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Anthrax





Quick Facts: Anthrax Anthrax is a serious bacterial infection and is not contagious;

The most common way to become infected is through the skin by direct exposure to an infected animal, or animal waste and by-products or contaminated soil

Veterinarians, farmers or researchers working with animals are at higher risk of being infected by anthrax;

Anthrax can enter the bloodstream from a cut in the skin, inhaling anthrax spores into the lungs, or by swallowing anthrax spores;

If left untreated with antibiotics, lethal toxins from the anthrax bacteria can multiply in the body and kill quickly;

The mortality rate for skin acquired anthrax that is untreated is 10 to 20 percent but very low if antibiotic therapy is begun promptly;

The mortality rate for anthrax acquired by inhaling into the lungs or through the gastrointestinal tract is much higher. Anthrax Vaccine Anthrax vaccine is licensed for use in adults between the ages of 18 and 65, who are at high risk for exposure to anthrax bacteria;

There is no anthrax vaccine licensed for use in children and the vaccine is not recommended for pregnant women;

BioThrax anthrax vaccine manufactured by Emergent BioSolutions is required for U.S. soldiers and adult military service personnel;

A series of five shots are given and individuals are not considered protected until they have the full series;

Not all individuals who receive anthrax vaccine may be protected and there is very limited data on effectiveness of the vaccine for inhalation anthrax;

Reported mild to moderate anthrax vaccine reactions include local swelling, pain and redness at the injection site, fever, chills and nausea that resolve without permanent damage;

Reported serious anthrax vaccine reactions involve autoimmune and brain dysfunction, including chronic disabling fatigue, persistent headaches, severe joint pain and crippling arthritis, numbness and muscle weakness, paralysis, brain inflammation, seizures, permanent memory loss and death.

Using the MedAlerts search engine, as of March 31, 2020 there had been 9046 adverse events reported to the Vaccine Adverse Events Reporting System (VAERS) in connection with anthrax-containing vaccines since 1990. Over 83 percent of those were anthrax vaccine-related adverse events occurring in adults ages 17-44. Of these anthrax-vaccine related adverse event reports to VAERS, 31 were deaths, with over half of the deaths occurring in in adults 17-44 years of age. Food & Drug Administration (FDA) BioThrax® - (Anthrax Vaccine Adsorbed)& Licensing Information Centers for Disease Control (CDC) CDC Anthrax Information

Anthrax Vaccine Information Statement (VIS) Department of Defense (DOD) MilVax information about anthrax, anthrax vaccine and mandatory anthrax vaccination policies of U.S. military. Vaccine Reaction Symptoms & Ingredients Our Ask 8, If You Vaccinate webpage contains vaccine reaction symptoms and more Search for Vaccine Reactions NVIC hosts MedAlerts, a powerful VAERS database search engine. MedAlerts examines symptoms, reactions, vaccines, dates, places, and more. Reporting a Vaccine Reaction Since 1982, the NVIC has operated a Vaccine Reaction Registry, which has served as a watchdog on VAERS. Reporting vaccine reactions to VAERS is the law. If your doctor will not report a reaction, you have the right to report a suspected vaccine reaction to VAERS. IMPORTANT NOTE: NVIC encourages you to become fully informed about Anthrax and the Anthrax vaccine by reading all sections in the Table of Contents , which contain many links and resources such as the manufacturer product information inserts, and to speak with one or more trusted health care professionals before making a vaccination decision for yourself or your child. This information is for educational purposes only and is not intended as medical advice.

What Is Anthrax?

Anthrax is a serious bacterial infection caused by Bacillus anthracis and it is not contagious.

Anthrax 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. Inpiduals 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.

Can Anthrax Cause Injury & Death?

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.

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.

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.

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.

Can You Get Anthrax from An Infected Person?

No. Not being a contagious disease, it is not possible for someone, who is directly exposed to anthrax spores and becomes sick, to transmit the disease to someone else by coughing or sneezing like many infectious diseases are spread. Each inpidual, 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.

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.

Has Anthrax Been Used for Bioterrorism?

There has never been a successful delivery of weaponized inhalation anthrax to any large population through a bomb, missile, crop duster or any other means. 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.

One article published in the medical literature 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. However, there has been no public confirmation that Iraq or any other country outside of Russia has developed a genetically engineered, weaponized strain of anthrax that can be successfully deployed in the form of a bioterrorism weapon to harm U.S. citizens.

On December 18, 2001, letters contaminated with a lab-developed experimental Ames strain of anthrax was sent through the mail to several U.S legislators on Capitol Hill in Washington, D.C. Immediately, 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 experimental strain of anthrax, to be given anthrax shots.

The civilians were urged to get the shots as well as finish a two- month course of antibiotics, primarily Cipro. Health officials maintained that anyone exposed to the experimental anthrax bacteria, could be harboring anthrax spores in their lungs and may become ill once they stop using the antibiotics.

It became evident that those still unidentified inpiduals, who sent letters containing anthrax spores through the U.S. mail system in 2001, had access to a strain of weaponized anthrax that had been processed into a high grade powder form. Genetic testing 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 of anthrax was provided to other labs doing anthrax research, reportedly 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 anthrax 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.

How Is Anthrax Diagnosed and Treated?

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.

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 pharmaceutical products, including antibiotics, like all vaccines, carry an inherent risk of injury or death for some inpiduals. After the anthrax contaminated letters were sent through the U.S. mail in 2001, postal workers were encouraged to get anthrax shots as well as take long term courses of antibiotics. Some of the workers had reactions to the antibiotics.

When taking long term antibiotic therapy, it is important to be aware of potential side effects. 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 for Treated Anthrax: The mortality rate for skin acquired 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.

What Is Anthrax Vaccine?

The manufacturer product information insert for anthrax vaccine (BioThrax manufactured by Emergent BioSolutions, Inc.) states:

“BioThrax, Anthrax Vaccine Adsorbed, is a sterile, milky-white suspension for intramuscular injections made from cell-free filtrates of microaerophilic cultures of an avirulent, nonencapsulated strain of Bacillus anthracis. The production cultures are grown in a chemically defined protein-free medium consisting of a mixture of amino acids, vitamins, inorganic salts and sugars. The final product, prepared from the sterile filtrate culture fluid contains proteins, including the 83kDa protective antigen protein, released during the growth period and contains no dead or live bacteria. The final product is formulated to contain 1.2 mg/mL aluminum, added as aluminum hydroxide in 0.85% sodium chloride. The final product is formulated to contain 25 μg/mL benzethonium chloride and 100 μg/mL formaldehyde, added as preservatives.”

Anthrax vaccine is licensed for use in adults between the ages of 18 and 65, who are at high risk for exposure to anthrax bacteria. There is no anthrax vaccine licensed for use in children.

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 inpiduals 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 to weaponized inhalation anthrax 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 continuing mandatory vaccination of all active duty and reserve personnel with anthrax vaccine a very controversial policy.

Harrison’s Principles of Internal Medicine (Thirteenth Edition, 1994) says of the currently licensed anthrax vaccine still routinely being given to all U.S. soldiers and military personnel:

“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.”

How Effective Is Anthrax Vaccine?

The current anthrax vaccine is given in a five-dose series over an 18 month period, followed by annual booster shots to maintain protection for those inpiduals at risk. Inpiduals are not considered protected until they have completed the full five-dose vaccination series.

The anthrax vaccine product information insert states that ”Vaccination with BioThrax may not protect all inpiduals. The extent to which one is protected prior to completion of the full immunization schedule is unknown.”

There is limited published data on controlled human trials to test the effectiveness 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 acquired anthrax.

However, 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. 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, weaponized strain of anthrax that is not covered by the vaccine strain, the vaccine may have limited or no effectiveness.

Can Anthrax Vaccine Cause Injury and Death?

The anthrax vaccine product information insert states: “ The most common ( > 10%) local (injection-site) adverse reactions observed in clinical studies were tenderness, pain, erythema and arm motion limitation. The most common ( > 5%) systemic adverse reactions were muscle aches, headache, and fatigue. Serious allergic reactions, including anaphylactic shock, have been observed during post-marketing surveillance in inpiduals receiving BioThrax.”

Most of the safety studies done on anthrax vaccine have been conducted by the Department of Defense. Many of these studies are unpublished and reportedly do not include long term follow-up, according to military veterans advocacy groups who have reported anthrax vaccine damage. Some have estimated that 20 to 48 percent of all those vaccinated have some kind of reaction to anthrax vaccine, ranging from mild to severe. Reported mild to moderate anthrax vaccine reactions have included not only severe local pain, swelling and redness at the injection site, but also fever, chills, and nausea that resolve without permanent damage.

Serious anthrax vaccine reactions resulting in permanent autoimmune and brain dysfunction have been reported and include:

chronic disabling fatigue;

persistent headaches;

severe joint pain and crippling arthritis;

numbness and muscle weakness;

severe memory loss;

paralysis;

brain inflammation

seizures;

death.

The BioThrax product information insert lists, among other serious health problems reported after use of anthrax vaccine, the following:

lymphadenopathy;

erythema multiforme;

Stevens Johnson syndrome;

paresthesia syncope;

tremor;

myalgia;

alopecia (hair loss);

cellulitis;

chronic fatigue;

mood-cognition problems.

As of March 31, 2019 there have been more than 9046 anthrax vaccine-related health problems reported to the federal Vaccine Adverse Events Reporting System (VAERS), including nearly 400 reports of cases that ended with permanent disability and 31 deaths. Many of the serious anthrax vaccine adverse events in the VAERS database are associated with soldiers and military personnel receiving BioThrax vaccine simultaneously with other vaccines, such as smallpox vaccine, even though the manufacturer states in the product information insert that BioThrax has never been studied in controlled clinical trials in combination with other vaccines given simultaneously.

In the late 1990’s and early 2000’s, congressional hearings were 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 anthrax vaccination policies. Testimony from vaccine injured military veterans included several hundred cases where career soldiers have faced court martial rather than agree to be vaccinated or revaccinated with anthrax vaccine after serious reactions have occurred.

Who Should Not Get Anthrax Vaccine?

Anthrax vaccine is licensed for inpiduals between the ages of 18 and 65, who are at high risk for being exposed to anthrax. There is no anthrax vaccine that has been tested or licensed for children under age 18.

What the Manufacturer Says: The anthrax vaccine manufacturer, Emergent BioSolutions, warns that "the use of BioThrax is contraindicated in persons with a history of anaphylactic or anaphylactic like reaction following a previous dose of BioThrax."

Pregnant Women: Anthrax vaccine has been assigned a Pregnancy Category “D” rating by the FDA, which means that there is positive evidence of risk revealed in human studies or fetal risk has been demonstrated in investigational or post-marketing surveillance data. The Emergent BioSolution product information insert also states: “BioThrax can cause fetal harm when administered to a pregnant woman” and also states that “Pregnant women should not be vaccinated against anthrax unless the potential benefit of vaccination have been determined to outweigh the potential risk to the fetus.”

Simultaneous Administration With Other Vaccines: The Emergent BioSolutions product information insert states” No prospective controlled clinical studies to assess the concomitant administration of BioThrax with other vaccines have been performed.”

History of Anthrax Vaccine Manufacturing

The anthrax vaccine was developed in the 1960’s at Fort Detrick by the Department of Defense, which still holds the patent. It was approved for licensure by the FDA in 1970.

For many years, the anthrax vaccine used by veterinarians, researchers and those handling animal products that could be contaminated with anthrax bacteria, was manufactured by the Michigan Department of Health in a Lansing, Michigan lab. The vaccine manufacturing plant owned by the state also had been used for many years to manufacture and distribute DPT vaccine for Michigan state residents.

In 1998, BioPort Corporation, headed by U.S. Admiral William J. Crowe, Jr. (now deceased) and international business entrepreneur Fuad El-Hibri, purchased the Michigan state lab. Anthrax vaccine manufacturing was taken over by Bioport Corporation when they purchased the Michigan state 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 failed FDA quality control inspection several times, which resulted in interruption of anthrax vaccine supplies and use of the vaccine by the military. In 2004, BioPort underwent corporate restructuring and was renamed Emergent BioSolutions.

Since 1998, BioPort/Emergent BioSolutions has delivered more than 30 million doses of anthrax vaccine, primarily to the U.S. Department of Defense as the sole source supplier of anthrax vaccine for the U.S. military. In 2009, the FDA granted Emergent Biosolutions a shelf life extension for BioThrax from three to four years.

In May 2011, the U.S. government awarded Emergent Biosolutions a 5-year sole source contract for the purchase of nearly 45 million doses of BioThrax.

What Is the Current Anthrax Vaccine Policy for U.S. Military Personnel?

After September 11, 2001, about 500,000 of the 2.4 million U.S. troops and reservists were given anthrax shots by November 2001. In response to the exposure of U.S. civilians to anthrax in 2001 through contaminated mail, the Centers for Disease Control made plans to make some of the military anthrax vaccine stockpiles available to lab technicians, bioterrorism investigators, “first responders” (police, firefighters, medical personnel) and others at high risk for weaponized anthrax exposure.

The anthrax vaccine given to military personnel and civilians after Sept. 11, 2001 had never received final FDA approval for being an effective way to prevent infection with inhalation anthrax, which is theoretically how the organism would be turned into a bioterrorism weapon. Therefore, BioThrax vaccine continued to be classified as experimental.

In December 2003 in response to a lawsuit brought on behalf of soldiers injured by anthrax vaccine, a federal court judge issued an injunction preventing the U.S. military from requiring soldiers to get anthrax shots without their voluntary, informed consent until the vaccine was no longer classified as “experimental” and was licensed by the FDA as safe and effective against inhalation anthrax. Between December 2003 and the end of 2005, the Department of Defense was compelled to inform military personnel about the benefits and risks of anthrax vaccine and obtain their informed, voluntary consent before vaccination.

In December 2005, the FDA licensed BioThrax as safe and effective against any form of anthrax exposure, including inhalation anthrax. Anthrax vaccine safety advocacy groups protested that the government had not done adequate additional testing of the vaccine’s safety and effectiveness against inhalation anthrax to justify removal of the “experimental vaccine” designation.

In 2006, the DOD reinstituted a mandatory anthrax vaccination policy for all soldiers and adult U.S. military personnel, which did not require obtaining informed consent.

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. For more information on general questions to consider when deciding about whether or not to use a particular vaccine, please visit our Ask 8 webpage.

NVIC Press Releases, Statements & Commentaries Related to Anthrax

The Vaccine Reaction

Parpia R, Fisher BL The Anthrax Vaccine and Gulf War Illness The Vaccine Reaction 30, 2017

Videos

“Direct Order” Documentary—Soldiers Ordered to Take Anthrax Vaccine The Vaccine Reaction 15, 2016

Links

Select Military and Biodefense Vaccine Project (MBVP) Articles

News Articles

References

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

( www.house.gov/reform ; www.access.gpo.gov/congress/cog005.html)

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 .