TABLE 8-6
Potential Countermeasures for Botulism

Antidote	Efficacy	Availability	Potential Civilian Utility	Stockpile
Active immunization: vaccine (toxoid of serotypes A—E) Formalin-fixed crude culture supernatant from strains producing appropriate serotypes vaccination 0, 2, and 12 weeks with annual booster.	~ 80% of recipients exhibit protective titers (CDC standard > 0.25 IU/ml) at 14 weeks; at 1 year booster almost none with measurable titer. Booster results in 90% of individuals with good response. Fully protects animals from all routes of challenge.	Investigational (IND)	Preexposure Task force	Health dept.
Passive immunization: Horse antibotulism serum (globulin) A despeciated globulin treated with Pepsin to produce F(ab1)2 Basic immunoglobulin molecule altered by removing complement- fixing (Fc) region to concentrate antigen binding sites.	Decreases risk of serum sickness of older equine version: Studied in monkeys with serotype A prevents disease development if pretreated. When given after exposure protective if given before the onset of clinical signs. If given after the onset of symptoms, no protection.	Research	Yes Postevent Prehospital and postexposure high-risk	Health dept.
Recombinant vaccines	Will enhance safety	Investigational		N/A
Monoclonal antibodies	Will enhance safety	Investigational		N/A
Aminopyridines (3,4-diaminopyridine)a	Limited success with prevention and reversal of muscle paralysis for human serotype A. in animal studies. No effect for other serotypes. High toxicity potential.	Not under further study.		N/A
Chimer of receptor binding protein for botulinum molecule (either monoclonal antibody or drug to neutralize intracellularly)	Preclinical studies only	Research		N/A
Botulism immune globulin harvested from human donors experimentally exposed to toxoidb	Longer biological half life with prolonged effective level	Investigational	Preexposure, postevent Prehospital and postexposure high-risk	Health dept.

^aSiegel et al., 1986; ^bFrankovich and Arnon, 1991.

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