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10/9/2001

CDC Has Anthrax, Smallpox Vaccination Guidelines Available

Kate Traynor

Vaccination against anthrax and smallpox, two diseases seen as possible biological warfare threats, was the subject of reports released in the past year by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices.1,2

CDC’s guidelines, which predate the September 11 terrorist attacks in New York and at the Pentagon, do not recommend preventive vaccination of the general population against anthrax or smallpox. According to the guidelines, the risk of smallpox occurring after a deliberate release of the organism is low. The risk of exposure to anthrax after a release, notes CDC, "cannot be calculated."

But, even if universal vaccination was recommended, not enough doses of anthrax or smallpox vaccine currently exist to immunize everyone in the United States.

The variola virus, which causes smallpox, was eradicated from the wild before 1980. Smallpox vaccination of the American public ended in 1972, although people who handle related orthopoxviruses in the laboratory continue to receive the vaccine. All remaining U.S. stocks of smallpox vaccine, totaling between 7 million and 8 million doses, are stored by CDC.

There is no FDA-approved treatment for smallpox.

CDC, in preparation for possible bioterrorist attacks, last September awarded a contract to Massachusetts-based OraVax (now Acambis) to prepare 40 million doses of smallpox vaccine by mid-2004.

But Health and Human Services Secretary Tommy G. Thompson, speaking before the Senate Appropriations Committee on October 3, said the contract’s date has now been moved up.

"We have developed an accelerated plan that will produce the new smallpox vaccine by mid to late next year," Thompson told committee members. All 40 million doses, he said, "will be delivered in the year 2002."

For now, should a release of smallpox virus occur, CDC recommends first vaccinating people initially exposed to the virus, close contacts of these people, and many health care and laboratory workers.

Bacillus anthracis, which causes anthrax, can be produced as dry spores that remain viable for decades, according to the Defense Department’s Anthrax Vaccine Immunization Program Web site. Although doxycycline, penicillin, and ciprofloxacin can be used to treat anthrax arising from germinated B. anthracis spores, CDC warns that "antibiotics...are not effective against the spore form of the organism." A 30-day course of doxycycline, penicillin, or ciprofloxacin improves a person’s chance of survival, presumably by killing the organisms as they germinate.

An anthrax vaccine was licensed for use in the United States in 1970. The Defense Department currently controls all domestic stocks of the vaccine. Through its Anthrax Vaccine Immunization Program, the department in 1998 started requiring most members of the armed forces to receive the six-dose vaccine series plus an annual booster shot. A shortage of the vaccine prompted a slowdown of the immunization program this past June.

Lansing, Michigan-based BioPort Corp. is the only manufacturer of U.S.-licensed anthrax vaccine. To fulfill the company’s contract with the Defense Department, BioPort is renovating its manufacturing facility. According to a statement from the company, "Once there is vaccine that is available to people outside of the Department of Defense, officials will determine the best route to make the vaccine available to areas outside of the military."

  1. Centers for Disease Control and Prevention. Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2000; 49(RR-15):1-39.
  2. Centers for Disease Control and Prevention. Vaccinia (smallpox) vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2001. MMWR. 2001; 50(RR-10):1-43.