Hamilton Michael A, Hong Tao, Casman Elizabeth, Gurian Patrick L
Department of Civil, Architectural and Environmental Engineering, Drexel University, Philadelphia, PA, USA.
ICF International, Durham, NC, USA.
Risk Anal. 2015 Jul;35(7):1348-63. doi: 10.1111/risa.12383. Epub 2015 May 5.
This article presents an analysis of postattack response strategies to mitigate the risks of reoccupying contaminated areas following a release of Bacillus anthracis spores (the bacterium responsible for causing anthrax) in an urban setting. The analysis is based on a hypothetical attack scenario in which individuals are exposed to B. anthracis spores during an initial aerosol release and then placed on prophylactic antibiotics that successfully protect them against the initial aerosol exposure. The risk from reoccupying buildings contaminated with spores due to their reaerosolization and inhalation is then evaluated. The response options considered include: decontamination of the buildings, vaccination of individuals reoccupying the buildings, extended evacuation of individuals from the contaminated buildings, and combinations of these options. The study uses a decision tree to estimate the costs and benefits of alternative response strategies across a range of exposure risks. Results for best estimates of model inputs suggest that the most cost-effective response for high-risk scenarios (individual chance of infection exceeding 11%) consists of evacuation and building decontamination. For infection risks between 4% and 11%, the preferred option is to evacuate for a short period, vaccinate, and then reoccupy once the vaccine has taken effect. For risks between 0.003% and 4%, the preferred option is to vaccinate only. For risks below 0.003%, none of the mitigation actions have positive expected monetary benefits. A sensitivity analysis indicates that for high-infection-likelihood scenarios, vaccination is recommended in the case where decontamination efficacy is less than 99.99%.
本文分析了在城市环境中释放炭疽芽孢杆菌孢子（导致炭疽病的细菌）后，为降低重新进入受污染区域的风险而采取的袭击后应对策略。该分析基于一个假设的袭击场景，即个体在初始气溶胶释放期间接触到炭疽芽孢杆菌孢子，随后服用预防性抗生素，这些抗生素成功保护他们免受初始气溶胶暴露的影响。然后评估因孢子再悬浮和吸入而重新进入受孢子污染建筑物的风险。所考虑的应对选项包括：对建筑物进行去污、对重新进入建筑物的个体进行疫苗接种、将个体从受污染建筑物中延长撤离，以及这些选项的组合。该研究使用决策树来估计一系列暴露风险下替代应对策略的成本和收益。模型输入最佳估计值的结果表明，对于高风险场景（个体感染几率超过11%），最具成本效益的应对措施包括撤离和建筑物去污。对于4%至11%的感染风险，首选方案是短期撤离、接种疫苗，然后在疫苗生效后重新进入。对于0.003%至4%的风险，首选方案是仅接种疫苗。对于低于0.003%的风险，没有任何缓解措施具有正的预期货币收益。敏感性分析表明，对于高感染可能性场景，在去污效果低于99.99%的情况下建议接种疫苗。
