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12/18/2001
WASHINGTON – Federal health officials said Tuesday they would offer experimental anthrax vaccine and an extra 40 days of antibiotics to thousands of Capitol Hill, media and postal workers in case any anthrax still lurks in their lungs.
But they expect only a small fraction of those people, who already were given two months of antibiotics for possible exposure to anthrax during the attacks-by-mail, to accept any of the precautionary extra treatment.
Indeed, Health and Human Services Secretary Tommy Thompson said workers will have to decide for themselves, in consultation with their doctors, whether to take extra antibiotics or get the vaccination.
The risk of getting anthrax after the standard two months of antibiotics is ``very mild, minor,'' stressed Dr. D.A. Henderson, the government's top bioterrorism adviser. ``It is not zero, however.''
Anthrax is inhaled in a dormant spore form. People get sick when those spores germinate deep in the lungs, letting the bacteria break out and multiply. Antibiotics kill bacteria, not the spores. So if a spore germinates after antibiotics are stopped, someone could get sick.
Some animal studies suggest that's a possibility, albeit rare. In one study, 1 percent of the anthrax spores monkeys inhaled still lurked in their lungs 75 days later, and in another a monkey died 98 days after spore inhalation.
The government has confirmed 18 cases of anthrax — 11 in inhaled form and seven skin infections — since the bioterror attack began in October. No new cases have been reported since a 94-year-old Connecticut woman died Nov. 21, the fifth death from the attacks.
Thousands of people potentially exposed to anthrax during the attacks have completed 60 days of antibiotics, and hundreds more quit taking them early. Yet none has gotten sick, which health officials call very reassuring.
Still, ``some of these people, especially those who may have been exposed to high levels of anthrax spores, may wish to take additional precautions beyond completing the 60-day antibiotic regimens,'' Thompson said.
The options:
—Do nothing, but contact a doctor promptly about any suspicious symptoms.
—Take an additional 40 days of antibiotics. That would cover people beyond the time animal studies suggest spores could incubate.
—Choose the vaccine plus 40 days of antibiotics. Because vaccination would require three shots at two-week intervals, the extra antibiotics are important to fully protect people before the third shot.
Anthrax vaccine is proven to work only if given before someone inhales anthrax, not after. So the Food and Drug Administration has given permission for people to be inoculated only if they are told the vaccinations are experimental.
Anthrax vaccine has long been used by veterinarians, scientists and the military, and side effects are rare. The main reactions are redness and swelling at the injection site; some swelling can be severe and last weeks, but eventually it recedes.
There is one other complication: Only one company makes anthrax vaccine, and its newly renovated factory has not passed FDA safety inspections. FDA officials say they have tested some 10,000 doses of immediately available vaccine to ensure they're usable.
Fewer than 3,000 people are thought to have been exposed to high levels of anthrax, Henderson said. Among them are about 70 Capitol Hill workers who were in the vicinity when a letter to Senate Majority Leader Tom Daschle — tainted with an estimated trillion anthrax spores — was opened, and some postal workers who processed tainted mail.
Capitol physician Dr. John Eisold said he would recommend the vaccine for those who were in Daschle's office and a few from Sen. Russ Feingold's office who were in the area when the letter was opened.
Senate staffers may get vaccinated as early as Wednesday, Henderson said. But doctors and other officials still were awaiting word from FDA on how the experimental vaccines would be given and what information patients would need.