Anthrax vaccine adsorbed (AVA) is the only FDA-licensed human anthrax vaccine in the United States. It is produced under the trade name BioThrax by the Emergent BioDefense Corporation (formerly known as BioPort Corporation) in Lansing, Michigan. The parent company of Emergent BioDefense is Emergent BioSolutions of Rockville, Maryland. It is sometimes called MDPH-PA or MDPH-AVA after the former Michigan Department of Public Health (MDPH; succeeded by the Michigan Department of Health and Human Services), which formerly was involved in its production. AVA originated in studies done in the 1950s and was first licensed for use in humans in 1970. In the US, the principal purchasers of the vaccine are the Department of Defense and Department of Health and Human Services. Ten million courses (60 million doses) of the vaccine have been purchased for the US Strategic National Stockpile in anticipation of the need for mass vaccinations owing to a future bio-terrorist anthrax attack. The product has attracted some controversy owing to alleged adverse events and questions as to whether it is effective against the inhalational form of anthrax. Description
Antigen
AVA is classified as a subunit vaccine that is cell-free and containing no whole or live anthrax bacteria. The antigen (immunologically active) portions are produced from culture filtrates of a toxigenic, but avirulent, nonencapsulated mutant — known as V770-NP1-R — of the B. anthracis Vollum strain. (The Vollum strain was the same one weaponized by the old U.S. biological warfare program.)
Bronchopulmonary dysplasia (BPD; part of the spectrum of chronic lung disease of infancy) is a chronic lung disease in which premature infants, usually those who were treated with supplemental oxygen, require long-term oxygen. The alveoli that are present tend to not be mature enough to function normally. It is more common in infants with low birth weight (LBW) and those who receive prolonged mechanical ventilation to treat respiratory distress syndrome (RDS). It results in significant morbidity and mortality. The definition of BPD has continued to evolve primarily due to changes in the population, such as more survivors at earlier gestational ages, and improved neonatal management including surfactant, antenatal glucocorticoid therapy, and less aggressive mechanical ventilation.Currently the description of BPD includes the grading of its severity into mild, moderate and severe. This correlates with the infants maturity, growth and overall severity of illness. The new system offers a better description of underlying pulmonary disease and its severity. Presentation
Complications
Feeding problems are common in infants with bronchopulmonary dysplasia, often due to prolonged intubation. Such infants often display oral-tactile hypersensitivity (also known as oral aversion). Physical findings:
hypoxemia;
hypercapnia;
crackles, wheezing, & decreased breath sounds;
increased bronchial secretions;
hyperinflation;
frequent lower respiratory infections;
delayed growth & development;
cor pulmonale;
CXR shows with hyperinflation, low diaphragm, atelectasis, cystic changes. Cause
Prolonged high oxygen delivery in premature infants causes necrotizing bronchiolitis and alveolar septal injury, with inflammation and scarring. This results in hypoxemia. Today, with the advent of surfactant therapy and high frequency ventilation and oxygen supplementation, infants with BPD experience much milder injury without necrotizing bronchiolitis or alveolar septal fibrosis.