Tularemia vaccine

Currently, the Working Group on Civilian Biodefense does not recommend tularemia vaccination for pre- or postexposure prophylaxis of the general popnla-tion for two reasons ... 

Consequently, the Working Group recommends continuing the program of providing the hve attenuated tularemia vaccine only for laboratory personnel routinely working with the organism (43). 

Aikimbayev, A., Chimirov, O. The strain Francisella mediaasiatica 240, attenuated, candidate of tularemia vaccine. Patent 312. Astana Committee on intellectual property rights of the Ministry of Justice of Republic Kazakhstan 2002. 

C. Vaccine. A live, attenuated tularemia vaccine is available as an investigational new drug (END). Its effectiveness in humans against the concentrated bacterial challenge expected in a BW attack is unproven. 

Saslaw S, Eigelsbach HT, Wilson HE, Prior JA, Carhart S. Tularemia vaccine study, I Intracutaneous challenge. Arch Intern Med. 1961 107 121-133. 

Karttunen R, Surcel H-M, Andersson G, Ekre H-PT, Herva E. Francisella tularensis-induced in vitro gamma interferon, tumor necrosis factor alpha, and interleukin 2 responses appear within 2 weeks of tularemia vaccination in human beings. J Clin Microbiol. 1991 29 753-756. 

Saslaw S, Carhart S. Studies with tularemia vaccines in volunteers, III Serological aspects following intracuta-neous or respiratory challenge in both vaccinated and nonvaccinated volunteers. Am J Med Sci. 1961 241 689-699. 

Saslaw S, Carlisle HN. Studies with tularemia vaccines in volunteers challenged with Pasteurella tularensis. Am JMedSci. 1961 242 166-172. 

Eigelsbach HT, Downs CM. Prophylactic effectiveness of live and killed tularemia vaccines, I Production of vaccine and evaluation in the white mouse and guinea pig. J Immunol. 1961 87 415-425. 

McCrumb FR Jr. Commission on Epidemiological Survey. Review of tularemia Studies on tularemia vaccine 1960-62. In Annual Report. Washington, DC Armed Forces Epidemiological Board 1962 81-86. 

Hornick RB, Eigelsbach HT. Aerogenic immunization of man with live tularemia vaccine. Bacteriol Rev. 1966 30 532-538. 

The United States Army Medical Research and Material Command is the IND holder for a live attenuated tularemia vaccine that appears to be effective against inhalational exposure. 

Scarification The making of a number of superficial incisions in the skin. It is the technique used to administer tularemia and smallpox vaccines. 

A vaccine for tularemia is under review by the Food and Drug Administration and is not currently available in the United States. 

A live attenuated vaccine derived from a less virulent form of F. tularensis is available for laboratory personnel who routinely work with tularemia. Postexposure prophylaxis for contacts of tularemia patients is not recommended, as person-to-person transmission is not known to occur. For persons who may have been exposed to F. tularensis, for example, by an act of bioterrorism, a 14-day oral course of ciprofloxacin or doxycycline is indicated (Dennis et al., 2001). 

With the exception of smallpox, next-generation candidates to replace the two current vaccines (smallpox and anthrax), and vaccines for botulism, tularemia, and Venezuelan equine encephalomyelitis will not be approved and available until the end of the decade at the earliest, hampered in part by the normal process for new drug approval and by the risk-averse nature of lead agencies within the Department of Defense. 

By 1969, the World Health Organization estimated that dispersal or an aerosol of 50 kg of FranciseUa tularensis over a metropolitan area of 2 million would cause 250,000 incapacitating injuries, including 19,000 deaths. Given the nature of the infection, the iUness would persist for several weeks, with relapses occurring over several months. Vaccination would partially protect only a small subset of individuals. The CDC has estimated the economic cost of a tularemia attack as 5.4 billion for every 100,000 people exposed (45). 

The attennated vaccine does not induce complete protection against inhalational tularemia... 

The natural tularemia foci in Kazakhstan occupy 552,400 km2 (26% of the territory of the Republic). The most effective method of prophylaxis is vaccination by live vaccine strain Francisella tularensis holarctica (Russian), which provides reliable immunity for 5 years. Annually, between 70,000 and 100,000 people are vaccinated and revaccinated. We have patented the strain F. tularensis mediasiatica KA-29 for creation of a domestic vaccine that is highly immunogenic, non reactogenic, and will induce crossimmunity [9],... 

F. Vaccination. Vaccination is the preferred method of biological defense. Fully licensed vaccines are currently available for anthrax, cholera, plague and smallpox. Vaccines for botulinum toxoid, Q fever, Rift Valley fever, tularemia, and VEE currently exist as IND products and would be available only under protocol with informed consent, therefore would not be readily available on the battlefield. No vaccine is currently available either FDA licensed or under IND status, for glanders, brucellosis, Staphylococcus enterotoxin B, ricin, or T-2 mycotoxins. 

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