Microbial Risk Assessment, Emergency Response Department, Health Protection Agency, Porton Down, Salisbury, Wiltshire, SP4 0JG, UK.
Epidemics. 2010 Dec;2(4):189-94. doi: 10.1016/j.epidem.2010.06.001. Epub 2010 Jun 10.
Responding rapidly and appropriately to a covert anthrax release is an important public health challenge. A methodology to assist the geographical targeting of such a response has recently been published; as have a number of independent studies that investigate mitigation strategies. Here, we review and combine some of these published techniques to more realistically assess how key aspects of the public health response might impact on the outcomes of a bioterrorist attack. We combine a within-host mathematical model with our spatial back-calculation method to investigate the effects of a number of important response variables. These include how previously reported levels of adherence with taking antibiotics might affect the total outbreak size compared to assuming full adherence. Post-exposure vaccination is also considered, both with and without the use of antibiotics. Further, we investigate a range of delays (2, 4 and 8 days) before interventions are implemented, following the last day of symptomatic onset of some number of observed initial cases (5, 10 and 15). Our analysis confirms that outbreak size is minimised by implementing prophylactic treatment after having estimated the exposed area based on 5 observed cases; however, imperfect (rather than full) adherence with antibiotics results in approximately 15% additional cases. Moreover, of those infected individuals who only partially adhere with a prophylactic course of antibiotics, 86% remain disease free; a result that holds for scenarios in which infected individuals inhale much higher doses than considered here. Increasing logistical delays have a particularly detrimental effect on lives saved with an optimal strategy of early identification and analysis. Our analysis shows that it is critical to have systems and processes in place to rapidly identify, geospatially analyse and then swiftly respond to a deliberate anthrax release.
迅速、恰当地应对炭疽的秘密释放是一个重要的公共卫生挑战。最近发表了一种帮助对这种反应进行地理定位的方法；还有一些独立的研究调查了缓解策略。在这里，我们回顾并结合了一些已发表的技术，以更真实地评估公共卫生应对的关键方面可能如何影响生物恐怖袭击的结果。我们将一个宿主内的数学模型与我们的空间回溯方法相结合，以研究许多重要的反应变量的影响。这些变量包括以前报告的抗生素服用依从率如何影响总爆发规模，与假设完全依从相比。还考虑了暴露后接种疫苗，包括有无抗生素的情况。此外，我们还研究了在实施干预措施之前延迟 2、4 和 8 天的情况，这是在观察到的一些初始病例（5、10 和 15）的最后一天出现症状后。我们的分析证实，通过根据 5 个观察病例估算暴露区域，然后实施预防性治疗，可以将疫情规模最小化；然而，抗生素的不完全（而不是完全）依从性会导致约 15%的额外病例。此外，在只有部分感染者遵循预防性抗生素疗程的情况下，86%的感染者没有发病；这一结果适用于感染者吸入比这里考虑的更高剂量的情况。增加后勤延迟对早期识别和分析的最优策略下挽救的生命有特别不利的影响。我们的分析表明，迅速识别、地理空间分析然后迅速应对蓄意炭疽释放，建立系统和流程至关重要。
