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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)

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Table 4

Effects of individual PEP campaign factors*

Variable Median projected caseload with PEP campaign, no. Projected averted cases from campaign start, no. (%)† Projected averted deaths, no. (%) Peak hospitalizations, no.
Days required to provide PEP to entire target population
1 580 583 (55) 190 (47) 339
614 550 (52) 183 (45) 363
3 651 513 (48) 166 (41) 385
4 680 483 (46) 160 (39) 405
5 723 441 (41) 142 (35) 431
6
749
415 (39)
135 (33)
448
Delay to PEP campaign start, d¶
614 550 (52) 183 (45) 363
3 681 482 (45) 156 (38) 402
4 753 411 (39) 131 (32) 450
5 821 343 (32) 107 (26) 494
6
881
283 (27)
88 (22)
535
PEP uptake, %#
15 1,034 130 (12) 47 (12) 618
40 824 340 (32) 111 (27) 489
65§ 614 550 (52) 183 (45) 363
90
404
760 (71)
259 (63)
235
Antimicrobial efficacy, %
10 1,099 64 (6) 19 (5) 653
50 857 307 (29) 97 (24) 508
90§
614
550 (52)
183 (45)
363
Adherence to regimen at event day 60, %
15 631 533 (50) 174 (43) 370
40§ 614 550 (52) 183 (45) 363
65 597 566 (53) 184 (45) 353
90 581 583 (55) 192 (47) 342

*Estimates were calculated by using values shown in Table 2. Base case scenario is the same as PEP evaluation scenario 3 (practical) using 3 days of case data (Table 3). Without a PEP campaign, the median projected caseload would be 1,164 (Table 3, Scenario 1 [no PEP]) using 3 days of case data. PEP, postexposure prophylaxis.
†% = PEP averted cases/(median attack size estimate without a PEP campaign – cases detected to date)
‡% = PEP averted deaths/(median attack size deaths estimate without a PEP campaign). This calculation assumes no deaths within the first 3 event days.
§Baseline scenario value (Table 2).
¶Determined by counting days from date of earliest illness onset (i.e., event day 1).
#Percentage of population targeted to receive prophylaxis who actually obtain and start prophylaxis.

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1These senior authors contributed equally to this article.

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