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Guideline Summary
Guideline Title
Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009.
Bibliographic Source(s)
Wright JG, Quinn CP, Shadomy S, Messonnier N, Centers for Disease Control and Prevention (CDC). Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep. 2010 Jul 23;59(RR-6):1-30. [259 references] PubMed External Web Site Policy
Guideline Status

This is the current release of the guideline.

This addendum updates a previous version: Use of anthrax vaccine in the United States. Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2000 Dec 15;49(RR-15):1-21.

Scope

Disease/Condition(s)

Anthrax

  • Naturally occurring anthrax
  • Bioterrorism-related anthrax
  • Cutaneous anthrax
  • Gastrointestinal anthrax
  • Inhalation anthrax
Guideline Category
Prevention
Risk Assessment
Treatment
Clinical Specialty
Emergency Medicine
Family Practice
Infectious Diseases
Internal Medicine
Obstetrics and Gynecology
Pediatrics
Preventive Medicine
Intended Users
Advanced Practice Nurses
Allied Health Personnel
Clinical Laboratory Personnel
Emergency Medical Technicians/Paramedics
Health Care Providers
Nurses
Physician Assistants
Physicians
Public Health Departments
Guideline Objective(s)
  • To provide updated information on anthrax epidemiology
  • To summarize the evidence regarding the effectiveness and efficacy, immunogenicity, and safety of anthrax vaccine adsorbed (AVA)
  • To provide recommendations for pre-event and preexposure use of AVA
  • To provide recommendations for postexposure use of AVA
Target Population

Adults and children at risk of or following exposure to Bacillus anthracis, including the following:

  • Military personnel
  • Persons involved in environmental investigations or remediation efforts
  • Persons involved in emergency response activities
  • Pregnant or breastfeeding women
  • Medical professionals
  • Persons who handle animals or animal products
  • Persons who perform certain types of laboratory work
  • Persons who work in postal facilities
Interventions and Practices Considered
  1. Preexposure prophylaxis
    • Anthrax vaccine adsorbed (AVA)
  2. Postexposure prophylaxis
    • AVA
    • Antimicrobial agent: ciprofloxacin, doxycycline, or amoxicillin
Major Outcomes Considered
  • Incidence of anthrax
  • Efficacy of anthrax vaccine adsorbed (AVA)
  • AVA related adverse events
  • Mortality and morbidity

Methodology

Methods Used to Collect/Select the Evidence
Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
Searches of Unpublished Data
Description of Methods Used to Collect/Select the Evidence

Relevant literature was identified through consultations with expert partners and other researchers. These data included safety evaluations, immunogenicity studies, efficacy analyses, vaccine supply information, and contemporary experience with the use of anthrax vaccine adsorbed (AVA) both as a preexposure vaccine and as a component of postexposure prophylaxis (PEP).

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Not stated
Rating Scheme for the Strength of the Evidence

Not applicable

Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence

Not stated

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

The Advisory Committee on Immunization Practices (ACIP) Anthrax Vaccine Work Group convened for the first time for an in-person meeting in October 2007. The work group consisted of 35 members representing the Department of Defense (DoD), the American College of Occupational and Environmental Medicine, the InterAgency Board for Equipment Standardization and Interoperability, the Office of the Biomedical Advanced Research and Development Authority, the National Institutes of Health (NIH), the American Veterinary Medical Association, the American Academy of Pediatrics, the American College of Obstetrics and Gynecology, the National Association of County and City Health Officials, and the Food and Drug Administration (FDA). The work group subsequently held 12 conference calls over 11 months to review and discuss both published and unpublished scientific data related to anthrax vaccine adsorbed (AVA). Work group members developed recommendation options during their calls. When scientific evidence was lacking, recommendations incorporated expert opinions of the work group members.

In December 2008, FDA approved a dose reduction and route change for AVA administration following submission of a biologics license application (BLA) supplement that was originally submitted in June 2005 by Emergent BioSolutions (Rockville, Maryland). This approval was based on data from the CDC-sponsored Anthrax Vaccine Research Program (AVRP) phase 4 clinical trial (referred to as the AVRP clinical trial in this report).

During the ACIP meeting in February 2008, presentations were made on anthrax epidemiology and transmission, published AVA safety and efficacy data, and unpublished data from the AVRP clinical trial. In June 2008, draft recommendations were presented to ACIP. During the October 2008 meeting, revised recommendations, with the exception of the dose reduction and route change, were presented to ACIP for a vote. In February 2009, ACIP recommended a new, 5-dose pre-event and preexposure priming series administered intramuscularly (IM).

Rating Scheme for the Strength of the Recommendations

Not applicable

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation

Not stated

Recommendations

Major Recommendations

Note from the Advisory Committee on Immunization Practices (ACIP) and the National Guideline Clearinghouse (NGC): These recommendations from the Advisory Committee on Immunization Practices (ACIP) update the previous recommendations for anthrax vaccine adsorbed (AVA) and reflect the status of anthrax vaccine supplies in the United States.

Substantial changes to these recommendations include the following: 1) reducing the number of doses required to complete the pre-event and preexposure primary series from 6 doses to 5 doses, 2) recommending intramuscular rather than subcutaneous AVA administration for preexposure use, 3) recommending AVA as a component of postexposure prophylaxis in pregnant women exposed to aerosolized Bacillus anthracis spores, 4) providing guidance regarding preexposure vaccination of emergency and other responder organizations under the direction of an occupational health program, and 5) recommending 60 days of antimicrobial prophylaxis in conjunction with 3 doses of AVA for optimal protection of previously unvaccinated persons after exposure to aerosolized B. anthracis spores.

Recommended Uses of Anthrax Vaccine

AVA may be used 1) via the licensed schedule to prevent infection by priming the immune system before exposure to Bacillus anthracis (pre-event or preexposure vaccination) and 2) after exposure to aerosolized B. anthracis spores under an Investigational New Drug (IND) or possibly under an Emergency Use Authorization (EUA [post-exposure prophylaxis (PEP) vaccination (see Tables below)]. Recommendations for the use of AVA differ for pre-event or preexposure vaccination and postexposure vaccination. For pre-event or preexposure vaccination, ACIP recommends 5 intramuscular (IM) doses administered at day 0, week 4, and months 6, 12, and 18, followed by annual boosters. To elicit the most substantial and rapid immune response possible among previously unvaccinated persons in a postexposure setting, PEP vaccination should be administered as a 3-dose subcutaneous (SC) series (at 0, 2, and 4 weeks) in conjunction with a 60-day course of appropriate antimicrobial agents.

Table. Recommended Preexposure and Postexposure Vaccination Schedules for Anthrax Vaccine Adsorbed

Type of Prophylaxis Schedule Route Dose
Preexposure 5 doses (0 weeks, 4 weeks, 6 months, 12 months, and 18 months)

Annual booster to maintain immunity
Intramuscular 0.5 mL
Postexposure* 3 doses (0, 2, and 4 weeks)†,§ Subcutaneous 0.5 mL

* For previously unvaccinated persons.

† In conjunction with 60-day antimicrobial postexposure prophylaxis.

§ Administered under an Investigational New Drug (IND) protocol or an Emergency Use Authorization (EUA)

Table. Recommendations for Use of Anthrax Vaccine Adsorbed, by Type of Population

Population Pre-event* Postexposure Prophylaxis (PEP)†
General public Not recommended Recommended
Special populations in the general public
Pregnant women Not recommended Recommended
Breastfeeding women Not recommended Recommended
Children (aged <18 yrs) Not recommended Determined on an event-by-event basis
Medical professionals Not recommended Recommended
Populations at risk for occupational exposure
Persons who handle animals or animal products Not routinely recommended§ Recommended
Persons who perform certain types of laboratory work Recommended¶ Based on pre-event vaccination status
Persons who work in postal facilities Not recommended Recommended
Military personnel As recommended by the Department of Defense As recommended by the Department of Defense
Persons involved in environmental investigations or remediation efforts Recommended Based on pre-event vaccination status
Persons involved in emergency response activities** Not routinely recommended; may be offered on a voluntary basis under the direction of a comprehensive occupational health and safety program Recommended

* Five 0.5-mL doses administered intramuscularly at 0 weeks, 4 weeks, 6 months, 12 months, and 18 months; annual boosters are required to maintain immunity.

† Three 0.5-mL doses administered subcutaneously at 0, 2, and 4 weeks after exposure to aerosolized Bacillus anthracis spores for persons who have not completed the pre-event vaccination schedule.

§ Recommended only if handling potentially infected animals in research settings or in areas with a high incidence of enzootic anthrax or when standards and restrictions are insufficient to prevent exposure to B. anthracis spores.

¶ Laboratorians who work 1) with high concentrations or pure cultures of B. anthracis spores, 2) with environmental samples associated with anthrax investigations, or 3) in spore-contaminated areas or other settings with exposure to aerosolized B. anthracis spores. Laboratorians who do not work in these settings are not recommended for pre-event vaccine.

** Persons involved in emergency response activities might include persons who work in police departments, fire departments, hazardous material units, and the National Guard, as well as other government responders. These persons might perform site investigations, respond to suspicious substance reports (also known as white powder incidents), and perform other related activities, such as evacuation procedures or other activities critical to the maintenance of infrastructure.

Pre-event and Preexposure Vaccination

By priming the immune system before exposure to B. anthracis spores, pre-event and preexposure vaccination might provide more protection than antimicrobial agents alone to persons at risk for occupational exposure to B. anthracis, including protection for persons exposed to large inocula, protection if the public health infrastructure cannot ensure immediate availability or timely delivery of postevent antimicrobial agents, and potential benefits if bioengineered strains were released, limiting antimicrobial PEP effectiveness. The potential benefits from pre-event and preexposure vaccination should be weighed against the resource requirements to implement and maintain the vaccination schedule, as well as the potential adverse events associated with vaccination. Decisions for pre-event vaccination should be made based on a calculated risk assessment. In the absence of such an assessment, vaccination may be considered based on an estimated/presumed risk-benefit assessment. Depending on the occupational activities of the vaccine recipient, pre-event or preexposure vaccination might not eliminate the need for appropriate personal protective equipment.

General Public

Because the location and timing of a bioterrorism attack cannot be predicted, the risk-benefit profile for pre-event vaccination for the general public is low, and pre-event vaccination is not recommended. Preventing the morbidity and mortality associated with a deliberate release of B. anthracis depends on public vigilance, early detection and diagnosis, appropriate treatment, and rapid administration of PEP.

Special Populations

Pregnant and Breastfeeding Women

In a pre-event setting, in which the risk for exposure to aerosolized B. anthracis spores is presumably low, vaccination of pregnant women is not recommended and should be deferred until after pregnancy. Breastfeeding is neither a precaution nor a contraindication to vaccination, and vaccination does not need to be deferred in a pre-event setting if the occupation of the breastfeeding mother poses a risk for exposure to B. anthracis.

Children

In a pre-event setting, in which the risk for exposure to aerosolized B. anthracis spores is presumably low, vaccination of children is not recommended.

Medical Personnel

Pre-event vaccination is not recommended for medical personnel. If exposed to aerosolized B. anthracis spores during a bioterrorism event, they should receive PEP in accordance with ACIP recommendations.

Populations at Risk for Occupational Exposure

Persons Handling Animals or Animal Products

Routine preexposure vaccination for persons who handle animals or animal products is recommended only for persons for whom previously discussed standards and restrictions are insufficient to prevent exposure to B. anthracis spores. Preexposure vaccination is not recommended for persons who routinely have contact with animal hide drums or animal hides; other preventive measures are available.

Routine vaccination of U.S. veterinarians and animal husbandry technicians is not recommended because of the low incidence of animal anthrax cases in the United States. However, vaccination might be recommended for veterinarians and other persons considered to be at high risk for anthrax exposure if they handle potentially infected animals in research settings or in areas with a high incidence of enzootic anthrax cases.

Laboratorians

Preexposure vaccination is recommended for laboratorians at risk for repeated exposure to fully virulent B. anthracis spores, such as those who 1) work with high concentrations of spores with potential for aerosol production; 2) handle environmental samples that might contain powders and are associated with anthrax investigations; 3) routinely work with pure cultures of B. anthracis; 4) frequently work in spore-contaminated areas after a bioterrorism attack; or 5) work in other settings where repeated exposures to B. anthracis aerosols may occur.

Persons Working in Postal Processing Facilities

Because of biodetection systems in postal processing centers, contamination of mail with B. anthracis spores is likely to be detected rapidly, allowing postexposure therapy to be initiated immediately. Therefore, persons who work in these facilities are not recommended to receive pre-event vaccination.

Military Personnel

Military personnel determined by Department of Defense (DoD) to have a calculable risk for exposure to aerosolized B. anthracis spores are recommended to receive preexposure vaccination. DoD has exclusionary criteria for employees, including an exclusion for pre-event vaccination of pregnant women.

Environmental Investigators and Remediation Workers

Vaccination is recommended for persons who, as part of their occupation, might repeatedly enter areas contaminated with B. anthracis spores.

Emergency and Other Responders

Emergency and other responders are not recommended to receive routine pre-event anthrax vaccination because of the lack of a calculable risk assessment. However, responder units engaged in response activities that might lead to exposure to aerosolized B. anthracis spores may offer their workers voluntary pre-event vaccination. The vaccination program should be carried out under the direction of a comprehensive occupational health and safety program.

Delayed Doses

Available data on AVA dosages suggest that increasing the interval between doses does not decrease the ultimate serologic response achieved or adversely affect the safety profile. Therefore, as with other vaccines, interruption of the vaccination schedule does not require restarting the entire series or the addition of extra doses.

PEP

PEP should be used for previously unvaccinated persons after exposure to aerosolized B. anthracis spores, whether the exposure is naturally occurring, occupationally related, or intentional. To elicit the most substantial and rapid immune response possible for previously unvaccinated persons in a postexposure setting, vaccination should be administered as recommended in conjunction with appropriate antimicrobial agents (Table 1 in the original guideline document and the "Recommended Preexposure and Postexposure Vaccination Schedules for Anthrax Vaccine Adsorbed" table above).

PEP After Inhalation Exposure

General Adult Population

ACIP recommends a postexposure regimen of 60 days of appropriate antimicrobial prophylaxis combined with 3 subcutaneous (SC) doses of AVA (administered at 0, 2, and 4 weeks postexposure) as the most effective protection against inhalation anthrax for previously unvaccinated persons aged ≥18 years who have been exposed to aerosolized B. anthracis spores.

After exposure to aerosolized B. anthracis spores, antimicrobial therapy should be initiated as soon as possible. Ideally, the first dose of vaccine should be administered within 10 days. Because AVA is not licensed for postexposure use, the vaccine will likely be made available either through an investigational new drug (IND) or an EUA during a public health emergency.

In general, the peak serologic response to anthrax vaccine occurs 10-14 days after the third dose. To ensure continued protection, persons for whom vaccination has been delayed should extend antimicrobial use to 14 days after the third dose, even though this practice might result in use of antimicrobials for >60 days. Antimicrobials should not be used for <60 days in previously unvaccinated persons who have been exposed to aerosolized B. anthracis spores.

Pregnant Women

In a postevent setting that poses a high risk for exposure to aerosolized B. anthracis spores, pregnancy is neither a precaution nor a contraindication to PEP. Pregnant women at risk for inhalation anthrax should receive AVA and 60 days of antimicrobial therapy as described.

Breastfeeding Women

In a postevent setting that poses a high risk for exposure to aerosolized B. anthracis spores, breastfeeding remains neither a precaution nor a contraindication to PEP. Breastfeeding women at risk for inhalation anthrax should receive AVA and 60 days of antimicrobial therapy as described.

Children

The use of AVA in children is not contraindicated in a postevent setting that poses a high risk for exposure to aerosolized B. anthracis spores. During such an event, public health authorities will determine whether, under the existing IND protocol, to offer vaccine to children aged 0-17 years. Under this IND protocol, 3 doses of vaccine would be administered in conjunction with 60 days of appropriate antimicrobial therapy.

PEP After Repeated Occupational Exposures

The combination of pre-event vaccine and appropriate personal protective equipment (PPE) effectively protects fully vaccinated persons who work in occupations that might result in repeated exposure to aerosolized B. anthracis spores (see Table 4 in the original guideline document). Antimicrobial PEP is not needed for fully vaccinated workers who wear appropriate PPE while working in environments contaminated with B. anthracis spores unless the PPE is disrupted. However, fully vaccinated workers who prefer additional protection may consider antimicrobial PEP under the direction of their occupational health program.

A 30-day course of antimicrobial PEP is recommended for partially vaccinated workers (see Table 4 in the original guideline document), fully vaccinated workers who do not wear PPE, and fully vaccinated workers whose PPE has been disrupted; these workers should continue with their licensed vaccination regimen.

A 60-day course of antimicrobial PEP is recommended for previously unvaccinated workers. These workers also should begin receiving AVA as soon as possible using the PEP schedule of 3 SC doses.

PEP After Naturally Occurring Cutaneous or Gastrointestinal Exposure

Vaccination is not recommended after cutaneous or gastrointestinal exposures that pose no risk for inhalation exposure. When a naturally occurring cutaneous exposure occurs, appropriate medical and public health personnel should be notified, and affected persons should be monitored for development of a spot, pimple, or boil-like lesion, especially in the exposed areas. For persons who experience a naturally occurring gastrointestinal exposure, such those who eat meat from an undercooked carcass of an anthrax-infected animal, antimicrobial PEP for 7-14 days may be considered.

Contraindication and Precautions for Use of AVA

The following contraindication and precautions are relevant for both preexposure and postexposure settings.

Contraindication

Although anaphylaxis after anthrax vaccination is extremely rare and no anaphylaxis deaths associated with AVA have been reported, an anaphylactic reaction can be life-threatening. Therefore, AVA is contraindicated for persons who have experienced an anaphylactic reaction after a previous dose of AVA or any of the vaccine components.

Precautions

  • Latex allergy: Because the vaccine vial stopper contains dry, natural rubber, caution should be used when administering the vaccine to persons with a latex allergy. Epinephrine solution (1:1000) should be available for immediate use in the event that an anaphylactic reaction occurs.
  • History of anthrax disease: A history of anthrax disease might increase the potential for severe local adverse reactions after AVA administration.
  • Impaired immune response: Patients with an impaired immune response might not be adequately immunized after administration of AVA.
  • Moderate or severe acute illness: In a standard preexposure vaccination program, vaccination of persons with moderate or severe acute illness should be postponed until after recovery. In a postevent setting, the risks of administering vaccine to a person who has been exposed to anthrax but has moderate or severe acute illness should be weighed against the benefits of vaccination. Vaccine may be administered to persons who have a mild illness with or without a low-grade fever.

Reporting Adverse Events

Adverse events that occur after administration of anthrax vaccine should be reported to Vaccine Adverse Event Reporting System (VAERS), regardless of whether the reporter considers the vaccine to be the cause of the event. Information about VAERS and how to report vaccine adverse events is available at http://vaers.hhs.gov External Web Site Policy. Adverse events that occur after administration of antimicrobial agents should be reported to the FDA MedWatch program at http://www.fda.gov/medwatch External Web Site Policy.

Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

The type of evidence supporting the recommendations is not specifically stated.

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

Appropriate use of anthrax vaccine adsorbed (AVA) for preexposure and postexposure exposure to Bacillus anthracis

Potential Harms

Prelicensure Adverse Event Surveillance of Anthrax Vaccine Adsorbed (AVA)

  • Local Reactions. In prelicensure evaluations, 6,985 persons received 16,435 subcutaneous (SC) doses: 9,893 initial series doses and 6,542 annual boosters. Severe local reactions (defined as edema or induration of >120 mm) occurred after 1% of vaccinations. Moderate local reactions (defined as edema and induration of 30-120 mm) occurred after 3% of vaccinations. Mild local reactions (defined as erythema, edema, and induration of <30 mm) occurred after 20% of vaccinations. In a study of the alum-precipitated precursor to AVA, moderate local reactions were documented in 4% of vaccine recipients and mild reactions in 30% of recipients.
  • Systemic Reactions. In prelicensure evaluations, systemic reactions (i.e., fever, chills, body aches, or nausea) occurred in <0.06% (in four of approximately 7,000) of vaccine recipients. In the study of the alum-precipitated precursor to AVA, systemic reactions occurred in 0.2% of vaccine recipients.

Postlicensure Adverse Event Surveillance of AVA

  • During January 1, 1998-December 31, 2008, Vaccine Adverse Reporting System (VAERS) received 6,015 nonduplicate reports from U.S. sources of adverse events after receipt of AVA, either alone or concurrently with other vaccines. Of these, 600 (9.9%) were categorized as serious events (i.e., events resulting in death, hospitalization, or permanent disability). Approximately 74% of all reported adverse events that occurred after administration of AVA were in persons aged <40 years. Twenty-six percent occurred in women and 72% in men; sex was not specified in 2% of the reports. The majority (75%) received AVA alone, and 25% received the vaccine concurrently with other vaccines. Eighty three percent of AVA reports were documented as being administered or funded by the military.
  • Adverse events reported to VAERS are coded using terms from the Medical Dictionary for Regulatory Activities (MedDRA). Approximately 800 different MedDRA terms were reported in conjunction with AVA during 1998-2008. The 10 most common adverse events that occurred after AVA administration (either alone or concurrently with other vaccines) were arthralgia (n = 1,036, 17.2%), headache (n = 981, 16.3%), pruritus (n = 878, 14.6%), pain (n = 824, 13.7%), injection-site erythema (n = 753, 12.5%), fever (n = 655, 10.9%), erythema (n = 626, 10.4%), pain at the injection site (n = 613, 10.2%), rash (n = 606, 10.1%), and myalgia (n = 583, 9.7%). As of December 31, 2008, VAERS had received 25 reports of death among AVA recipients. Causes of death included a spectrum of cardiovascular disorders, unintentional or intentional injuries, malignancies, and chronic illnesses. Death reports have been summarized elsewhere.
  • Data on short-term and long-term adverse events, the effect of the route of administration on adverse events, the effect of vaccination on pregnancy and breastfeeding, and the effect of vaccination on children are summarized in the original guideline document.

Contraindications

Contraindications

Contraindications

Although anaphylaxis after anthrax vaccination is extremely rare and no anaphylaxis deaths associated with anthrax vaccine adsorbed (AVA) have been reported, an anaphylactic reaction can be life-threatening. Therefore, AVA is contraindicated for persons who have experienced an anaphylactic reaction after a previous dose of AVA or any of the vaccine components.

See the "Major Recommendations" field of this summary for precautions to the use of the anthrax vaccine.

Qualifying Statements

Qualifying Statements
  • The Food and Drug Administration (FDA) final order for use of anthrax vaccine adsorbed (AVA) emphasizes the need to continue postmarketing safety studies, and the Institute of Medicine (IOM) reports document the need for additional long-term follow-up of vaccine recipients. Vaccine Analytic Unit (VAU) continues to conduct research to address these issues through a combination of studies, including continued screening of the Vaccine Adverse Event Reporting System (VAERS) database for identification of potential long-term adverse events, hypothesis testing research studies using the Defense Medical Surveillance System (DMSS) database, and assessments of new safety signals identified from VAERS or other sources.
  • Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
  • References to non-Centers for Disease Control and Prevention (CDC) sites on the Internet are provided as a service to Morbidity and Mortality Weekly Report (MMWR) readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Getting Better
Staying Healthy
IOM Domain
Effectiveness
Safety
Timeliness

Identifying Information and Availability

Bibliographic Source(s)
Wright JG, Quinn CP, Shadomy S, Messonnier N, Centers for Disease Control and Prevention (CDC). Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep. 2010 Jul 23;59(RR-6):1-30. [259 references] PubMed External Web Site Policy
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
2000 Dec 15 (revised 2010 Jul 23)
Guideline Developer(s)
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]
Source(s) of Funding

United States Government

Guideline Committee

Advisory Committee on Immunization Practices (ACIP)

ACIP Anthrax Vaccine Working Group

Composition of Group That Authored the Guideline

Advisory Committee on Immunization Practices (ACIP)

Chair: Dale Morse, MD, New York State Department of Health, Albany, New York

Executive Secretary: Larry Pickering, MD, National Center for Immunization and Respiratory Diseases, CDC, Atlanta, Georgia

Members: Carol Baker, MD, Baylor College of Medicine, Houston, Texas; Robert Beck, JD, Consumer Representative, Palmyra, Virginia; Lance Chilton, MD, University of New Mexico, Albuquerque, New Mexico; Paul Cieslak, MD, Oregon Public Health Division, Portland, Oregon; Kristen Ehresmann, MPH, Minnesota Department of Health, St. Paul, Minnesota; Janet Englund, MD, University of Washington and Children's Hospital and Regional Medical Center, Seattle, Washington; Franklyn Judson, MD, University of Colorado Health Sciences Center, Denver, Colorado; Susan Lett, MD, Massachusetts Department of Public Health, Boston, Massachusetts; Michael Marcy, MD, UCLA Center for Vaccine Research, Torrance, California; Cody Meissner, MD, Tufts Medical Center, Boston, Massachusetts; Kathleen Neuzil, MD, University of Washington, Seattle, Washington; Mark Sawyer, MD, University of California--San Diego, San Diego, California; Ciro Valent Sumaya, MD, Texas A&M Health Science Center, College Station, Texas; Jonathan Temte, MD, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin

ACIP Anthrax Vaccine Working Group

Chair: Dale Morse, MD, Albany, New York

Members: Robert Beck, JD, Palmyra, Virginia; Jennifer Wright, DVM, Atlanta, Georgia; Conrad P. Quinn, PhD, Atlanta, Georgia; Sean Shadomy, DVM, Atlanta, Georgia; Brian Plikaytis, MSc, Atlanta, Georgia; Nancy Messonnier, MD, Atlanta, Georgia; Charles Rose, PhD, Atlanta, Georgia; Michael McNeil, MD, Atlanta, Georgia; Stacey Martin, MSc, Atlanta, Georgia; Jennifer Jarrell-Wilson, MPH, Atlanta, Georgia; Cindy Thomas, DVM, Atlanta, Georgia; Renee Funk, DVM, Atlanta, Georgia; Nelson Arboleda, MD, Atlanta, Georgia; Nicki Pesik, MD, Atlanta, Georgia; Mary Ari, PhD, Atlanta, Georgia; Rita Traxler, MPH, Atlanta, Georgia; Theresa Smith, MD, Atlanta, Georgia; Alex Hoffmaster, PhD, Atlanta, Georgia; Ted Cieslak, MD, Atlanta, Georgia; Patrick Garman, PhD, Falls Church, Virginia; Wayne Hachey, DO, Falls Church, Virginia; Julianne Clifford, PhD, Delaplane, Virginia; Alexandra Worobec, MD, Washington, DC; Ed Nuzum, DVM, Bethesda, Maryland; Jeffrey Duchin, MD, Seattle, Washington; Richard Beigi, MD, Pittsburgh, Pennsylvania; David Kimberlin, MD, Birmingham, Alabama; John Grabenstein, West Point, Pennsylvania; Paul Offit, MD, Philadelphia, Pennsylvania; Christopher Chase, DVM, Brookings, South Dakota; Monique Mansoura, PhD, Washington, DC; Ken Miller, MD, Irvine, California; Ken Chase, MD, Washington, DC

Financial Disclosures/Conflicts of Interest

Not stated

Guideline Status

This is the current release of the guideline.

This addendum updates a previous version: Use of anthrax vaccine in the United States. Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep 2000 Dec 15;49(RR-15):1-21.

Guideline Availability

Electronic copies: Available from the Centers for Disease Control and Prevention (CDC) Web site External Web Site Policy.

Print copies: Available from the Centers for Disease and Control Prevention, MMWR, Atlanta, GA 30333. Additional copies can be purchased from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402-9325; (202) 783-3238.

Availability of Companion Documents

None available

Patient Resources

None available

NGC Status

This summary was completed by ECRI on March 15, 2001. This summary updated by ECRI to include the 2002 addendum on September 6, 2006. This NGC summary was updated by ECRI Institute on December 23, 2010.

Copyright Statement

No copyright restrictions apply.

Disclaimer

NGC Disclaimer

The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

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