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Pulmonary anthrax is nearly 100% fatal. To our knowledge, Gulf War Syndrome
(GWS) has no known disease associated mortality rate (1). To implicate the
anthrax vaccine as a possible etiology of GWS, Ness et. al. (2) proposed
risking unvaccinated human exposure to anthrax. The authors state they
understand those not receiving vaccination may be deprived of potential
protection "in case of conflict." They cite the precedent of a human study
which evaluated risk of gastroenteritis from sea water exposure.
[paragraph 2]Predicting the likelihood of gastroenteritis from sea bathing is reasonable.
Risking an almost certain death from pulmonary anthrax to associate vaccination
with GWS is unreasonable. Anthrax may take 3 forms in humans,
the mortality from which are in no way comparable to gastroenteritis. GI
and pulmonary anthrax have the mortality rates of >50% and ~ 100%
respectively, regardless of treatment . Even untreated anthrax of the skin
has a 20 % mortality rate which decreases to <_1 if="if" treated="treated" _3.="_3." paragraph="paragraph" _3="_3" their="their" proposal="proposal" is="is" carried="carried" further="further" we="we" suggest="suggest" both="both" trial="trial" groups="groups" receive="receive" a="a" quinalone.="quinalone." this="this" will="will" control="control" for="for" quinalone-associated="quinalone-associated" adverse="adverse" drug="drug" effects="effects" _4="_4" as="as" quinalones="quinalones" may="may" be="be" used="used" prophylactically="prophylactically" in="in" the="the" gulf.="gulf." it="it" also="also" serve="serve" to="to" increase="increase" number="number" of="of" survivors="survivors" non-vaccinated="non-vaccinated" group="group" should="should" there="there" an="an" exposure="exposure" anthrax="anthrax" spores="spores" _5.="_5." p="p"/> * Historically, the anthrax bacillus is known to look like railroad box cars under the light microscope.
We respectfully now refer to the disease as "the box cars of death."
RA Piepenbrink, Internist
LS Bowling, Cardiologist
WM Hall, Internist
LA Parker, Internist
Pensacola, Florida, USA
-----
1. Kang H and T Bullman. "Mortality among US veterans of the Persian Gulf War" NEJM 1996 335:1498-1504(14NOV).
2. Ness et. al. "All troops sent to the gulf should be randomized to receive anthrax vaccination or placebo" BMJ 1998 316:1322 (25 April).
3. Mandell, G. et. al. (eds). Principles and Practice of Infectious Diseases. 1995. 4th ed., p. 1885-1889.
4. Pirmohamed, M. "Clinical Review: Adverse Drug Reactions" BMJ. 1998; 316: 1295-1298 (25 April ).
5. Fauci, A. et. al. (eds). Harrison's Principles of Internal Medicine. 1998. 14th ed. p897-899.
Competing interests:
No competing interests
07 May 1998
Roger A Piepenbrink
Internal Medicine Staff
Naval Hospital; Department of Internal Medicine; Pensacola, Florida, USA
Must placebos be loaded into the "box cars of death"?
Pulmonary anthrax is nearly 100% fatal. To our knowledge, Gulf War Syndrome
(GWS) has no known disease associated mortality rate (1). To implicate the
anthrax vaccine as a possible etiology of GWS, Ness et. al. (2) proposed
risking unvaccinated human exposure to anthrax. The authors state they
understand those not receiving vaccination may be deprived of potential
protection "in case of conflict." They cite the precedent of a human study
which evaluated risk of gastroenteritis from sea water exposure.
[paragraph 2]Predicting the likelihood of gastroenteritis from sea bathing is reasonable.
Risking an almost certain death from pulmonary anthrax to associate vaccination
with GWS is unreasonable. Anthrax may take 3 forms in humans,
the mortality from which are in no way comparable to gastroenteritis. GI
and pulmonary anthrax have the mortality rates of >50% and ~ 100%
respectively, regardless of treatment . Even untreated anthrax of the skin
has a 20 % mortality rate which decreases to <_1 if="if" treated="treated" _3.="_3." paragraph="paragraph" _3="_3" their="their" proposal="proposal" is="is" carried="carried" further="further" we="we" suggest="suggest" both="both" trial="trial" groups="groups" receive="receive" a="a" quinalone.="quinalone." this="this" will="will" control="control" for="for" quinalone-associated="quinalone-associated" adverse="adverse" drug="drug" effects="effects" _4="_4" as="as" quinalones="quinalones" may="may" be="be" used="used" prophylactically="prophylactically" in="in" the="the" gulf.="gulf." it="it" also="also" serve="serve" to="to" increase="increase" number="number" of="of" survivors="survivors" non-vaccinated="non-vaccinated" group="group" should="should" there="there" an="an" exposure="exposure" anthrax="anthrax" spores="spores" _5.="_5." p="p"/> * Historically, the anthrax bacillus is known to look like railroad box cars under the light microscope.
We respectfully now refer to the disease as "the box cars of death."
RA Piepenbrink, Internist
LS Bowling, Cardiologist
WM Hall, Internist
LA Parker, Internist
Pensacola, Florida, USA
-----
1. Kang H and T Bullman. "Mortality among US veterans of the Persian Gulf War" NEJM 1996 335:1498-1504(14NOV).
2. Ness et. al. "All troops sent to the gulf should be randomized to receive anthrax vaccination or placebo" BMJ 1998 316:1322 (25 April).
3. Mandell, G. et. al. (eds). Principles and Practice of Infectious Diseases. 1995. 4th ed., p. 1885-1889.
4. Pirmohamed, M. "Clinical Review: Adverse Drug Reactions" BMJ. 1998; 316: 1295-1298 (25 April ).
5. Fauci, A. et. al. (eds). Harrison's Principles of Internal Medicine. 1998. 14th ed. p897-899.
Competing interests: No competing interests