in the
current world scenario, but also because anthrax has
always been a common problem in the
country." In addition, he said, the vaccine
currently in use "is not intended for the general
public, and is only meant for special groups, such as
the [armed] forces."
.- U.S.
Drug Makers Promise Free Antibiotics
After a
rash of bad publicity and threats to suspend its
patent because of the national emergency, German
drug-maker Bayer AG agreed to sell its now-famous
Cipro for 95¢ a tablet, still a far cry from free.
But on the heels of that decision, U.S. drug-makers
met with Homeland Security Director Tom Ridge and,
according to Reuters Health, promised to "provide
the government with free drugs and scientific experts
to help keep its pledge to stockpile enough supplies
for every American."
.
That promise would
provide the government with access to seven additional
antibiotics believed to be effective treatments for
anthrax, including two in the same class as Cipro --
Bristol-Myers Squibb's Tequin (gaitfloxacin) and
Johnson & Johnson's Levaquin (levofloxacin).
At this point, neither has been approved for the
treatment of anthrax. But both companies assured
the government a supply of as many as 100 million
tablets each if the FDA allowed them to include an
indication for the treatment of anthrax on their
labels, pending outcomes of laboratory tests. Of
course, with the usually long regimen associated with
these drugs, 100 million tablets would only be enough
for 4-8 million people.
.
Both of the drugs are
extremely expensive: Levaquin currently sells at
about $8 per tablet wholesale, while Tequin sells for
about $6.82 per tablet wholesale. In addition,
ten vaccine makers have also promised to supply the
government with enough smallpox vaccine for every
American by the end of next year, although details of
that plan have yet to be worked out.
. - CDC
offers physicians guidelines for diagnosing inhalation
anthrax
On November 1st, a panel of experts
from the Centers for Disease Control, which included
Surgeon General Dr. David Satcher, held a telephone briefing
on how office-based physicians should diagnose and
treat inhalation anthrax. Dr. Virginia Caine,
who is with the Division of Infectious Diseases at the
Indiana University School of Medicine, stressed the
importance of early diagnosis for inhalational
anthrax, since the time from the onset of symptoms to
death can be as little as 3 days.
.
"The
early signs are very similar to influenza," she
said. But there are a few key signs that can
help to distinguish it. These include "a
wide mediastinum, lymphadenopathy,
and pleural effusion."
Dr. Caine also noted that rhinitis
may often not be present. In addition, the white
blood cell count -- usually a fairly reliable
indicator of significant bacterial infection -- may
not necessarily be elevated. She also noted that
not all patients will present with a fever. A
common course of the disease does mimic flu-like
symptoms initially, after which patients will feel
better, but then enter a second phase, characterized
by shortness of breath and chest tightness.
"About 50% complain of acute abdominal pain and
5% have a usually fatal hemorrhagic meningitis,"
Dr. Caine said.
.
According to a CDC report, a
physician who suspects inhalational anthrax should
determine whether the patient has had 2 to 5 days of
flu-like symptoms, and, if so, obtain a white blood
cell count, chest x-ray, and blood cultures. If
the x-ray is abnormal, computerized tomography should
also be used. If the results on any of these
tests are abnormal, or if the patient is moderately to
severely ill, a prophylactic regimen of antibiotics is
recommended. For mildly ill patients, the
recommendation was for close observation for the
development of any new symptoms, and at least
consideration of a prophylactic regimen of
antibiotics. Dr. Caine's stressed, however, that
if suspicions arise that a patient does have anthrax,
"go ahead and treat -- don't
wait."
.
The Surgeon general
noted that "The CDC has a stockpile of
antibiotics and very well-trained epidemiologists all
over the U.S. to respond to this problem.
But," he added. "We are dependent on
physicians to identify early cases of anthrax."
NOTES:
mediastinum; The space
in the thoracic cavity behind the sternum and in between the two pleural sacs,
containing the lungs.
lymphadenopathy; Swelling of the lymph nodes.
pleural
effusion; A collection of fluid or blood in the pleural space, i.e., the
chest cavity around the lungs.
rhinitis; inflammation of the mucous
membrane of the nose.
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