Vaccines, therapeutics, and prophylaxis for selected biological warfare agents. (Rx).

The threat of bioterrorism has stimulated renewed interest in the "Blue Book," a pocket-sized manual published by the U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Md. The fourth edition of the manual, entitled "Medical Management of Biological Casualties Handbook" (February 2001), includes a summary of medical agents from which this table is adapted.

The authors note that although most of the regimens are based on standard treatment guidelines, some regimens may differ because the clinical presentation of certain diseases caused by biological weapons can vary from the endemic form. The regimens may be derived from in vitro data, animal models, and limited human data.

The authors also note that the investigational new drug (IND) products that are mentioned are often used in laboratory settings to protect health care workers, but these products are not available commercially and can be given only under a protocol with informed consent. They are mentioned for scientific completeness and are not necessarily to be construed as recommendations for therapy.

The online version of the "Blue Book" manual is available at www.usamriid.army.mil/education/bluebook.html and at www.nbc-med.com. To order the printed manual, contact Diane Sexton at the Document Automation and Production Service at Aberdeen (Md.) Proving Grounds by calling 410-278-4635, sending a fax to 410-278-5080, or sending an e-mail to dsexton@daps.dla.mil.

 
DISEASE         VACCINE 
 
Anthrax         BioPort vaccine (licensed): 0.5 mL 
                given subcutaneously at 0, 2, and 4 
                wk and 6, 12, and 18 mo, then 
                annual boosters 
 
 
 
 
Botulism        Department of Defense pentavalent 
                toxoid vaccine for serotypes A-E 
                (IND): 0.5 mL by deep 
                subcutaneous injection at 0, 2, and 
                12 wk, then annual boosters 
 
Brucellosis     No human vaccine available 
 
 
 
 
Cholera         Wyeth-Ayerst vaccine: two doses of 
                0.5 mL each, given IM or 
                subcutaneously at 0 and 7-30 days, 
                then boosters every 6 months 
 
 
 
 
 
 
Plague          Greer inactivated vaccine (licensed) 
                is no longer available 
 
 
 
 
 
 
 
 
 
Q fever         Investigational new drug (IND) 610: 
                inactivated whole-cell vaccine given 
                as single 0.5-mL subcutaneous 
                injection 
 
 
 
Smallpox        Wyeth calf lymph vaccinia vaccine 
                (licensed): single dose by 
                scarification 
 
Tularemia       ND, live attenuated vaccine: single 
                0.1-mL dose given by scarification 
 
 
 
 
 
 
 
 
Viral           Venezuelan equine encephalitis TC- 
encephalitides  83 live attenuated vaccine (IND): 
                single 0.5-mL subcutaneous dose; 
                Venezuelan equine encephalitis C- 
                84 vaccine (formalin-inactivated TC- 
                83, ND): up to three 0.5-mL doses 
                given subcutaneously; Eastern equine 
                encephalitis inactivated vaccine (IND): 
                0.5 mL given subcutaneously at 0 and 
                28 days; Western equine encephalitis 
                inactivated vaccine (IND): 0.5 mL given 
                subcutaneously at 0, 7, and 28 days 
 
Viral           Argentine hemorrhagic fever Candid 
hemorrhagic     No. 1 vaccine (cross-protection for 
fevers          Bolivian hemorrhagic fever) (IND); 
                Rift Valley fever inactivated vaccine 
                (IND) 
 
 
 
 
DISEASE         CHEMOPROPHYLAXIS 
 
Anthrax         Oral ciprofloxacin 500 mg b.i.d. for 
                4 wk; if unvaccinated, begin initial 
                doses of vaccine OR 
                Oral doxycycline 100 mg b.i.d. for 
                4 wk plus vaccination 
                In the absence of vaccine, continue 
                chemoprophylaxis for at least 60 days. 
 
Botulism        NA 
 
 
 
 
 
Brucellosis     Oral doxycycline 200 mg/day plus 
                oral rifampin 600 mg/day for 6 wk 
 
 
 
Cholera         NA 
 
 
 
 
 
 
 
 
 
Plague          Oral doxycycline 100 mg b.i.d. for 
                7 days or duration of exposure OR 
                Oral ciprofloxacin 500 mg b.i.d. for 
                7 days OR 
                Oral tetracycline 500 mg q.i.d. for 
                7 days 
 
 
 
 
 
Q fever         Oral tetracycline 500 mg q.i.d. for 
                5 days (start 8-12 days after 
                exposure) OR 
                Oral doxycycline 100 mg b.i.d. for 
                5 days (start 8-12 days after 
                exposure) 
 
Smallpox        IM vaccinia immune globulin 0.6 
                mL/kg within 3 days of exposure; 
                best within 24 hr 
 
Tularemia       Oral doxycycline 100 mg b.i.d. for 
                14 days OR 
                Oral tetracycline 500 mg q.i.d. for 
                14 days OR 
                Oral ciprofloxacin 500 mg every 12 
                hr for 14 days 
 
 
 
 
Viral           NA 
encephalitides 
 
 
 
 
 
 
 
 
 
 
 
Viral           NA 
hemorrhagic 
fevers 
 
 
 
 
 
 
DISEASE         CHEMOTHERAPY 
 
Anthrax         IV ...