For over a year, efforts have been directed toward developing a new therapy against life-threatening anthrax infection for patients who are failing to respond to combination antibiotic therapy and intensive care. This investigational treatment, termed hyperimmune globulin, consists of purified and concentrated antibody against anthrax.
The February 1 2002 issue of Science (vol.295, p.777) contains a description of the new approach. The antibody against anthrax is derived from the plasma of people who have been vaccinated with the FDA-licensed anthrax vaccine. Because the anthrax vaccine consists primarily of the “Protective Antigen (PA)” of anthrax, most antibody derived from vaccinated individuals is directed against PA. Since PA is one required subunit of the two toxins produced by the anthrax bacteria, this anthrax hyperimmune globulin is primarily an antitoxin antibody. Anthrax toxin(s) are thought to play a critical role in the way that the anthrax bacteria cause fulminant illness and death.
On February 9th of this year, the Washington Hospital Center’s monthly Regional Bioterrorism Preparedness Forum heard a 2-hour presentation on anthrax vaccine and anthrax-specific hyperimmune globulin by colleagues in the Army and Navy.
In September of 2002, the Centers for Disease Control and Prevention (CDC) awarded a company called Cangene a contract to develop anthrax hyperimmune globulin as an adjunct to antibiotic therapy in very ill patients.
According to the November 15 2002 issue of Morbidity and Mortality Weekly Report (MMWR 51(45): 1024-1026), the Advisory Committee on Immunization Practices (ACIP) to the CDC has recommended that additional research be focused on new therapies for anthrax, “including use of antitoxin (e.g., hyperimmune globulin) for treating anthrax.”
Front-line clinicians, public health officials, and pharmacists -- who will again be faced with an emergency in the event of a new anthrax attack -- would welcome an opportunity to become familiar with the Investigational New Drug (IND) protocol under which anthrax hyperimmune globulin could potentially be made available for emergency use to treat critically ill and dying patients. Preparedness, not panic.