Brookmeyer Ron, Johnson Elizabeth, Bollinger Robert
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA.
Proc Natl Acad Sci U S A. 2003 Aug 19;100(17):10129-32. doi: 10.1073/pnas.1631983100. Epub 2003 Jul 30.
A critical consideration in effective and measured public health responses to an outbreak of inhalational anthrax is the optimum duration of antibiotic prophylaxis. We develop a competing-risks model to address the duration of antibiotic prophylaxis and the incubation period that accounts for the risks of spore germination and spore clearance. The model predicts the incubation period distribution, which is confirmed by empirical data. The optimum duration of antibiotic prophylaxis depends critically on the dose of inhaled spores. At high doses, we show that exposed persons would need to remain on antibiotic prophylaxis for at least 4 months, and considerable morbidity would likely occur before antibiotic prophylaxis could even be initiated. At very low doses, 60 days of antibiotic prophylaxis is adequate. Exposure doses can be estimated from the cumulative attack rate up to the point antibiotic prophylaxis begins. The model explains that whereas < or =60 days of antibiotics were enough to protect persons in the 2001 U.S. outbreak, because doses were very low, at moderate or high doses considerably longer durations would be necessary to adequately protect exposed populations.
在对吸入性炭疽疫情做出有效且适度的公共卫生应对措施时，一个关键的考虑因素是抗生素预防的最佳持续时间。我们开发了一个竞争风险模型，以解决抗生素预防的持续时间和潜伏期问题，该模型考虑了孢子萌发和孢子清除的风险。该模型预测了潜伏期分布，这一点得到了实证数据的证实。抗生素预防的最佳持续时间严重依赖于吸入孢子的剂量。在高剂量情况下，我们表明暴露人群需要接受至少4个月的抗生素预防，并且在甚至能够开始抗生素预防之前，可能会出现相当高的发病率。在非常低的剂量下，60天的抗生素预防就足够了。暴露剂量可以从开始抗生素预防时的累积发病率来估计。该模型解释说，在2001年美国疫情中，≤60天的抗生素足以保护人群，因为剂量非常低，但在中高剂量情况下，需要相当长的时间才能充分保护暴露人群。
