Special NVIC Report
Barbara Loe Fisher, Editor
BIOLOGICAL WARFARE AND ANTHRAX VACCINE
The terrorist attacks on New York City and Washington, D.C. on September 11, 2001 and, soon after, the release of anthrax-contaminated mail in the U.S. postal system, have prompted calls by some for use of anthrax vaccine in the civilian population. Although there is a possibility that terrorists will attempt to launch an attack on civilians in the continental U.S. using anthrax organisms, there are logistical problems associated with a successful biological weapons assault, including difficulty of delivering the organisms to large numbers of people. Most notably, a successful bioterrorism attack involving large numbers of American civilians will require a failure of both internal and external homeland security measures, which were put in place following September 11.
Every vaccine, like every drug, carries an inherent risk of injury or death and some individuals will be genetically or biologically more vulnerable to vaccine reactions than other individuals. All vaccination campaigns result in casualties and, therefore, benefits and risks must be carefully assessed before implementation, especially in the absence of a proven attack. Every precaution must be taken to minimize vaccine casualties while protecting the informed consent rights of all citizens.
Biological warfare is not a new phenomenon. History is full of examples of warring factions trying to weaken each other’s troops or civilian populations by making them sick. From the ancient Greeks and Romans, who polluted the water supplies of their enemies with dead animals, to warriors in medieval times who catapulted corpses of people infected with bubonic plague into the castles of their enemies, to European conquerors who came to the New World and used smallpox contaminated blankets to kill native Indians with no natural immunity to smallpox, there is a long history of man using disease as a weapon.
Modern biological weapons using lethal microorganisms were developed in the 1930s by Japanese scientists, including an aerosolized anthrax that was designed to be used in a specially designed fragmentation bomb. Both the U.S. and Britain developed biological weapons during World War II using anthrax, botulinum toxin, encephalitis virus, staph enterotoxin and other deadly organisms. Even though the U.S. has had biological weapons capability, the U.S. has never used biological weapons on any nation.
Anthrax is a serious bacterial infection caused by Bacillus anthracis and most commonly occurs in animals such as cattle, sheep, horses and goats after they graze in areas contaminated with spores of B. anthracis. The body wastes and carcasses of infected animals, or flies that eat infected carcasses, and contaminated hides and meat are all sources of anthrax. Individuals who work with animals or animal by-products or are exposed to contaminated soil are at highest risk of contracting anthrax.
The bacteria, which must be in the presence of oxygen to survive, produce spores that can survive for years in dry soil but are destroyed by boiling or by treatment with hydrogen peroxide or dilute formaldehyde. Most common strains of B. anthracis are susceptible to penicillin and certain other antibiotics. However, a genetically engineered strain of anthrax that has been chemically treated and designed specifically as a biological weapon may be lethal enough to evade the protection that current antibiotics provide.
B. anthracis can invade the human bloodstream, multiply and spread to lymph nodes and many organs and kill quickly. The bacteria, which produce virulent toxin, can enter the bloodstream through a cut in the skin; by inhaling the anthrax spores through the nose; or by swallowing the spores into the gastrointestinal system. The cutaneous (skin) route is much less deadly than inhaling or swallowing the organism.
Anthrax is not a contagious disease. Someone who is directly exposed to anthrax spores and becomes sick cannot pass the disease along to someone else by coughing or sneezing as most infectious diseases can be spread. Each individual who gets sick with anthrax must have come into direct contact with the bacteria through a cut in the skin, through inhaling the spores into the lungs or through swallowing the spores, such as by eating contaminated meat.
Symptoms of Cutaneous (Skin) Anthrax: If the anthrax exposure route is through the skin, symptoms include a formation of a small, red skin lesion(s) that becomes swollen, larger and blackened over a week’s time. There may or may not be fever and swollen lymph nodes. Spontaneous healing occurs in 80 to 90 percent of cases. In 10 to 20 percent of cases that go on to develop bacteremia (massive bacterial infection of the blood), high fever and rapid death follows.
Symptoms of Inhalation (Lungs) Anthrax: Within one to three days of breathing in the anthrax spores, there is headache, fever, muscle aches, extreme fatigue, shortness of breath, coughing, low blood pressure and respiratory failure that can lead to death within 24 hours even with treatment.
Symptoms of gastrointestinal Anthrax : After swallowing anthrax spores, fever, nausea, vomiting, abdominal pain, bloody diarrhea develops and can lead to death. If the tonsils are affected, symptoms can include fever, sore throat, swollen lymph nodes, and respiratory distress.
Laboratory Diagnosis: A blood test that uses fluorescent antibody staining or culture can confirm anthrax infection, unless the patient has been treated with antibiotics. More sensitive lab tests can be performed for anthrax disease confirmation.
Treatment: For skin anthrax, treatments have included a penicillin shot used to destroy viable B. anthracis in skin lesions within 5 hours, followed by a 10 day oral course of penicillin. Other antibiotics, including doxycycline, ciprofloxacin, and chloramphenicol have also been used. Skin lesions are frequently cleaned and covered and used dressings disinfected before disposal. Antibiotic treatment has also been used with inhalation and gastrointestinal anthrax but with less success.
Antibiotic Side Effects: All drugs, including antibiotics, like all vaccines carry an inherent risk of injury or death for some individuals. Overuse of antibiotics and use of antibiotics in the absence of bacterial infection has contributed to the development of antibiotic-resistant strains of organisms that can cause life threatening illness. This has made it necessary to develop more powerful antibiotics, some of which carry serious side effects.
In addition to killing unwanted toxic bacteria, such as anthrax, antibiotics also kill the normal flora of the gastrointestinal tract and can cause nausea, diarrhea, vomiting and yeast infections. Rashes, hives, and other allergic reactions, including anaphylactic shock leading to death, can occur. Some antibiotics can cause central nervous system problems, including severe headaches, drowsiness, dizziness, irritability and restlessness, nerve paralysis and seizures. Other antibiotic reactions include blood disorders, such as anemia and thrombocytopenia (which can lead to uncontrolled bleeding); kidney and liver dysfunction and serum sickness that causes fatigue, muscle weakness and painful joints.
Prognosis: The mortality rate for skin anthrax that is untreated is 10 to 20 percent but very low with antibiotic therapy. The mortality rate for inhalation anthrax is 50 to 90 percent even with antibiotic therapy. The mortality rate for gastrointestinal anthrax is about 50 percent with antibiotic therapy. If meningitis is a complication of anthrax infection, it is usually fatal.
NORMAL EXPOSURE TO ANTHRAX: The most common way to get anthrax is to come into contact with an infected animal or animal waste and by-products. Veterinarians, farmers, or researchers working with animals are at higher risk, as are those working in industries that handle animal by-products like meat and animal skins. As already discussed, the cutaneous (skin) form of anthrax has a very low death rate with appropriate antibiotic therapy after exposure.
BIOTERRORISM EXPOSURE TO ANTHRAX: If the anthrax bacteria is used as a biological weapon to kill large numbers of people, it will most likely be used in the deadly aerosol form so that large numbers of people will inhale it. This will mean that the anthrax strain and size of spores will have to be specifically designed for weapons purposes and will require an effective delivery system. So far, there has never been a successful delivery of inhalation anthrax to any large population through a bomb, missile, crop duster or any other means.
However, even though inhalation anthrax has never been successfully delivered to large numbers of people, it has become evident that whoever sent the anthrax through the U.S. mail system had access to a strain of weaponized anthrax that had been processed into a high grade powder form. Genetic tests on the anthrax-contaminated letters, which resulted in the deaths of five Americans, have confirmed that it was the variant Ames strain of anthrax developed during experimental research originating at the U.S. Army Medical Research Institute of Infectious Disease (USAMRIID) at Fort Detrick, Maryland. Reportedly, the Ames strain was provided to other labs doing anthrax research, including Porton Down, a British military lab; Louisiana State University; Northern Arizona University, as well as Dugway Proving Ground military research facility in Utah, where anthrax spores were reportedly processed into the powder form that can be inhaled easily.
The fact that the genetically engineered and weaponized anthrax strain used in the contaminated mail can be traced back to a U.S. military research facility suggests that there are internal lab security issues that need to be addressed before it can be assumed that the best solution to preventing bioterrorism is to implement prophylactic mass vaccination or medication programs.
Harrison’s Principles of Internal Medicine (Thirteenth Edition, 1994) says of the currently licensed anthrax vaccine:
“Improved anthrax vaccines for humans are needed because the current vaccines are impure and chemically complex, elicit only slow-onset protective immunity, provide incomplete protection, and cause significant adverse reactions.”
In the 1950s, after several government lab researchers died of anthrax , the government began working on an anthrax vaccine. The only anthrax vaccine available in the US today was licensed by the FDA in 1970 for human use by high risk individuals such as researchers, veterinarians, those working in the wool mill and livestock industries and others who handle animals or animal products. In the early 1990’s during the Gulf War, large numbers of US military personnel thought to be at risk for biological warfare exposure were injected with anthrax vaccine, along with 15 other vaccines as well as an experimental drug, to protect against a possible biological warfare attack.
Since then, there have been persistent reports of serious anthrax vaccine reactions among military personnel, who received the vaccine and are now suffering with a pattern of autoimmune and brain damage that has come to be known as “Gulf War Syndrome.” Some sick veterans blame the anthrax vaccine, perhaps in combination with the many other vaccines the soldiers received along with exposures to chemical toxins in the Gulf War, for their disabilities. This has made the U.S. military’s vaccination of all active duty and reserve personnel with anthrax vaccine a very controversial policy.
How the Vaccine is Made: The anthrax vaccine is a killed bacterial vaccine produced from a strain of anthrax that does not cause the disease. Additives include aluminum hydroxide, formaldehyde and benzethonium chloride.
Strength and Duration of Immunity: The current anthrax vaccine requires six shots given over an 18 month period, followed by annual booster shots to maintain protection. The first three doses are given two weeks apart and then three doses spread over an 18 month period.
There is little published data on controlled human trials to test the efficacy of the vaccine. Developed primarily to protect workers who are exposed to skin anthrax by handling animals and animal by-products, it is reportedly about 90 percent effective against skin anthrax. But there is little data for humans about how effective the current vaccine is in protecting those who get the rarer but more deadly form of inhalation anthrax, although some experimental data in monkeys and other animals suggests the vaccine may be at least partially effective against inhalation anthrax.
If humans are exposed to a genetically engineered strain of anthrax that is not covered by the vaccine strain, the vaccine may have limited or no effectiveness. Several years ago there was an article published in the medical literature which revealed that the Russians have developed a genetically engineered strain of anthrax. During the Gulf War, there was fear that Iraq might have this genetically engineered anthrax strain that would make the vaccinated U.S. troops vulnerable but there has been no confirmation that Iraq or any other country outside of Russia has a genetically engineered strain of anthrax.
Vaccine Reactions: Most of the safety studies done on anthrax vaccine have been conducted by the Department of Defense, are unpublished, and reportedly do not include long term follow-up, according to military veterans advocacy groups who have reported anthrax vaccine damage. Reported reactions to anthrax vaccine have ranged from mild to severe local reactions, fever, chills and nausea that resolve without permanent damage to serious reactions resulting in permanent autoimmune and brain dysfunction, including chronic disabling fatigue, persistent headaches, severe joint pain and crippling arthritis, numbness and muscle weakness, severe memory loss, paralysis, seizures and death. It is estimated that 20 to 48 percent of all those vaccinated have some kind of reaction to anthrax vaccine, ranging from mild to severe.
During the past four years, a series of congressional hearings have been held in the U.S. House of Representatives Government Reform Committee on anthrax vaccine safety, efficacy and lack of informed consent protections in the military’s mandatory vaccination policies. Testimony from vaccine injured military veterans have included several hundred cases where career soliders have faced court martial rather than agree to be vaccinated or revaccinated with anthrax vaccine after serious reactions have occurred.
Contraindications: The vaccine manufacturer warns that:
- “Any acute respiratory disease or other active infection is generally considered to be adequate reason for deferring an injection.”
- “A history of a severe reaction to a previous dose of anthrax vaccine is a contraindication to immunization with this vaccine.”
- Persons receiving cortico-steroid therapy or other agents which would tend to depress the immune system may not be adequately immunized with the dosage schedule recommended.”
Other Considerations: The vaccine manufacturer’s product insert states that “studies have not been performed to ascertain whether Anthrax Vaccine Adsorbed has carcinogenic action or any effect on fertility.”
The Vaccine Manufacturer: The anthrax vaccine was developed at Fort Detrick by the Department of Defense, which still holds the patent. For many years, the anthrax vaccine was manufactured by the Michigan Department of Health. In 1998, manufacturing was taken over by Bioport Corporation when they purchased the plant, made modifications, and geared up to meet the Pentagon’s goal of vaccinating all 2.4 million active duty and reserve troops with anthrax vaccine. Bioport has failed FDA quality control inspection several times, which has curtailed vaccine supplies and use of the vaccine in the military.
Plans for Vaccination of High Risk Persons: As of November, 2001, about 500,000 of the 2.4 million U.S. troops and reservists had received the anthrax vaccine. In response to the exposure of U.S. civilians to anthrax through contaminated mail, the Centers for Disease Control began making plans to use some of the military anthrax vaccine stockpiles available to lab technicians, bioterrorism investigators and others currently at high risk for anthrax exposure. There has also been discussion about making anthrax vaccine available to police, firefighters and postal workers.
On December 18, 2001 federal health officials and military anthrax experts urged thousands of U.S. Postal Service employees in Washington D.C, New York and New Jersey, as well as Capitol Hill staffers possibly exposed to mail contaminated with the Ames strain of anthrax to be vaccinated because they are finishing a two month course of antibiotics. Health officials say those who have been exposed to the anthrax could be harboring anthrax spores in their lungs and may become ill once they stop using the antibiotics. Because the vaccine has not received final FDA approval, the vaccine continues to be classified as experimental.
BEFORE YOU GET VACCINATED:
When making a decision about whether to get vaccinated with a particular vaccine, including anthrax vaccine, you need to become fully informed about the risks and complications of the disease the vaccine is designed to prevent, as well as the risks and complications of the vaccine. In addition to information in this report, you should consult one or more doctors as well as obtain more information from other resources.
At a minimum, you should ask yourself the following questions before getting vaccinated:
1. Are you sick right now with a viral or bacterial infection?
2. Have you had a bad reaction to a vaccination before?
3. Do you have a personal or family history of:
- vaccine reactions
- convulsions or neurological disorders
- severe allergies
- immune system disorders
4. Do you know if you are at high risk of reacting to vaccines?
5. Do you have full information on the vaccine’s side effects and contraindications?
6. Do you know how to identify a vaccine reaction?
7. Do you know how to report a vaccine reaction?
8. Do you know the vaccine manufacturer’s name and lot number?
Physical Exam: It is a good idea to have your doctor give you a physical exam before each vaccination to make sure the results of the exam are written in your medical record so you have proof that you are in good health at the time of vaccination. Be sure to tell the doctor if you have recently recovered from an illness or if any of the members of your family are ill.
Detailed Medical History: The examining physician should take a detailed personal medical history, including family history, before you are vaccinated. Be sure to mention if you or anyone in your family has a history of vaccine reactions, convulsions or neurological disease, severe allergies, immune system disorders (such as thyroid disease, lupus, rheumatoid arthritis, diabetes, asthma, eczema), or other chronic health problems.
REPORTING A VACCINE REACTION
If you suffer a serious health problem within 30 days of vaccination, your doctor should report what happened to the Vaccine Adverse Event Reporting System (VAERS). If your doctor will not report, the National Vaccine Information Center will help you report. You can obtain a government Vaccine Adverse Event Reporting form by calling 1-800-822-7967.
Any serious deterioration in mental, physical or emotional health following vaccination should be reported. This includes development of such symptoms as persistent fever; extreme pain and swelling at the site of the injection; severe joint pain; tingling in hands or feet; numbness or muscle weakness; disruption in sensory perception such as vision or hearing; serious memory loss, inability to concentrate or depression; extreme fatigue; persistent headaches; seizures or other chronic health problems that were not present before vaccination or worsened after vaccination.
The National Vaccine Information Center also maintains a Vaccine Reaction Registry that serves as an independent oversight mechanism on VAERS. You can report a vaccine reaction to NVIC on this web site.
KEEP YOUR OWN RECORDS
Ask your doctor to write down any deterioration in health you suffer after vaccination in your permanent medical record, as well as the date, manufacturer’s name and lot number of all vaccinations given. Ask for a copy for your personal records.
Isselbacher KJ, Braunwald E et al, eds. 1994. Harrison’s Principles of Internal Medicine. Thirteenth Edition. New York: McGraw-Hill.
The Department of Defense. Anthrax Vaccine Immunization Program: About the Vaccine. www.anthrax.osd.mil/
Centers for Disease Control. Anthrax (Bacillus anthracis): Frequently asked questions. www.cdc.gov/ncidod/dbmd/anthrx.htm.
Bioport Corporation. March 1999. Anthrax Vaccine Adsorbed. Manufacturer Product Insert. (www.bioport.com)
Physicians’ Desk Reference. 2001. Montvale: Medical Economics Co., Inc.
Committee on Government Reform, U.S. House of Representatives. Subcommittee on National Security, Veterans Affairs and International Relations. Series of congressional hearings on anthrax vaccine held in 1999. (www.house.gov/reform/ns/past_hearings/anthrax.htm)
Committee on Government Reform, U.S. House of Representatives. Subcommittee on National Security, Veterans Affairs and International Relations.
Subcommittee Report: The Department of Defense Anthrax Vaccine Immunization Program: Unproven Force Protection. House Report 106-556
U.S. General Accounting Office. September 1999. GAO Report: Combating Terrorism: Need for Comprehensive Threat and Risk Assessments of Chemical and Biological Attacks. GAO/NSIAD-99-163.
Hafemeister R. February 6, 1998. British avoiding vaccines for troops in Gulf. Belleville News-Democrat.
Riechmann D. March 4, 1998. Anthrax vaccine works on monkeys. The Associated Press.
Fukuda K, Nisenbaum R, Stewart G et al. September 16, 1998. Chronic multisymptom illness affecting Air Force veterans of the Gulf War. Journal of the American Medical Association.
Graham B. October 30, 1998. Dose of explanation comes with anthrax shots. The Washington Post.
Unwin C, Blatchley N, Coker W et al. January 16, 1999. Health of UK servicemen who served in Persian Gulf War. The Lancet.
Jackson PJ, Hugh-Jones ME et al. February 3, 1998. PCR analysis of tissuesamples from the 1979 Sverdlovsk anthrax victims: the presence of multiple Bacillus anthracis strains in different victims. Proceedings of the National Academy of Sciences of the United States of America.
Funk D. June 28, 1999. Marine refuses vaccines, gets jail, discharge. Air Force Times.
Daniels D. June 29, 1999. Anthrax shots bad medicine?: vaccine’s possible perils listed in military papers. The San Diego Union-Tribune. (www.uniontrib.com)
Kreisher O. July 22, 1999. Military personnel assail anthrax shots’ side effects. The San Diego Union-Tribune.
Manning A. October 19, 1999. Anthrax vaccine injects anger into military: fearing reactions, troops quit the service. USA Today.
Crawley JW. December 4, 1999. Pentagon postpones its anthrax inoculations. The San Diego Union-Tribune.
Graham B. December 14, 1999. Pentagon anthrax program suffers setback: new manufacturing plant fails FDA inspection; inoculation expansion delayed. The Washington Post.
Hudson A. October 10, 2001. Anthrax, smallpox vaccines called for. The Washington Times.
Hoffman KB. October 10, 2001. Company working on anthrax vaccine. Associated Press.
Spencer J., Scardaville M. October 11, 2001. Understanding the bioterrorist threat: facts and figures. The Heritage Foundation Backgrounder (www.heritage.org/library/backgrounder).
Dyer G., Cookson C. October 11, 2001. Spreading calm in small doses. Financial Times.
Pear R. October 20, 2001. Government talks with drug companies about buying anthrax antibiotics. The New York Times.
Jackson RL. October 22, 2001. Lansing-based anthrax vaccine maker hit by major lawsuit: suit claims shots caused adverse reactions in soldiers. Los Angeles Times.
Fleischer-Black M., Van Voris B. October 23, 2001. Anthrax Vaccine’s Liability Issue. The National Law Journal.
Hanchette J. October 27, 2001. Why can’t we immunize Americans against anthrax? Gannett News Service.
Johannes L. October 29, 2001. CDC to make anthrax vaccine available to workers put at risk in the line of duty. The Wall Street Journal.
Walsh E. December 11, 2001. VA links Gulf War, Lou Gehrig’s Disease. The Washington Post.
Weiss R., Schmidt S. December 16, 2001. Capitol Hill anthrax matches Army’s stocks. The Washington Post.
Vedantam S., Connolly C. December 18, 2001. Anthrax vaccine urged for Hill staff. The Washington Post.
Williams TD. June 02, 2001. Anthrax vaccine complaints on rise. The Hartford Courant.
Garrett L. 2000. Betrayal of Trust. New York: Hyperion.
ABOUT THE EDITOR: Barbara Loe Fisher is co-founder and president of the National Vaccine Information Center. She is co-author of DPT: A Shot in the Dark; author of The Consumer’s Guide to Childhood Vaccines; and editor of THE VACCINE REACTION and The Vaccine Hotline newsletters. She served on the National Vaccine Advisory Committee and the Institute of Medicine Vaccine Safety Forum and is the consumer voting member of the FDA Vaccines and Related Biological Products Advisory Committee.
The following statement is authored by Meryl Nass, M.D., A.B.I.M., a biowarfare epidemiologist who is an expert on anthrax vaccine. She has assisted Gulf War veterans suffering from neuroimmune dysfunction and has provided expert testimony to Congress on the safety and efficacy of the anthrax vaccine. Dr. Nass is a member of the Medical Advisory Board of the National Vaccine Information Center.
ANTHRAX VACCINE CAUSES GULF WAR SYNDROME
by Meryl Nass, M.D.
Until 1998, there existed no published papers that explored whether
receiving anthrax vaccine was related to Gulf War illnesses. Instead,
several expert committees (lacking experience with anthrax) were asked
to comment on whether anthrax vaccine was likely to be a cause of Gulf
War Illnesses. The committees were given DOD briefings, did not review
the literature (there were no published studies of safety or efficacy
for the licensed anthrax vaccine), concluded that a relationship was
unlikely, and then recommended against further research (1).
Studying American veterans was particularly difficult because many were
not told whether they were given anthrax vaccine, and the vaccinations
were specifically not entered into service members' shot records. Other
centralized vaccine records have been lost. Despite concerns about the
investigational status of anthrax vaccine when used for biological
warfare, no informed consent was obtained from service members at the
time of the Gulf War, and no waiver of informed consent was sought from
The Canadian Department of National Defense (DND) hired a consulting
company (Goss Gilroy Inc.) to study the health of Canadian Gulf Veterans
and look at various exposures. Their report was published on the DND
website. They found a significant relationship between receiving
non-routine (biological warfare) immunizations and developing chronic
fatigue, a very common symptom of GWS (2).
In 1999 a British study examined a large number of Gulf War exposures in
large cohorts of British Gulf War and non-deployed Gulf-era veterans,
and Bosnia veterans. They found that for both the Gulf War and the
Bosnia veterans, receiving anthrax vaccine was related to developing an
illness consistent with Gulf War Syndrome (GWS). They wrote,
"Vaccination against biological warfare and multiple routine
vaccinations were associated with the CDC multi-symptom syndrome in the
Gulf War cohort (3)."
This group published a follow-up paper in the British Medical Journal
that claimed that only Gulf War veterans who received vaccines after
deployment, not before, showed this relationship. However, they later
retracted this conclusion, and acknowledged that the timing of
vaccination did not affect the relationship between vaccination and GWS.
A study of Kansas Gulf War veterans was published in 2000 (4). This
study also found that deployment vaccines were related to GWS: 34% of
Gulf War veterans met the definition for GWS, while only 4% of non-deployed,
non-vaccinated Gulf-era veterans met the definition. However, 12% of Kansas
Gulf-era veterans who were vaccinated in preparation for deployment, but then
were not sent to the Gulf, also met the GWS definition. The paper concluded,
"Vaccines used during the war may be a contributing factor."
A second study of British Gulf War veterans was published in 4/2001.
This study looked at the relationship between various Gulf War exposures
and subsequent health. It did not look at specific deployment vaccines,
but instead evaluated the number of vaccinations received in relation to
GWS. It said, "Consistent, specific, and credible relations, warranting
further investigation, were found between health indices and two
exposures, the reported number of inoculations and days handling
The Veterans Administration collected data on thousands of Gulf War
veterans who presented for evaluation of Gulf War Syndrome. Although
unpublished, the data were presented at a conference on GWS in January
2001 (6). The VA asked veterans if they thought they had received
anthrax vaccine at the time of the Gulf War, among many other potential
exposures, and inquired about symptoms of illness. Those who believed
they had received anthrax vaccine were twice as likely to report a
multitude of symptoms as those who believed they were not vaccinated.
These are all the Gulf War data that are available in the open
literature. Every study that examined the question of whether vaccines
in general, or specific non-routine vaccines, or anthrax vaccine alone
may have contributed to GWS, has found a positive relationship.
The French Ministry of Defense (MOD) recently convened an advisory
committee to study GWS chaired by Professor Roger Salamon. This
committee reviewed the existing world literature on GWS, and suggested
that "multiple vaccinations given during the war, particularly those for
anthrax, botulinum and plague, seem associated with an excess of (GWS)
signs and symptoms (7)."
There are no published long-term adverse event data from the anthrax
vaccine immunization program, which began vaccinating servicemembers in
March, 1998. However, the unpublished study done by Captain Jean Tanner
at Dover Air Force Base suggests that recent anthrax vaccine recipients
face similar medical problems as the Gulf War veterans (8).
Meryl Nass, MD
1. Expert committees listed in my Testimony to the House National
Security Subcommittee, April 29, 1999.
2. http:// www.dnd.ca/menu/press/Reports/Health/health_study_eng_1.htm
3. Unwin C et al. Health of UK servicemen who served in the Persian Gulf
War. The Lancet 1999; 353:169-178.
4. Steele L. Prevalence and patterns of Gulf War Illness in Kansas
veterans: Association of symptoms with characteristics of person, place,
and time of military service. Am J Epidemiol 2000; 152:991-1001.
5. Cherry N et al. Health and exposures of United Kingdom Gulf War
veterans. Part II:
The relation of health to exposure. Occup Environ Med 2001; 58: 299-306.
6. Mahan CM, Kang HK, Ishii EK et al. Anthrax vaccination and
self-reported symptoms, functional status and medical conditions in the
national health survey of Gulf War era veterans and their families.
Environmental Epidemiology Service, Veterans Health Administration,
Washington, DC. Presented January 25, 2001 @ Research Working Group:
Military and Veterans Health Coordinating Board Conference on Illnesses
among Gulf War Veterans: A Decade of Scientific Research