Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 23, Number 1—January 2017
Research

Modeling Tool for Decision Support during Early Days of an Anthrax Event

Gabriel RainischComments to Author , Martin I. Meltzer1, Sean Shadomy, William A. Bower, and Nathaniel Hupert1
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (G. Rainisch, M.I. Meltzer, S. Shadomy, W.A. Bower, N. Hupert); Weill Cornell Medical College and New York–Presbyterian Hospital, New York, New York, USA (N. Hupert)

Main Article

Table 3

PEP scenarios, by campaign logistics and antimicrobial drug use components*

Scenario (description) Logistics components   Drug-use components
Scenario 1 (no PEP) Not applicable   Not applicable
Scenario 2 (ideal) 1-day delay,† 1-day campaign   90% uptake,‡ 80% adherence§
Scenario 3 (practical: logistics follow CRI guidance, and utilization data based on the Amerithrax attacks) 2-day delay,† 2-day campaign   65% uptake,‡ 40% adherence§
Scenario 4 (constrained) 2-day delay,† 4-day campaign   40% uptake,‡ 25% adherence§

*Amerithrax, anthrax attacks in the United States during 2001; CRI, Cities Readiness Initiative; PEP, postexposure prophylaxis.
†Delay days are determined by counting the days from the date of earliest illness onset (i.e., event day 1). Public health messaging also begins on the same day as the campaign. The delay dictates the number of days of case data potentially available as input. Two days of case data are available as input in Scenario 2, and 3 days are available as input in Scenarios 3 and 4.
‡Proportion of the population targeted by public health officials to receive PEP who actually obtain and start PEP (11).
§Proportion fully adhering to the PEP regimen on event day 60 (18).

Main Article

References
  1. Inglesby  TV, O’Toole  T, Henderson  DA, Bartlett  JG, Ascher  MS, Eitzen  E, et al.; Working Group on Civilian Biodefense. Anthrax as a biological weapon, 2002: updated recommendations for management. JAMA. 2002;287:223652.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11980524&dopt=Abstract DOIGoogle Scholar
  2. Jernigan  JA, Stephens  DS, Ashford  DA, Omenaca  C, Topiel  MS, Galbraith  M, et al.; Anthrax Bioterrorism Investigation Team. Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States. Emerg Infect Dis. 2001;7:93344. DOIPubMedGoogle Scholar
  3. Baccam  P, Willauer  D, Krometis  J, Ma  Y, Sen  A, Boechler  M. Mass prophylaxis dispensing concerns: traffic and public access to PODs. Biosecur Bioterror. 2011;9:13951.PubMedGoogle Scholar
  4. Hupert  N, Wattson  D, Cuomo  J, Hollingsworth  E, Neukermans  K, Xiong  W. Predicting hospital surge after a large-scale anthrax attack: a model-based analysis of CDC’s cities readiness initiative prophylaxis recommendations. Med Decis Making. 2009;29:42437. DOIPubMedGoogle Scholar
  5. Wein  LM, Craft  DL; Anthrax Modeling working Group. Evaluation of public health interventions for Anthrax: a report to the secretary’s council on Public Health Preparedness. Biosecur Bioterror. 2005;3:34856. DOIPubMedGoogle Scholar
  6. Zaric  GS, Bravata  DM, Cleophas Holty  JE, McDonald  KM, Owens  DK, Brandeau  ML. Modeling the logistics of response to anthrax bioterrorism. Med Decis Making. 2008;28:33250. DOIPubMedGoogle Scholar
  7. Egan  JR, Legrand  J, Hall  IM, Cauchemez  S, Ferguson  NM, Leach  S. Re-assessment of mitigation strategies for deliberate releases of anthrax using a real-time outbreak characterization tool. Epidemics. 2010;2:18994. DOIPubMedGoogle Scholar
  8. Walden  J, Kaplan  EH. Estimating time and size of bioterror attack. Emerg Infect Dis. 2004;10:12025. DOIPubMedGoogle Scholar
  9. Centers for Disease Control and Prevention. Strategic National Stockpile (SNS) [cited 2015 Apr 1]. http://www.cdc.gov/phpr/stockpile/stockpile.htm
  10. Egan  JR, Hall  IM. A review of back-calculation techniques and their potential to inform mitigation strategies with application to non-transmissible acute infectious diseases. J R Soc Interface. 2015;12:20150096. DOIPubMedGoogle Scholar
  11. SteelFisher  G, Blendon  R, Ross  LJ, Collins  BC, Ben-Porath  EN, Bekheit  MM, et al. Public response to an anthrax attack: reactions to mass prophylaxis in a scenario involving inhalation anthrax from an unidentified source. Biosecur Bioterror. 2011;9:23950. DOIPubMedGoogle Scholar
  12. Meselson  M, Guillemin  J, Hugh-Jones  M, Langmuir  A, Popova  I, Shelokov  A, et al. The Sverdlovsk anthrax outbreak of 1979. Science. 1994;266:12028. DOIPubMedGoogle Scholar
  13. Wilkening  DA. Sverdlovsk revisited: modeling human inhalation anthrax. Proc Natl Acad Sci U S A. 2006;103:758994. DOIPubMedGoogle Scholar
  14. Toth  DJ, Gundlapalli  AV, Schell  WA, Bulmahn  K, Walton  TE, Woods  CW, et al. Quantitative models of the dose-response and time course of inhalational anthrax in humans. PLoS Pathog. 2013;9:e1003555. DOIPubMedGoogle Scholar
  15. Kelly  DJ, Chulay  JD, Mikesell  P, Friedlander  AM. Serum concentrations of penicillin, doxycycline, and ciprofloxacin during prolonged therapy in rhesus monkeys. J Infect Dis. 1992;166:11847. DOIPubMedGoogle Scholar
  16. Meyerhoff  A, Albrecht  R, Meyer  JM, Dionne  P, Higgins  K, Murphy  D. US Food and Drug Administration approval of ciprofloxacin hydrochloride for management of postexposure inhalational anthrax. Clin Infect Dis. 2004;39:3038. DOIPubMedGoogle Scholar
  17. Vietri  NJ, Purcell  BK, Lawler  JV, Leffel  EK, Rico  P, Gamble  CS, et al. Short-course postexposure antibiotic prophylaxis combined with vaccination protects against experimental inhalational anthrax. Proc Natl Acad Sci U S A. 2006;103:78136. DOIPubMedGoogle Scholar
  18. Jefferds  MD, Laserson  K, Fry  AM, Roy  S, Hayslett  J, Grummer-Strawn  L, et al.; Centers for Disease Control and Prevention Anthrax Adherence Team. Adherence to antimicrobial inhalational anthrax prophylaxis among postal workers, Washington, D.C., 2001. Emerg Infect Dis. 2002;8:113844. DOIPubMedGoogle Scholar
  19. Holty  JE, Bravata  DM, Liu  H, Olshen  RA, McDonald  KM, Owens  DK. Systematic review: a century of inhalational anthrax cases from 1900 to 2005. Ann Intern Med. 2006;144:27080. DOIPubMedGoogle Scholar
  20. Barakat  LA, Quentzel  HL, Jernigan  JA, Kirschke  DL, Griffith  K, Spear  SM, et al.; Anthrax Bioterrorism Investigation Team. Fatal inhalational anthrax in a 94-year-old Connecticut woman. JAMA. 2002;287:8638. DOIPubMedGoogle Scholar
  21. Hendricks  KA, Wright  ME, Shadomy  SV, Bradley  JS, Morrow  MG, Pavia  AT, et al.; Workgroup on Anthrax Clinical Guidelines. Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis. 2014;20:20. DOIPubMedGoogle Scholar
  22. Jernigan  DB, Raghunathan  PL, Bell  BP, Brechner  R, Bresnitz  EA, Butler  JC, et al.; National Anthrax Epidemiologic Investigation Team. Investigation of bioterrorism-related anthrax, United States, 2001: epidemiologic findings. Emerg Infect Dis. 2002;8:101928. DOIPubMedGoogle Scholar
  23. Walsh  DM, Van Groningen  C, Craig  B. Logistics modelling: improving resource management and public information strategies in Florida. J Bus Contin Emer Plan. 2011;5:24656.PubMedGoogle Scholar
  24. Shepard  CW, Soriano-Gabarro  M, Zell  ER, Hayslett  J, Lukacs  S, Goldstein  S, et al.; CDC Adverse Events Working Group. Antimicrobial postexposure prophylaxis for anthrax: adverse events and adherence. Emerg Infect Dis. 2002;8:112432. DOIPubMedGoogle Scholar
  25. Brookmeyer  R, Johnson  E, Bollinger  R. Modeling the optimum duration of antibiotic prophylaxis in an anthrax outbreak. Proc Natl Acad Sci U S A. 2003;100:1012932. DOIPubMedGoogle Scholar
  26. Wright  JG, Quinn  CP, Shadomy  S, Messonnier  N; Centers for Disease Control and Prevention (CDC). Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep. 2010;59(RR-6):130.PubMedGoogle Scholar
  27. Wilkening  DA. Modeling the incubation period of inhalational anthrax. Med Decis Making. 2008;28:593605. DOIPubMedGoogle Scholar

Main Article

1These senior authors contributed equally to this article.

Page created: December 14, 2016
Page updated: December 14, 2016
Page reviewed: December 14, 2016
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external