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From page 1... ... Delivering antibiotics effectively following an anthrax attack is a tremendous public health challenge, however, because of the large number of people who may be exposed and the brief time window during which people exposed to anthrax spores must start taking antibiotics to prevent illness and death. This report considers the use of prepositioning strategies to com plement current plans for distributing and dispensing anthrax antibi otics, which rely heavily on postattack delivery from the centralized Strategic National Stockpile or state stockpiles. Read the entire page →
From page 2... ... Delivering antibiotics effectively following an anthrax attack is a tremendous public health challenge, however, because of the large number of people who may be exposed and the brief time window during which people exposed to anthrax spores must start taking antibiotics to prevent illness and death. Since the anthrax attack in 2001, the nation has made much progress in developing plans for the rapid delivery of antibiotics. Read the entire page →
From page 3... ... Discussions about prepositioning strategies over the past several years, however, have raised concern about their potential to introduce increased health risks, increased costs, legal and regulatory issues, questions of equity and fairness, and logistical burdens on public health departments. Prepositioning is just one potential component of a larger endeavor to enhance the nation's capability to prevent illness and death from an anthrax attack. Read the entire page →
From page 4... ... More specifically, the ad hoc committee will produce a report that will: • C onsider the role of prepositioned medical countermeasures for the public (e.g., prepositioning at home, local stockpiles, and work place caches) within an overall MCM dispensing strategy that in cludes traditional MCM dispensing and distribution strategies such as points of dispensing (PODs) Read the entire page →
From page 5... ... Finally, the committee identified federal- and national-level actions that would facilitate the evaluation and development of prepositioning strategies. ANTIBIOTICS FOR POSTEXPOSURE ANTHRAX PROPHYLAXIS Inhalational anthrax is considered to be the most dangerous form of anthrax infection resulting from bioterrorism because aerosolized spores of B Read the entire page →
From page 6... ... A clear understanding of the incubation period is critical for decision making about effective antibiotic distribution and dispensing strategies, including prepositioning strategies. An exposed population will exhibit a range of times from exposure to the appearance of symptoms for the exact same exposure/dose, and the shape of the distribution curve is important for decision making about prophylaxis strategies. Read the entire page →
From page 7... ... Finding 2-2: Review of the limited available data on human inhalational anthrax shows that people exposed to aerosolized anthrax have incubation periods of 4 to 8 days or longer. Much of the modeling used to derive shorter estimates is based on data from the Sverdlovsk incident,3 and the assumptions made potentially lead to an underestimate of the minimum incubation period. Read the entire page →
From page 8... ... Example strategies Example strategies Example strategies include personal include MCM forward- include workplace stockpiles and MedKits. deployed by the SNS; and hospital caches. Read the entire page →
From page 9... ... The Department of Health and Human Services should convene state, local, and tribal governments and private-sector organizations to de velop national guidance that will facilitate and ensure consistency for public-private cooperation in the prepositioning, distribution, and dis pensing of medical countermeasures and help leverage existing private sector systems and networks. A DECISION-AIDING FRAMEWORK FOR STATE, LOCAL, AND TRIBAL PUBLIC HEALTH OFFICIALS Because communities differ in their needs and capabilities, the committee developed a decision-aiding framework to assist state, local, and tribal public health officials in determining whether prepositioning strategies would be beneficial for their community. Read the entire page →
From page 10... ... The committee developed a decision-aiding framework to assist state, local, and tribal jurisdictions in deciding which prepositioning strategies, if any, to implement in their community. The key elements of this framework are: • A ssessment of risk and current capabilities -- Consideration of the risk of an anthrax attack -- Assessment of current capability for timely detection of an attack -- Assessment of current dispensing capability, including (1) Read the entire page →
From page 11... ... More specifically, the Centers for Disease Control and Prevention, in collaboration with state, local, and tribal jurisdictions, should facilitate assessment of the entire distribu tion and dispensing system by: • d emonstrating Strategic National Stockpile distribution capabilities to high-risk jurisdictions; • f acilitating large-scale, realistic exercises in high-risk jurisdictions to test dispensing capability; and • c ontinuing efforts to identify objective criteria and metrics for evaluating the performance of jurisdictions in implementing mass dispensing. Incorporation of Ethical Principles and Public Engagement Jurisdictions must ensure that their dispensing plans adhere to ethical principles with respect to both general considerations in drafting public health policy and issues specific to the question of prepositioning anthrax MCM. Read the entire page →
From page 12... ... • P roportionality -- Use burdensome measures, such as those that restrict liberty, only when they offer a commensurate gain in public health and when no less onerous alternatives are both available and feasible. • C ommunity engagement -- Engage the public in the development of ethically sound dispensing plans for medical countermeasures, including plans to preposition antibiotics, so as to ensure the in corporation of community values. Read the entire page →
From page 13... ... Importance of Adequate Dispensing Capability and Timely Decision to Dispense In the event of an attack, forward-deploying stockpiles and caches will have the potential to decrease morbidity and mortality only if the community has adequate dispensing capability, and the time from release until dispensing is initiated is brief compared with the minimum incubation period. Analytical models of existing distribution strategies show that in the event of a large-scale attack, dispensing capability -- not antibiotic inventories -- is likely to be the rate-limiting factor in getting antibiotics to the potentially exposed population. Read the entire page →
From page 14... ... Recommendation 5-4: Give priority to improving dispensing capabil ity and developing prepositioning strategies such as forward-deployed or cached medical countermeasures. In public health planning efforts, state, local, and tribal jurisdictions should give priority to improving the dispensing capability of points of dispensing and push strategies and to developing forward-deployed or cached prepositioning strategies. Read the entire page →
From page 15... ... exposed and potentially exposed individuals. c MCM dispensing capability in the event of a large attack. Read the entire page →
From page 16... ... The available evidence and reasoning leading to the committee's conclusions and recommendations with respect to predispensed MCM are summarized below. Predispensed Medical Countermeasures Predispensing of MCM is unique relative to other potential prepositioning strategies because it puts the MCM directly into the hands of the intended end-users. Read the entire page →
From page 17... ... , the risk of not getting antibiotics following an anthrax attack may outweigh the potential health risks associated with inappropriate use. In addition, with a more limited, targeted strategy, or a strategy that involves a direct relationship between patient and physician, it may be easier to provide patient education about proper antibiotic use, institute systems to decrease inappropriate use and manage costs, and/or develop an alternative dispensing mechanism in case of an attack with antibioticresistant anthrax. Read the entire page →
From page 18... ... (Recommendation 6-1) rapidly following an anthrax attack regardless of specific decisions made about prepositioning. Read the entire page →
From page 19... ... The Department of Health and Human Services should conduct additional research in the following broad areas: epidemiological and medical issues regarding anthrax and postexposure prophylaxis for anthrax, operations and logistics, behavior and communications, safety, and cost-effectiveness. Read the entire page →

From page 1...

... Delivering antibiotics effectively following an anthrax attack is a tremendous public health challenge, however, because of the large number of people who may be exposed and the brief time window during which people exposed to anthrax spores must start taking antibiotics to prevent illness and death. This report considers the use of prepositioning strategies to com plement current plans for distributing and dispensing anthrax antibi otics, which rely heavily on postattack delivery from the centralized Strategic National Stockpile or state stockpiles.

Summary Pages 1-20

Summary
Pages 1-20