Anthrax vaccinations delayed as officials struggle to explain process

Thursday, December 20th 2001, 12:00 am

By: News On 6

WASHINGTON (AP) _ Local health officials advised thousands of Washington postal workers not to get anthrax vaccine, as federal scientists struggled to dispel confusion over just who should consider the experimental inoculations.

Shots could begin on Capitol Hill as early as Thursday afternoon, as the Centers for Disease Control and Prevention put the final touches on a consent form, written in layman's terms, explaining the pros and cons.

But a day after the CDC announced it would offer either experimental vaccinations or 40 more days of antibiotics to thousands who were heavily exposed to anthrax during the bioterror attacks-by-mail, confusion escalated over just who the government thinks really needs the extra therapy.

``We're in a state of quandary,'' said U.S. Postal Service vice president Azeezaly Jaffer.

Thousands of postal workers in several states, including Jaffer, are potential candidates for extra therapy but can't tell if they're at high enough risk to seek it out, he said. Nor do they know where to get it.

``The employees are hungry for information, and they're trying to understand what it is that the medical community wants them to do,'' Jaffer said.

``I fully understand the frustration,'' CDC Director Dr. Jeffrey Koplan told The Associated Press. But because anthrax attacks have never happened before, ``there's no scientific literature that says `you get it and you don't.' It ends up being a judgment call.''

With the CDC refusing to recommend that people choose one way or the other, Washington's health department late Wednesday night issued an advisory saying local postal workers need no more treatment and should merely watch out for suspicious symptoms. Anyone who wishes either the vaccine or another 40 days of antibiotics should contact the CDC directly, said Mayor Anthony Williams. The CDC had not yet issued a phone number for such people to call.

In contrast, Capitol Hill physicians have recommended that 70 workers there get vaccinated, and several said in interviews they planned to.

The worry is that animal studies suggest in rare cases, anthrax can lurk in the body for more than the 60 days of antibiotic therapy typically prescribed. There's no evidence that has ever happened in people, but because the mailed anthrax was so potent, and doctors have little experience treating people, the CDC decided to be excessively cautious and offer certain people additional therapy.

Koplan said three groups should consider seriously accepting the options:

_People who had significant contact with an anthrax-laced powder or envelope, which mostly includes 70 Capitol Hill workers nearby when a heavily contaminated letter to Senate Majority Leader Tom Daschle was opened.

_People who worked in areas where someone became infected with inhaled anthrax.

_People in environments heavily contaminated with anthrax.

Those last two groups include workers in Washington's central Brentwood and New Jersey's Hamilton Township postal facilities, he said.

But even those people must weigh if they're willing to take more antibiotics or three vaccine injections, both options that can cause side effects, he said. People who can see a doctor easily for any anthrax-like symptoms might choose merely to monitor their health closely for another month, he said.

``There really is value in people with any of these potential exposures to discuss it with someone they trust who is a medical authority,'' Koplan said.

CDC officials spent several hours answering questions and, in a few cases, handing out additional antibiotics to some Senate workers Wednesday. Koplan said similar help would be available to post office workers.

Anthrax vaccine itself is not experimental, used for decades by veterinarians, scientists and the military. But it has never been given after exposure to anthrax, so it is uncertain whether it will work for these people.

Thus, anyone seeking vaccination must sign the CDC-written consent form, which will outline side effects including swelling, sometimes severe and lasting weeks, at the injection site and rare but sometimes serious allergic reactions.

Another complication: the vaccine was made by BioPort Inc. of Lansing, Mich., which has not been allowed to sell the shots for several years because the Food and Drug Administration has repeatedly cited the company for improper manufacturing practices. BioPort took a step toward resuming routine vaccine production Wednesday when the FDA completed an inspection that found a handful of problems yet to be fixed. The FDA cautioned that full licensing awaits at least one more inspection, of a BioPort contractor, next month.

However, the FDA has tested the 10,000 doses of vaccine that the CDC is offering to people exposed to anthrax and certified its safety.