Abstract
Coxiella burnetii is a category B bioterrorism agent. We numerically evaluated the risks and benefits from postexposure prophylaxis (PEP) after an intentional release of C. burnetii to the general population, pregnant women, and other high-risk populations. For each group, we constructed a decision tree to estimate illness and deaths averted by use of PEP/100,000 population. We calculated the threshold points at which the number of PEP-related adverse events was equal to the cases averted. PEP was defined as doxycycline (100 mg 2x/day for 5 days), except for pregnant women, where we assumed a PEP of trimethoprim-sulfamethoxazole (160 mg/800 mg 2x/day) for the duration of the pregnancy. PEP would begin 8-12 days postexposure. On the basis of upper-bound probability estimates of PEP-related adverse events for doxycycline, we concluded that the risk for Q fever illness outweighs the risk for antimicrobial drug-related adverse events when the probability of C. burnetii exposure is >or=7% (pregnant women using trimethoprim-sulfamethoxazole = 16%).
Highlights
Coxiella burnetii is a category B bioterrorism agent
Total medical outcomes averted for each group were calculated by using the following general equation: Total medical cases averted = (Total adverse health outcomes caused by Q fever without postexposure prophylaxis (PEP))
Without taking social or political concerns into account, a threshold point can be interpreted as the decision point for PEP use
Summary
Coxiella burnetii is a category B bioterrorism agent. We numerically evaluated the risks and benefits from postexposure prophylaxis (PEP) after an intentional release of C. burnetii to the general population, pregnant women, and other high-risk populations. On the basis of upper-bound probability estimates of PEP-related adverse events for doxycycline, we concluded that the risk for Q fever illness outweighs the risk for antimicrobial drug–related adverse events when the probability of C. burnetii exposure is >7% (pregnant women using trimethoprim-sulfamethoxazole = 16%). Studies have cited that 10%–30% of all patients with acute disease report persistent symptoms (e.g., fatigue, myalgia, night sweats) more than a year after acute infection occurred [10,16]. Pregnant women are at increased risk for severe acute C. burnetii infection because of the bacterium’s predilection for the placenta. Premature birth (33%) and spontaneous abortion/neonatal deaths (39%) occur frequently in acutely ill pregnant women [17]
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