Abstract
Health officials lack field-implementable tools for forecasting the effects that a large-scale release of Bacillus anthracis spores would have on public health and hospitals. We created a modeling tool (combining inhalational anthrax caseload projections based on initial case reports, effects of variable postexposure prophylaxis campaigns, and healthcare facility surge capacity requirements) to project hospitalizations and casualties from a newly detected inhalation anthrax event, and we examined the consequences of intervention choices. With only 3 days of case counts, the model can predict final attack sizes for simulated Sverdlovsk-like events (1979 USSR) with sufficient accuracy for decision making and confirms the value of early postexposure prophylaxis initiation. According to a baseline scenario, hospital treatment volume peaks 15 days after exposure, deaths peak earlier (day 5), and recovery peaks later (day 23). This tool gives public health, hospital, and emergency planners scenario-specific information for developing quantitative response plans for this threat.
Highlights
Health officials lack field-implementable tools for forecasting the effects that a large-scale release of Bacillus anthracis spores would have on public health and hospitals
The back-calculation techniques of Egan et al permit estimation of the final outbreak size after a certain number of observed cases under different postexposure prophylaxis (PEP) assumptions [7,10]. These models can be reconciled with the Cities Readiness Initiative (CRI) timeline, they were not designed for direct use by public health practitioners, and the earlier work assumes 90% PEP uptake by the infected population, which is an overestimation (>25%) of the probable public response [11]
Our modeling tool provides estimates of future inhalation anthrax (IA) caseloads over time and quantifies the effects of various prophylaxis and treatment response options
Summary
Health officials lack field-implementable tools for forecasting the effects that a large-scale release of Bacillus anthracis spores would have on public health and hospitals. Walden and Kaplan built a model that presumes equal probability of various event sizes and requires at least 5 days of case data before robust estimates of final attack sizes can be calculated [8] This timing may be insufficient given the US Cities Readiness Initiative (CRI) guideline that postexposure prophylaxis (PEP) dispensing be completed within 48 hours of event detection [9]. The back-calculation techniques of Egan et al permit estimation of the final outbreak size after a certain number of observed cases under different PEP assumptions [7,10] These models can be reconciled with the CRI timeline, they were not designed for direct use by public health practitioners (use requires the R coding language and understanding of maximum-likelihood functions), and the earlier work assumes 90% PEP uptake by the infected population, which is an overestimation (>25%) of the probable public response [11]. It is unclear whether plume modeling is sufficiently timely and robust to guide local response decisions
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