Grabenstein John D
Merck Vaccines and Infectious Diseases, West Point, Pennsylvania 19486-0004, USA.
Clin Infect Dis. 2008 Jan 1;46(1):129-36. doi: 10.1086/523578.
Anthrax spores rank as the leading threat among bioweapons. This article reviews the accumulated evidence for immunization, either active or passive, to counter the malicious release of anthrax spores. The key protective factor in current anthrax vaccines for humans is a protein called protective antigen, which allows ingress of toxins into cells. The US vaccine is licensed to prevent anthrax, regardless of the route of exposure. Its dosing schedule is cumbersome and somewhat painful (shortcomings that may be resolved by ongoing clinical studies). It can be prescribed with the confidence commensurate with dozens of human safety studies and experience in 1.8 million recent vaccinees. For post-exposure prophylaxis, combining antibiotic prophylaxis and active immunization before illness onset may offer the best combination of prompt and sustained protection, especially for people who inhale large doses of spores. To treat anthrax infection, passive immunization using a polyclonal or monoclonal antibody product may offer important clinical benefit, especially if the anthrax bacteria are resistant to multiple antibiotics.
炭疽芽孢是生物武器中的首要威胁。本文综述了通过主动或被动免疫来应对炭疽芽孢恶意释放的已有证据。目前用于人类的炭疽疫苗中的关键保护因子是一种名为保护性抗原的蛋白质，它能使毒素进入细胞。美国的这种疫苗被批准用于预防炭疽，无论暴露途径如何。其给药方案繁琐且有点痛苦（这些缺点可能会通过正在进行的临床研究得到解决）。鉴于有数十项人体安全性研究以及近期180万接种者的经验，它的使用是有充分信心保证的。对于暴露后预防，在发病前将抗生素预防与主动免疫相结合可能会提供即时和持续保护的最佳组合，特别是对于吸入大量芽孢的人。对于治疗炭疽感染，使用多克隆或单克隆抗体产品进行被动免疫可能会带来重要的临床益处，特别是在炭疽杆菌对多种抗生素耐药的情况下。
