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URGENT AND SPECIFIC PROPHYLAXIS IN THE SYSTEM OF DEFENSE AGAINST PATHOGENS

S.Yu. Pchelintsev

JSC "Institute of Immunological Engineering"

There is no doubt, that biological warfare is the most available and probable for use unconventional weapon. Accidents of late demonstrated that theoretical potency of use of this kind of warfare in shooting war outgrew in its real application in terroristic acts.

The use of bacteriological weapon in terroristic aims significantly displaces the aspects and priorities in the developed earlier schemes of prevention, dissemination and liquidation of the consequences of its application.

The following aspects should be considered:

All these above-mentioned features of biological warfare use in present-day conditions stipulate the directions of urgent and specific prophylaxis means for population protection against pathogens.

As it has been already said, the first effect of biological agent exposure on people would be infection and fierce stress. This determines the tactics of urgent prophylaxis as a complex of medicinal measures directed to non-specific control of infection process development and to liquidation of stress aftereffects.

In bioterroristic acts, a special feature of stress is its durability. The feeling of fear of infection and of attack repeat continues for a long period of time even after the agent identification, disposal of the infection source and stabilization of epidemiological situation. Prolonged application of antibiotics or any other preparations induced dysbacterioses, damages of liver, spleen, nervous system, etc. to the detriment of populace health should be considered as a harm inflicted by panic.

People being in the zone of a bioterroristic act, first of all demonstrate manifested psycho-emotional breakdowns, deviations of behavioral reactions. The anti-infection protection is down regulated on the background of immunoregulatory disorders. The activity of cardiovascular and respiratory systems disturbs significant biochemical and hormonal deviations are registered, parenchymatous organs are damaged.

Medicinal measures included in the complex of urgent prophylaxis are given in the Table 1.

Table 1. Urgent Prophylaxis

Correction of stress aftereffects Symptomatic Treatment Urgent anti-infection prophylaxis
Tranquilizers
Hypnotics
Hormonal preparations Antioxidants Immunoregulatory preparations with neuro psychotropic and anti-stress activities (cytokines)
Other preparations, normalizing functions of organs and systems
Preparations relieving clinical course of a disease
(intensive disintoxication therapy, anti-inflammatory agent, analgesics and others)

1. General (before the determination of the agent or a species of infectious toxin):
- Antibiotics of wide spectrum of action
- Antiviral preparations
- Immunity stimulators

2. Special (after the determination of the agent and its sensitivity to antibiotics):
- Antibiotics with targeted action
- Therapeutic antisera
- Therapeutic vaccines
- Anatoxins

A large number of special literatures is devoted to the pharmacological treatment of the stress aftereffects and symptomatic treatment of the infectious process. Precise schemes of medical aid for such patients following special demands of infectious diseases hospitals are developed.

General anti-infection prophylaxis is mainly aimed at the control of infectious process by antibiotics with a wide spectrum of action (fluoroquinolines, tetracyclines, benzyl penicillin, etc.), by sulfanilamides, antiviral preparations, including interferons. In this period, various synthetic and natural immunostimulators, cytokines, vitamins, hormonal drugs are widely applicated. Very often, after identification of the agent and evaluation of its sensitivity to antibiotics, special anti-microbial prophylactics is performed using the same preparations, changing only the scheme. Special, the most effective schemes of pharmacological therapy (aerosol, enteric) are developed and described for every infectious nosology. The treatment of patients affected by the agent of viral origin is the most difficult problem. There are not very many antiviral preparations, and they are poorly effective and non-specific.

Immunoprophylaxis takes a special place both in special urgent and specific anti-infection prophylaxis. And special attention should be paid to this aspect.

Specific immunotherapy is aimed to the appearance of specific antibodies against antigens or toxins of the agents in the host organism. Such antibodies appear in the organism either after active immunization, or after their inoculation with antisera (passive immunization). Vaccines could be live, inactivated and combined.

Inactivated vaccines are subdivided into:

Live vaccines are prepared based on attenuated strains of microorganisms with stable avirulence. The vaccine strain is reproduced in the organism of the inoculated and induces the vaccinal infectious process after the inoculation. The most inoculated have vaccinal infection without manifested clinical symptoms, and in the result, the stable immunity is formed as a rule.

Anatoxins are bacterial toxins neutralized with formalin at higher temperature following with purification and concentration. Anatoxins are adsorbed on various mineral adsorbents, for example, on aluminium hydroxide. Adsorption significantly up-regulates anatoxin immunogenic activity. Anatoxins provide development of a stable immunological memory, thus explaining a possibility to use anatoxins for urgent active prophylaxis of diphtheria and tetanus.

Therapeutic antisera are the blood sera of immunized or people subjected to the disease before, or animals carrying specific antibodies against the agent. Immunoglobulins isolated from such sera are often used for therapy or prophylaxis.

Possibility of application of specific immunotherapy of infections and of prophylactic vaccination against the agents, which most probably could be used as a bacteriological warfare, is represented in the Table 2.

Table 2. Disease Vaccine Therapeutic

Disease Vaccine Therapeutic Preparation
Plague Live vaccine  
Anthrax Live, chemical, combined vaccine Equine Immunoglobulins
Tularemia Live vaccine  
Pox (variola) Live vaccine (vaccinia virus) Therapeutic Serum
Botulism Anatoxin for prophylaxis in lower doses. Equine Trivalency Anatoxin
Venezuelan Equine Encephalomyelitis Live vaccine  
Marburg fever - Serum of recovered fever patients. Seldom, weak therapeutic effect.
Cholera Killed, Live Attenuated Vaccine Choleragen-anatoxin
Glanders - -
Typhus Live from avirulent strain  
Yellow fever Live attenuated vaccine  
Q-fever Inactivated vaccine  

Prophylactic inoculations against especially dangerous infections are traditionally performed in natural epidemiological foci or when professional contamination is possible. Vaccination of military contingent is performed either according to the same principles or in connection with the trips. The schemes of complex vaccination have been elaborated for military contingents. Those vaccination schemes includes up to 10-15 antigens in case of emergency (live, chemical, anti-toxic vaccines).

Another feature of biological warfare use with terroristic purposes is impossibility to perform vaccinations. It is impossible to inoculate all the population against all possible agents.

The first persons to face the situation which would arise after the use of biological warfare will be the medical profession: infectionists, epidemiologists, practitioners, staff of medicinal institutions and of various institutions of the Ministry of public health, experts, the military and services of the Ministry of extraordinary situations. Just now, this contingent is to be armed with all the needed methodical materials on clinic, diagnostic, specific prophylaxis and possible therapy of the infections, the agents of which could be used by bioterrorists. Exactly these contingents are to be inoculated not against one, but against a complex of infectious agents. They would perform the task of localization of epidemiological foci and of rendering help to the casualties. Specific prophylaxis of the population of the attacked regions using one particular vaccine should begin only after pathogen identification.

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Proceedings of First Russian Workshop on Biological Security
Copyright © Committee of Scientists for Global Security and Arms Control