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Virtual Naval Hospital

Medical Management of Biological Casualties Handbook

Appendix I: BW Agents: Vaccines, Therapeutics and Prophylactics

U.S. Army Medical Research Institute of Infectious Diseases,Fort Detrick, Frederick, Maryland
Peer Review Status: Internally Peer Reviewed


DISEASE

VACCINE

CHEMOTHERAPY (Rx)

CHEMOPROPHYLAXIS (Px)

COMMENTS

Anthrax

Michigan Biologic Products Institute vaccine (licensed) 0.5 mL SC @ 0, 2, 4 wk, 6, 12, 18 mo then annual boosters

Ciprofloxacin 400 mg IV q 8-12 h

Ciprofloxacin 500 mg PO bid x 4 wk If unvaccinated, begin initial doses of vaccine

Potential alternates for Rx: gentamicin, erythromycin, and chloramphenicol

Doxycycline 200 mg IV, then 100 mg IV q 8-12 h

Doxycycline 100 mg PO bid x 4 wk plus vaccination

Penicillin 2 million units IV q 2 h plus streptomycin 30 mg/kg IM qd (or gentamicin)

PCN for sensitive organisms only

Cholera

Wyeth-Ayerst Vaccine 2 doses 0.5 mL IM or SC @ 0, 7-30 days, then boosters Q 6 months

Oral rehydration therapy during period of high fluid loss

Vaccine not recommended for routine protection in endemic areas (50% efficacy, short term)

Tetracycline 500 mg q 6 h x 3 d

Alternates for Rx: erythromycin,

Doxycycline 300 mg once, or 100 mg q 12 h x 3 d

trimethoprim and sulfamethoxazole, and furazolidone

Ciprofloxacin 500 mg q 12 h x 3 d

Quinolones for tetra/doxy resistant strains

Norfloxacin 400 mg q 12 h x 3 d

Q Fever

IND 610 - inactivated whole cell vaccine given as

single 0.5 ml s.c. injection

Tetracycline 500 mg PO q 6 h x 5-7 d

Tetracycline start 8-12 d post-exposure x 5 d

Currently testing vaccine to determine the necessity of skin testing prior to use.

Doxycycline 100 mg PO q 12 h x 5-7 d

Doxycycline start 8-12 d post-exposure x 5 d

Glanders

No vaccine available

Sulfadiazine 100 mg/kg in divided doses x 3 weeks may be effective

TMP-SMX may be effective

Post-exposure prophylaxis may be tried with TMP-SMX

No large therapeutic human trials have been conducted owing to the rarity of naturally occurring disease.

DISEASE

VACCINE

CHEMOTHERAPY (Rx)

CHEMOPROPHYLAXIS (Px)

COMMENTS

Plague

Greer inactivated vaccine (FDA licensed): 1.0 mL IM; 0.2 mL IM 1-3 mo later; 0.2 mL 5-6 mo after dose 2; 0.2 mL boosters @ 6,12, 18 mo after dose 3 then q 1-2 years

Streptomycin 30 mg/kg/d IM in 2 divided doses x

10 d (or gentamicin)

Doxycycline 100 mg PO bid x 7 d or duration of exposure

Ciprofloxacin 500 mg PO bid x

7 d

Plague vaccine not protective against aerosol challenge in animal studies

Doxy 200 mg IV then 100 mg IV bid x 10-14 d

Doxycycline 100 mg PO bid x 7 d

Tetracycline 500 mg PO qid x 7 d

Alternate Rx: trimethoprim-sulfamethoxazole

Chloramphenicol 1 gm IV qid x 10-14 d

Chloramphenicol for plague meningitis

Tularemia

IND - Live attenuated vaccine: one dose by scarification

Streptomycin 30 mg/kg IM qd x 10-14 d

Doxycyline 100 mg PO bid x 14 d

Gentamicin 3-5 mg/kg/d IV x 10-14 d

Tetracycline 2 g/d PO x 14 d

Brucellosis

No human vaccine available

Doxycycline 200 mg/d PO plus rifampin 600-900 mg/d PO x 6 wk

Doxycycline and rifampin x 3 wk

Trimethoprim-sulfamethoxazole may be substituted for rifampin; however, relapse may reach 30%

Ofloxacin 400/rifampin 600 mg/d PO x 6 wks

Viral encephalitides

VEE DOD TC-83 live attenuated vaccine (IND): 0.5 mL SC x1 dose

Supportive therapy: analgesics and anticonvulsants prn

NA

TC-83 reactogenic in 20%

No seroconversion in 20%

Only effective against subtypes 1A, 1B, and 1C

VEE DOD C-84 (formalin inactivated TC-83) (IND): 0.5 mL SC for up to 3 doses

C-84 vaccine used for non-responders to TC-83

EEE inactivated (IND):

0.5 mL SC at 0 & 28 d

EEE and WEE inactivated vaccines are poorly

WEE inactivated (IND):

0.5 mL SC at 0, 7, and 28 d

Immunogenic. Multiple immunizations are required

DISEASE

VACCINE

CHEMOTHERAPY (Rx)

CHEMOPROPHYLAXIS (Px)

COMMENTS

Viral Hemorrhagic Fevers

AHF Candid #1 vaccine

(x-protection for BHF) (IND)

Ribavirin (CCHF/arenaviruses)

30 mg/kg IV initial dose

15 mg/kg IV q 6 h x 4 d

7.5 mg/kg IV q 8 h x 6 d

NA

Aggresive supportive care and management of hypotension very important

RVF inactivated vaccine (IND)

Passive antibody for AHF, BHF, Lassa fever, and CCHF

Smallpox

Wyeth calf lymph vaccinia vaccine (licensed): 1 dose by scarification

Cidofovir (effective in vitro)

Vaccinia immune globulin 0.6 mL/kg IM (within 3 d of exposure, best within 24 h)

Pre and post exposure vaccination recommended if > 3 years since last vaccine

Botulism

DOD pentavalent toxoid for serotypes A - E (IND): 0.5 ml deep SC @ 0, 2 & 12 wk, then yearly boosters

DOD heptavalent equine despeciated antitoxin for serotypes A-G (IND): 1 vial (10 mL) IV

Skin test for hypersensitivity before equine antitoxin administration

CDC trivalent equine antitoxin for serotypes A, B, E (licensed)

StaphylococcusEnterotoxin B

No vaccine available

Ventilatory support for inhalation exposure

Ricin

No vaccine available

Inhalation: supportive therapy G-I : gastric lavage, superactivated charcoal, cathartics

T-2 Mycotoxins

No vaccine available

Decontamination of clothing and skin

 

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