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Adverse Reactions to Anthrax Immunisation in a Military Field Hospital
  1. Maj SC Hayes, MB ChB RAMC, Regimental Medical Officer1 and
  2. Lt Col MJ World, BSc MD FRCP RAMC, Professor of Military Medicine2
  1. 133 Field Hospital Fort Blockhouse, Gosport, Hants, PO12 2AB
  2. 2Royal Defence Medical College, Fort Blockhouse, Gosport, Hants, PO12 2AB 106201.1307{at}compuserve.com

Abstract

Objective To determine the outcome of anthrax immunisation.

Methods Adverse reactions (occurrence, nature, severity and incapacity) and immune responses to a voluntary programme of anthrax immunisation at 0, 3, 6, and 24 weeks were monitored by questionnaire and voluntary blood sampling in 129 members, including 24 immunised 7 years previously (immunes), of a military field hospital alerted for possible deployment.

Results Follow-up was complete in 85%. Ninety-eight (76%) received the first anthrax immunisation. Uptake was greater (p=0.015) in immunes. Initial prevalence of adverse reaction was 63%. Subsequent uptake and adverse reaction dwindled significantly (p<0.001). Only 28 (22%) were immunised at 24 weeks. Proportions reporting adverse reactions following the initial immunisation were greater in immunes (p=0.046) and officers (p=0.02). There was no significant (p=0.36) correlation between uptake of immunisation and prevalence of adverse reaction. Antecedent adverse reaction did not reduce the proportion of participants accepting immunisation subsequently. The nature of adverse reactions (47% local, 24% systemic and 27% both ) and severity were the same throughout. Forty-five percent of adverse reactions caused incapacity. Seventy-four percent of these had pain in the injected arm (± systemic symptoms) which prevented lifting or driving for 48 hours in 63%. Immune responses were greater in immunes.

Conclusions It was concluded that anthrax immunisation results in a higher than expected prevalence of adverse reaction with initial incapacity of military significance affecting 18%. Greater immune responses may increase adverse reaction but this does not affect acceptance of anthrax immunisation. Poor completion rates necessitate development of a new anthrax immunisation strategy.

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