Tularemia vaccination

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). 

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 ... 

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

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). 

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],... 

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. 

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. 

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. 

Diagnosis of SEB intoxication may be difficult in the early stage because certain other diseases such as influenza, Q Fever, tularemia or plague may manifest similar symptoms. Treatment should include supportive care. Oxygenation, hydration and ventilator to help breathing may be needed in severe intoxication. Antibiotics may be effective. Currently there is no vaccine to protect humans from this toxin. 

Vaccines to prevent tularemia have included those made from killed, whole cells and live, attenuated strains. A whole-cell, killed vaccine was developed by L. Foshay and associates94 in the 1930s, but proved to be of limited efficacy. Experimental studies24 done with human volunteers showed that this vaccine reduced the frequency of systemic symptoms but did not prevent the local lesion after intracutaneous challenge. Additional studies25 with aerosol challenge in humans showed that the killed vaccine neither prevented nor modified the disease. 

Evidence based on an analysis of laboratory-acquired infections99 indicates that immunization with the live, attenuated LVS vaccine prevents the typhoidal and ameliorates the ulceroglandular forms of tularemia. The LVS vaccine is currently available as an Investigational New Drug from the U.S. Army Medical Research and Materiel Command, Fort Detrick, Frederick, Maryland 21702-5011. 

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. 

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