Screening for Anthrax Postexposure Antibiotic Prophylaxis—The New York City Approach

Mark Misener, David T. Starr, Allison J. Scaccia, Vibhuti Arya
2018 Health Security  
Individuals exposed to spores of B. anthracis must take a course of antibiotics as postexposure prophylaxis (PEP) to prevent inhalation anthrax. During an anthrax event, public health authorities are responsible for conducting dispensing operations to offer PEP to exposed individuals. Jurisdictions have developed antibiotic PEP screening algorithms to determine which antibiotic is appropriate for each individual. Variability exists with regard to screening questions and dispensing decisions
more » ... d on responses to those questions. It is likely that individuals with similar profiles will receive different antibiotics based solely on the jurisdiction in which they receive their PEP. This lack of consistency among jurisdictions may lead to a loss of confidence in the public health response among the public, the healthcare community, the media, and government leaders, which could compromise the response itself. We present New York City's planning assumptions, screening algorithm, a rationale for our screening questions, and our reasons for excluding screening questions asked by other jurisdictions. We hope that our efforts may assist others in developing and refining their algorithms and associated public messaging and encourage standardization with neighboring jurisdictions where appropriate. P ublic health planning for and response to a largescale release of aerosolized spores of Bacillus anthracis, the agent that causes inhalation anthrax, incorporates many critical elements. The identification and treatment of ill individuals, communication with the public and local stakeholders (eg, healthcare providers, media, elected officials), and the dispensing of antibiotics and vaccine as postexposure prophylaxis (PEP) to all potentially exposed individuals must be considered. Depending on the location, quantity, and mechanism of an anthrax release, thousands to millions of people from many jurisdictions may be exposed and require PEP. These individuals will need to obtain PEP from points of dis-pensing (PODs) or other dispensing options operated under the jurisdiction of state and local health authorities. State and local public health authorities throughout the United States, including the New York City Department of Health and Mental Hygiene (DOHMH), have developed screening algorithms to determine what type of antibiotic PEP is dispensed to clients in response to an anthrax attack. Yet, as has been described, these were developed using general guidance, but not specific recommendations, from federal health authorities. 1 Therefore, variation exists among these algorithms with regard to screening questions and the dispensing choices based on responses to those questions. Given this variation, it is highly likely that clients with similar
doi:10.1089/hs.2018.0025 pmid:30133374 fatcat:q5crxn3syfd35jfnalbwuiow3i