Vaccination botulism

Bacterial vaccines less generally available than those listed in the table include botulism vaccine, necrotizing enteritis... 

Drugs There is an antitoxin stored at the CDC. To arrange to use this antitoxin, call your state health department (or CDC at 404-639-2206 or 404-639-3753 workdays, or call weekends or evenings at 404-639-2888). This chemotherapy (antitoxin) available from CDC is a licensed trivalent equine antitoxin for serotypes A, B, and E. There is no reversal of botulism disease with this drug, but the antitoxin does usually prevent further nerve damage. The U.S. Department of Defense (DOD) has a heptavalent equine despeciated antitoxin for serotypes A - G (IND). DOD also has pentavalent toxoid (vaccine) for serotypes A - E (IND). The currently recommended schedule is for use at zero, two, and twelve weeks with a one year booster. This vaccine is supposed to induce solidly protective antitoxin levels in greater that 90 percent of those vaccinated after one year. Contact USAMRIID, (U.S. Army Medical Research Institute of Infectious Diseases), Fort Detrick, Maryland. Tel. 301-619-2833. 

Available killed vaccines include acellular pertussis, anthrax, botulism, cholera, diptheria, hepatitis A, hepatitis B, Haemophilus influenzae type b (Hib), influenza, Lyme disease, meningococcus, pertussis, plague, pneumococcus, polio, rabies, tetanus, typhoid, and typhoid VI. 

Byrne MP, Smith LA (2000) Development of vaccines for prevention of botulism. Biochimie 82 955-66... 

Eitzen, 2003). Botulism Immune Globulin Intravenous (human), a pentavalent investigational vaccine, is available through the California Department of Health Services for administration in infantile botulism. 

Botulinum toxin is extremely poisonous to humans. Coats, gloves, face shields, and protective cabinets are recommended for handling botulism specimens. Ideally, laboratory personnel should be vaccinated with C. botulinum antitoxin. Universal precautions should be used when caring for patients suspected of botulism. Isolation is not necessary but droplet precautions should be instituted (Arnon et al., 2001). 

Pulmonary Dyspnea CNS Cranial nerve deficits are universal Descending symmetric paralysis Gastrointestinal Constipation (later in course) OTHER FORMS OF BOTULISM ISOLATION/DECON PRECAUTIONS Droplet precautions Extensive precautions for laboratory personnel VACCINE Botulinum toxoid vaccine available but restricted in use to military and laboratory personnel. POSTEXPOSURE PROPHYLAXIS None... 

There are as yet no FDA-approved vaccines to prevent botulism. An investigational pentavalent botuliniun toxoid (PBT) product, developed at Fort Detrick, is available for persons at risk for botulism (i.e. laboratory workers, warfighters). While determined to be safe and immunogenic, PBT is not useful or recommended for post-exposure prophylaxis. Antitoxin titers do not develop until a month after the third dose in the vaccine schedule. PBT is reserved for employees at high risk for BoNT exposure but not the general population. Several factors limit the usefrdness of PBT as a vaccine for inoculating the general population. 

A pentavalent botulinum toxoid (botulinum toxin in different antigenic types) has been used for more than 30 years in some countries to prevent the disease in laboratory workers and to protect troops against attack. Pre-exposure immunization for the general population is neither feasible nor desirable the vaccine is ineffective for postexposure prophylaxis. Treatment of botulism consists of passive immunization and supportive care. Most licensed antitoxins contain antibodies against the most common toxin types A, B, and E. About 9% of recipients of equine antitoxin developed urticaria, serum sickness, or other hypersensitivity reactions. In 2% of recipients anaphylaxis occurred within 10 minutes of antitoxin... 

Chemical Abstracts Service Registry Number CAS 93384-43-1. Botulinum toxins comprise a series of seven related protein neurotoxins that prevent fusion of synaptic vesicles with the presynaptic membrane and thus prevent release of acetylcholine. Exposure in a battlefield or terrorist setting would most likely be to inhaled aerosolized toxin. The clinical presentation is that of classical botulism, with descending skeletal muscle weakness (with an intact sensorium) progressing to respiratory paralysis. A toxoid vaccine is available for prophylaxis, and a pentavalent toxoid can be used following exposure its effectiveness wanes rapidly, however, after the end of the clinically asymptomatic latent period. Because treatment is supportive and intensive (involving long-term ventilatory support), the use of botulinum toxin has the potential to overwhelm medical resources especially at forward echelons of care. 

The treated toxins are sometimes referred to as formol toxoids. Toxoid vaccines are very effective in the prevention of those diseases such as diphtheria, tetanus, botulism and clostridial infections of farm animals, in which the infecting bacteria produce disease through the toxic effects of secreted proteins which enzymically modify essential cellular components. Many of the clostridial toxins are lytic enzymes. Detoxification is also required for the pertussis toxin component of acellular pertussis vaccines. 

Bacterial vaccines of restricted availability include anthrax, botulism, plague, Q fever, typhus and tularaemia vaccines. 

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. 

It is is the third most toxic substance known after plutonium and botulism it is a protein toxin that is extracted from the castor bean (Ricinus communis). The USA Centers for Disease Control (CDC) considers 500 pg to be the lethal dose of ricin in humans if exposure is from injection or inhalation. Ricin is poisonous if inhaled, injected, or ingested, acting by the inhibition of protein synthesis. While there is no known antidote, the US military has developed a vaccine. 

Recombinant vaccines, monoclonal antibodies, and antibody fragments all have potential benefit, but require extensive investigation. Advances in these areas would benefit unintentional botulism case care, and the effort could provide prophylaxis and early treatment for those exposed to a potential toxin in a foodborne epidemic. Investigation of new techniques for this disorder would thus have substantial societal benefit for a rare clinical occurrence that is also a possible biological warfare event. 

Of course, most of the hazards do not lie exactly on the line of best fit. For example both botulism and risks from smallpox vaccinations are both low probability events, the frequency of which are generally overestimated by lay people. However, the risk of botulism is greatly overestimated, while that from the smallpox vaccination is overestimated to a lesser extent. The same is true when two high probability events such as homicide and diabetes are compared. The frequency of both is underestimated but that of diabetes is underestimated to a greater extent than homicide. 

Because of the complexity of bioassays, the expenses for animals and facilities, and ethical considerations, many investigators have sought in vitro methods for detection and quantitation of botulism toxins and antitoxins. One of the earliest was the Ramon flocculation test (57), in which the reaction between a toxin and its homologous antitoxin standard was visualized by a precipitation reaction. This was advantageous in vaccine production because the toxoid, which cannot be measured by bioassay can be quantitated in a comparable manner as the toxin by this test. The flocculation unit (Lf) was used as the antigenic unit employed in the formulation of botulism toxoids used for human immunization (7). 

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