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USA to increase smallpox vaccine stockpile
Newsdesk Resurgence of anthrax in south India Two people have died in the latest outbreak of human anthrax in India. This is the third outbreak in the past 2 years. The present outbreak occurred at three villages in Kolar district (Karnataka, south India) between June and August 2001 when 25 sheep and cows died. Villagers deskinned dead animals, sold the hides, and consumed the meat. In July 1999, too, an outbreak was reported from Karnataka. Eight cases occurred at Jenukuruba in Mysore district, after some people ate meat of an infected deer. Five people died in this incident. Another outbreak took place at Bandhughutu (Midnapore, West Bengal) in May 2000. Here, too, tribal people feasted on roasted meat of dead animals. 43 people were affected, with three deaths.
Authorities at the National Institute of Communicable Diseases in New Delhi point out that a large number of animals are getting infected with anthrax, but transmission to people has been low. “The animal-to-human transmission ratio is 20/1 and is mostly found in tribal areas where they eat meat of dead animals”, says Udayvir Singh Rana, deputy director of NICD. “In the three episodes since 1999, we have seen that although a large number of people come in contact with infected animals or eat the meat, only a few get infected.” NICD also found that cutaneous anthrax predominates, accounting for 95% of the total cases. But all outbreaks are not officially recorded. 35 cases, including 12 of anthrax meningo-encephalitis (AME), were
reported in 1999 in Pondicherry. All those with AME died. Except for three patients, all others had a history of handling animals, animal meat, or hide. The Christian Medical College, Vellore, also recorded 23 cases of human anthrax in 1994 and 1995 in Tamil Nadu. “The disease is more or less endemic in south India, in the trijunction of Andhra Pradesh, Tamil Nadu, and Karnataka states”, says Tarun Kumar Dutta (Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry). “Anthrax has never been contained in livestock in India due to the lack of vaccination efforts on the part of authorities, and due to ineffective vaccines available at present”, points out Dutta. Dinesh C Sharma
USA to increase smallpox vaccine stockpile
290
smallpox may be used by bioterrorists. “A smallpox release is not as likely as an anthrax release”, says Henderson, “but although I would rate the risk as small, it is not zero and the potential consequences are grave”. Last year, Acambis agreed to produce 40 million doses of a tissue-culture-derived vaccine by mid-2005. According to Acambis (www.acambis.com/cfm/index.cfm),
Rights were not granted to include this image in electronic media. Please refer to the printed journal. AP
Following recent anthrax attacks, the attention of US public-health experts is turning to the potential use of smallpox by bioterrorists. Production of a new smallpox vaccine by Acambis (Cambridge, MA, USA) is to be accelerated, and both the US government and WHO are investigating whether any other companies can make additional vaccine stocks. On November 4 the US Centers for Disease Control and Prevention announced that it was preparing expert teams to respond to possible smallpox outbreaks. Smallpox was officially eradicated globally in December 1979. However, mass vaccination for smallpox in developed countries was discontinued in the early 1970s when risk-benefit analyses indicated that the existing vaccines posed a greater risk to health than the disease itself. Consequently, up to 50% of the US population has no smallpox immunity and the degree of protection retained by people who were vaccinated more than 25–30 years ago is uncertain. This lack of immunity is one reason why Donald Henderson (Johns Hopkins University, Baltimore, MD, USA) and other experts believe
Anthony Fauci, director of NIAID, at a Congressional hearing on smallpox.
“this programme has been accelerated”. Tom Monath, vice-president of research and medical affairs at Acambis, comments that “data from extensive preclinical studies indicate that the new vaccine is a pretty good match for the currently licensed vaccine”. Clinical trials, which should start early in 2002,
will concentrate primarily on safety and demonstration of an immune response since, as discussed by Steven Rosenthal and colleagues (US Food and Drug Administration, Rockville, MD, USA) in Emerging Infectious Diseases, “the usual measures of efficacy that require exposure to natural disease currently are not possible because the disease has been globally eradicated” (www.cdc.gov/ncidod/EID/vol7no6/ros enthal.htm). For now, the USA has 12–15 million doses of pre-eradication vaccine for emergency use. Worldwide, 90 million doses were available in 1998. Unfortunately, says WHO’s David Heymann (Geneva, Switzerland), “we don’t know the quality of most of that vaccine”. On October 26, WHO reiterated its previous recommendation against mass smallpox vaccination (www.who.int/ emc/diseases.smallpox). “In the case of an outbreak, vaccine stocks would be used to immunise health workers and civil officers dealing with the outbreak and to contain the outbreak”, explains Heymann. He adds that “it’s saddening to see that all the progress we made on smallpox could now be in jeopardy”. Jane Bradbury
THE LANCET Infectious Diseases Vol 1 December 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Authorities at the National Institute of Communicable Diseases in New Delhi point out that a large number of animals are getting infected with anthrax, but transmission to people has been low. “The animal-to-human transmission ratio is 20/1 and is mostly found in tribal areas where they eat meat of dead animals”, says Udayvir Singh Rana, deputy director of NICD. “In the three episodes since 1999, we have seen that although a large number of people come in contact with infected animals or eat the meat, only a few get infected.” NICD also found that cutaneous anthrax predominates, accounting for 95% of the total cases. But all outbreaks are not officially recorded. 35 cases, including 12 of anthrax meningo-encephalitis (AME), were
reported in 1999 in Pondicherry. All those with AME died. Except for three patients, all others had a history of handling animals, animal meat, or hide. The Christian Medical College, Vellore, also recorded 23 cases of human anthrax in 1994 and 1995 in Tamil Nadu. “The disease is more or less endemic in south India, in the trijunction of Andhra Pradesh, Tamil Nadu, and Karnataka states”, says Tarun Kumar Dutta (Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry). “Anthrax has never been contained in livestock in India due to the lack of vaccination efforts on the part of authorities, and due to ineffective vaccines available at present”, points out Dutta. Dinesh C Sharma
USA to increase smallpox vaccine stockpile
290
smallpox may be used by bioterrorists. “A smallpox release is not as likely as an anthrax release”, says Henderson, “but although I would rate the risk as small, it is not zero and the potential consequences are grave”. Last year, Acambis agreed to produce 40 million doses of a tissue-culture-derived vaccine by mid-2005. According to Acambis (www.acambis.com/cfm/index.cfm),
Rights were not granted to include this image in electronic media. Please refer to the printed journal. AP
Following recent anthrax attacks, the attention of US public-health experts is turning to the potential use of smallpox by bioterrorists. Production of a new smallpox vaccine by Acambis (Cambridge, MA, USA) is to be accelerated, and both the US government and WHO are investigating whether any other companies can make additional vaccine stocks. On November 4 the US Centers for Disease Control and Prevention announced that it was preparing expert teams to respond to possible smallpox outbreaks. Smallpox was officially eradicated globally in December 1979. However, mass vaccination for smallpox in developed countries was discontinued in the early 1970s when risk-benefit analyses indicated that the existing vaccines posed a greater risk to health than the disease itself. Consequently, up to 50% of the US population has no smallpox immunity and the degree of protection retained by people who were vaccinated more than 25–30 years ago is uncertain. This lack of immunity is one reason why Donald Henderson (Johns Hopkins University, Baltimore, MD, USA) and other experts believe
Anthony Fauci, director of NIAID, at a Congressional hearing on smallpox.
“this programme has been accelerated”. Tom Monath, vice-president of research and medical affairs at Acambis, comments that “data from extensive preclinical studies indicate that the new vaccine is a pretty good match for the currently licensed vaccine”. Clinical trials, which should start early in 2002,
will concentrate primarily on safety and demonstration of an immune response since, as discussed by Steven Rosenthal and colleagues (US Food and Drug Administration, Rockville, MD, USA) in Emerging Infectious Diseases, “the usual measures of efficacy that require exposure to natural disease currently are not possible because the disease has been globally eradicated” (www.cdc.gov/ncidod/EID/vol7no6/ros enthal.htm). For now, the USA has 12–15 million doses of pre-eradication vaccine for emergency use. Worldwide, 90 million doses were available in 1998. Unfortunately, says WHO’s David Heymann (Geneva, Switzerland), “we don’t know the quality of most of that vaccine”. On October 26, WHO reiterated its previous recommendation against mass smallpox vaccination (www.who.int/ emc/diseases.smallpox). “In the case of an outbreak, vaccine stocks would be used to immunise health workers and civil officers dealing with the outbreak and to contain the outbreak”, explains Heymann. He adds that “it’s saddening to see that all the progress we made on smallpox could now be in jeopardy”. Jane Bradbury
THE LANCET Infectious Diseases Vol 1 December 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.