Anthrax Attack Plans Need to Be Handled Locally, Report Says

Institute of Medicine committee recommends local officials plan antibiotic distribution

By Steven Reinberg
HealthDay Reporter

FRIDAY, Sept. 30 (HealthDay News) -- Since the 9/11 tragedy and the anthrax scare that followed in its wake, Americans have lived with the potential threat of another, possibly more serious, anthrax attack.

Now, a new report from the Institute of Medicine advises that plans for making antibiotics available to respond to a large-scale anthrax attack should be drawn up by local officials and based on the level of risk and the ability to get antibiotics to those affected.

"There are a lot of details involved," said Dr. Gordon Dickinson, a professor of infectious diseases at the Miller School of Medicine at the University of Miami. He was not involved in drafting the report.

"You've got to have local involvement to decide about distribution and where the needs are," Dickinson said. "So, leaving it up to local people makes sense."

To prevent anthrax from developing after exposure, antibiotics are most effective when taken before symptoms start, usually about four days or so after exposure, according to the report.

Currently, plans on the federal, state and local level are based on getting antibiotics from the U.S. Centers for Disease Control and Prevention's Strategic National Stockpile, which maintains medical supplies that can be rapidly sent to affected areas.

In an anthrax attack, antibiotics from these stockpiles would be sent to distribution points located throughout an affected region. The goal of the program is to get antibiotics to those exposed within 48 hours.

"Delivering antibiotics effectively following an anthrax attack is a tremendous public health challenge," Robert Bass, chair of the committee that wrote the report and executive director of the Maryland Institute for Emergency Medical Services Systems, said in a statement.

"The Strategic National Stockpile has ample supplies of the antibiotics. The issue is not whether inventory is adequate, but how to get the medication into people's hands soon enough to be effective. Because needs and capabilities vary across the country, state and local governments will have to examine which strategies would work best for them should an attack occur," he said.

Making this happen can be difficult, so the report advises that "each jurisdiction should assess the benefits and costs of different strategies for storing antibiotics locally and determine which ones would be most appropriate for their communities."

For communities most at risk, such as major metropolitan areas, the committee recommended that local officials should consider stockpiling antibiotics themselves. This could get them to exposed people faster, the committee noted.

However, the downside to this strategy is cost, because this approach is more expensive than relying on a centralized distribution system. In addition, once such a plan is in place it is difficult to change, the committee added.

In locales where the threat is low, this stockpiling approach may not add any capability not already covered by the CDC's stockpile.

No plan is foolproof, Dickinson said. People will get sick and some will die in an attack regardless of how carefully the response is planned, he explained.

Another strategy the committee considered was giving antibiotics to people before an attack occurs, much as people working in nuclear power plants are given iodine tablets in case of a radiation leak or attack on the plant.

Antibiotic prescriptions or emergency kits are two ways antibiotics could be made available to people before an anthrax attack.

The committee, however, rejected this approach because it was not cost-effective and it left the door open for abusing the antibiotics. Examples of using the antibiotics inappropriately include taking them to treat an unrelated condition or when they were not needed, such as reacting to a false alarm or an anthrax attack that is far away.

Dickinson noted that only those exposed to anthrax need to be treated. The bacteria are not transmitted from person to person. However, panic in an anthrax attack is perhaps more of a problem than treating those directly exposed, he said.

While this strategy is not for most people, first responders, health care providers and other public safety personnel might benefit from having a kit containing antibiotics, the report says.

This might also be a viable approach for people who, due to a medical condition, would not be able to get to a distribution center to get antibiotics in an anthrax attack.

In addition, the report offers communities guidance in how to assess and plan for delivering antibiotics in cases of an attack. The committee notes that the report is limited to antibiotics used in an anthrax attack and does not relate to planning for "other kinds of terrorist attacks, natural disasters and infectious diseases."

The study was sponsored by the U.S. Department of Health and Human Services.

More information

For more information on anthrax, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Gordon Dickinson, M.D., professor, infectious diseases, Miller School of Medicine, University of Miami; Sept. 30, 2011, Institute of Medicine report, Prepositioning Antibiotics for Anthrax

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