Evaluation of anthrax vaccine safety in 18 to 20 year olds: A first step towards age de-escalation studies in adolescents

Abstract Background/objectives Anthrax vaccine adsorbed (AVA, BioThrax ® ) is recommended for post-exposure prophylaxis administration for the US population in response to large-scale Bacillus anthracis spore exposure. However, no information exists on AVA use in children and ethical barriers exist to performing pre-event pediatric AVA studies. A Presidential Ethics Commission proposed a potential pathway for such studies utilizing an age de-escalation process comparing safety and immunogenicity data from 18 to 20 year-olds to older adults and if acceptable proceeding to evaluations in younger adolescents. We conducted exploratory summary re-analyses of existing databases from 18 to 20 year-olds ( n  = 74) compared to adults aged 21 to 29 years ( n  = 243) who participated in four previous US government funded AVA studies. Methods Data extracted from studies included elicited local injection-site and systemic adverse events (AEs) following AVA doses given subcutaneously at 0, 2, and 4 weeks. Additionally, proportions of subjects with ≥4-fold antibody rises from baseline to post-second and post-third AVA doses (seroresponse) were obtained. Results Rates of any elicited local AEs were not significantly different between younger and older age groups for local events (79.2% vs. 83.8%, P  = 0.120) or systemic events (45.4% vs. 50.5%, P  = 0.188). Robust and similar proportions of seroresponses to vaccination were observed in both age groups. Conclusions AVA was safe and immunogenic in 18 to 20 year-olds compared to 21 to 29 year-olds. These results provide initial information to anthrax and pediatric specialists if AVA studies in adolescents are required.