Immunogenicity and safety of four different dosing regimens of anthrax vaccine adsorbed for post-exposure prophylaxis for anthrax in adults

Abstract

Background: Strategies to implement post exposure prophylaxis (PEP) in case of an anthrax bioterror event are needed. To increase the number of doses of vaccine available we evaluated reducing the amount of vaccine administered at each of the vaccinations, and reducing the number of doses administered.

Methods: Healthy male and non-pregnant female subjects between the ages of 18 and 65 were enrolled and randomized 1:1:1:1 to one of four study arms to receive 0.5 mL (standard dose) of vaccine subcutaneously (SQ) at: (A) days 0, 14; (B) days 0 and 28; (C) days 0, 14, and 28; or (D) 0.25 mL at days 0, 14, and 28. A booster was provided on day 180. Safety was assessed after each dose. Blood was obtained on days 0, 7, 14, 21, 28, 35, 42, 49, 56, 63, 70, 84, 100, 180, and 201 and both Toxin Neutralizing antibody and anti-PA IgG antibody measured.

Results: Almost all subjects developed some local reactions with 46-64% reported to be of moderate severity and 3.3% severe during the primary series. Vaccine groups that included a day 14 dose induced a ≥ 4 fold antibody rise in more subjects on days 21, 28, and 35 than the arm without a day 14 dose. However, schedules with a full day 28 dose induced higher peak levels of antibody that persisted longer. The half dose regimen did not induce antibody as well as the full dose study arms.

Conclusion: Depending on the extent of the outbreak, effectiveness of antibiotics and availability of vaccine, the full dose 0, 28 or 0, 14, 28 schedules may have advantages.

Keywords: Anthrax; Post exposure prophylaxis; Vaccine.

Figure 1

Progress of subjects through trial

Figure 2

Antibody response over time: A) Geometric mean titer of TNA NF₅₀ antibody B) Geometric mean concentration of anti-PA IgG Enzyme Linked Immunosorbent Assay (ELISA) Blood was obtained at specified time points for the 4 study arms evaluated and antibody titers determined as described in the methods.

Figure 2

Antibody response over time: A) Geometric mean titer of TNA NF₅₀ antibody B) Geometric mean concentration of anti-PA IgG Enzyme Linked Immunosorbent Assay (ELISA) Blood was obtained at specified time points for the 4 study arms evaluated and antibody titers determined as described in the methods.