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Interactions of Drugs, Biologics, and Chemicals in U.S. Military Forces
Interactions of Drugs, Biologics, and Chemicals in U.S. Military Forces
Committee to Study the Interactions of Drugs, Biologics, and Chemicals in U.S. Military Forces
Robert G. Petersdorf, William F. Page, and Susan Thaul, Editors
Medical Follow-up Agency
INSTITUTE OF MEDICINE
NATIONAL ACADEMY PRESS
Washington, D.C. 1996
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Interactions of Drugs, Biologics, and Chemicals in U.S. Military Forces
NATIONAL ACADEMY PRESS
• 2101 Constitution Avenue, N.W. • Washington, DC 20418
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.
This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.
Support for this project was provided by the Department of the Army (contract no. DAMD17-95-5028). The views, opinions, and/or findings contained in this report are those of the Committee to Study the Interactions of Drugs, Biologics, and Chemicals in U.S. Military Forces and should not be construed as an official Department of the Army position, policy or decision unless so designated by other documentation.
International Standard Book No. 0-309-05593-8
Additional copies of this report are available from:
National Academy Press
Box 285 2101 Constitution Avenue, N.W. Washington, DC 20055
Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area)
Copyright 1996 by the National Academy of Sciences . All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.
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Interactions of Drugs, Biologics, and Chemicals in U.S. Military Forces
COMMITTEE TO STUDY THE INTERACTIONS OF DRUGS, BIOLOGICS, AND CHEMICALS IN U.S. MILITARY FORCES
ROBERT G. PETERSDORF, Chair, Distinguished Professor of Medicine,
University of Washington, Puget Sound Health Care System, Seattle
DONNA DAY BAIRD, Epidemiologist,
Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
WALTER H. CARTER, Chair,
Department of Biostatistics, Virginia Commonwealth University/Medical College of Virginia
JOY A. CAVAGNARO, Senior Pharmacologist,
Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, Maryland
JOHN DOULL, Professor,
Department of Pharmacology, Toxicology and Therapeutics, University of Kansas Medical Center, Kansas City
MARY CAROLYN HARDEGREE, Director,
Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, Food and Drug Administration, Bethesda, Maryland
DAVID KORN, Professor of Pathology,
Stanford University School of Medicine and Distinguished Scholar in Residence, Association of American Medical Colleges, Washington, D.C.
GENEVIEVE M. MATANOSKI, Professor of Epidemiology,
School of Hygiene and Public Health, Johns Hopkins University
PHILIP K. RUSSELL, Professor of International Health,
School of Hygiene and Public Health, Johns Hopkins University
JAY P. SANFORD, Professor of Internal Medicine,
University of Texas Southwestern Medical Center, and Dean Emeritus, Uniformed Services University of the Health Sciences, Bethesda, Maryland
ANDY STERGACHIS, Chair,
Department of Pharmacy, School of Pharmacy, University of Washington
STEPHEN I. WASSERMAN, Chair,
Department of Medicine, University of California at San Diego Medical Center
RAYMOND S. H. YANG, Director,
Center for Environmental Toxicology and Technology, Colorado State University
Study Staff
RICHARD N. MILLER, Director,
Medical Follow-up Agency
WILLIAM F. PAGE, Study Director
CAROL A. MACZKA, Senior Program Officer
ERIN M. BELL, Research Associate
PAMELA C. RAMEY-McCRAY, Project Assistant
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Interactions of Drugs, Biologics, and Chemicals in U.S. Military Forces
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Interactions of Drugs, Biologics, and Chemicals in U.S. Military Forces
Preface
At the request of the Department of the Army, the Medical Follow-up Agency of the Institute of Medicine established a committee to review the available medical and scientific information on the interactions of drugs, biologics, and chemicals. The committee was asked to consider this topic further, specifically regarding U.S. military personnel, who are exposed to numerous drugs, biologics, and vaccines throughout their basic training and prior to and during deployment.
The committee met in Washington, D.C., on four separate occasions: September 5–6, 1995, and March 5–6, May 1–2, and June 18, 1996. During the first two meetings the committee heard testimony from officials of the U.S. Army, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the British Ministry of Defence. This report sets forth the results of the committee's deliberations.
The committee is deeply appreciative of the testimony and written material submitted by the various agencies and of the work of the Medical Follow-up Agency. In particular, the committee thanks Richard Miller, William Page, Carol Maczka, Erin Bell, Pamela Ramey-McCray, and Nancy Diener for staff support. The committee also thanks Michael Hayes and Michael Edington for editorial review.
Robert G. Petersdorf, Chair
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Interactions of Drugs, Biologics, and Chemicals in U.S. Military Forces
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Interactions of Drugs, Biologics, and Chemicals in U.S. Military Forces
Contents
EXECUTIVE SUMMARY
1
Background,
1
The Committee's Charge,
2
Scope of the Problem,
2
Categorical Approach,
3
Available Literature,
4
Uses of Automated Multipurpose Databases for Epidemiologic Surveillance,
4
Study and Management of Interactions,
5
Findings and Recommendations,
6
1
INTRODUCTION
9
Background,
9
The Committee's Charge,
10
Scope of the Problem,
10
Report Focus,
12
2
CURRENT PROPHYLACTIC AGENTS
14
Basic Preventive Series,
15
Agents Used During Deployments,
15
3
SURVEILLANCE TOOLS CURRENTLY AVAILABLE TO THE MILITARY
19
Current Military Surveillance Systems,
20
U.S. Department of Veterans Affairs Automated Databases,
27
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Interactions of Drugs, Biologics, and Chemicals in U.S. Military Forces
Current Civilian Surveillance Systems,
29
Summary of Strengths and Limitations of Current Surveillance Tools,
32
4
STRATEGY FOR IDENTIFYING AND DEALING WITH INTERACTIONS
34
Known Interactions,
35
Potential Interactions,
36
Unknown Interactions,
37
5
THE STUDY AND MANAGEMENT OF INTERACTIONS
52
Known Interactions,
52
Potential Interactions,
53
Unknown Interactions,
55
Conclusion,
68
6
FINDINGS AND RECOMMENDATIONS
69
Findings,
69
Recommendations,
70
REFERENCES
73
APPENDIX
77
GLOSSARY
79
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