Local Health Department Considers the 49th Hour through Long-Term Mass Prophylaxis Planning

Anthrax response plans, exercises, and assessments over the past decade have focused almost exclusively on the first 48 hours of the public health response following a jurisdiction-wide exposure and provision of an initial 10-day supply of antibiotics from the Strategic National Stockpile (SNS). But mass dispensing of the subsequent 50-day course of antibiotics and administration of the 3-dose vaccine series have received considerably less attention, although these follow-up activities may prove even more complex. In 2014, the Philadelphia Department of Public Health (PDPH) made its first foray into this next frontier of mass prophylaxis planning conducting an exercise to assess throughput and accuracy and to evaluate the resources needed to operationalize a long-term mass dispensing model. The data and findings of the PDPH exercise are explained in detail in The 49th Hour: Analysis of a Follow-up Medication and Vaccine Dispensing Field Test in the Journal of Health Security.

There are many challenges associated with conducting a long-term mass medication response:

  • Acquiring the necessary staff, medications, ancillary supplies, and access to facilities to conduct operations to carry-out follow-up dispensing operations.
  • Medication compliance issues with persons taking their 50-day antibiotic courses as directed and persons returning for the three shots of anthrax vaccine needed to provide lasting immunity.
  • Adverse events would be likely for many persons taking antibiotics over an extended time and persons with pre-existing medical conditions or contraindications may need follow-up care from the healthcare community.
  • The healthcare community of the impacted jurisdiction would be overwhelmed handling the medical service needs; particularly renal care providers who would need to re-dose medications for many patients.
  • The epidemiological and environmental data needed to refine the population needing follow-up medications may not be available by the time follow-up operations need to occur.
  • Taking medications for an extended period could also lead to antibiotic resistance in other pathogens and to the development of Clostridium difficile colitis infections could occur in many individuals.
  • The public messaging of such a response would be a challenging for the affected jurisdiction and the surrounding areas.

Despite these challenges, the model presented in the publication offers an example of how a local jurisdiction approached 50-day antibiotic medication screening and dual model pill and vaccine point of dispensing (POD). This planning is timely as the BP3 Operational Readiness Review (ORR) tool contained a section assessing jurisdictional plans to sustain medication dispensing follow-on needs for the 50-day antibiotic course dispensing campaign. Official guidance to address the many complexities of a long-term response has not yet been released but it is likely that some guidance on long-term mass medication planning will be released over the course of the next year.

The authors of the publication will be presenting their long-term mass medication model and exercise findings at the 2015 Preparedness Summit on Thursday, April 16th from 10:30 AM-12 PM. The authors of the publication are eager to hear other people’s thoughts on this model and welcome insights from other jurisdictions who may have thought about the challenges of such a response. Feel free to share your ideas and thoughts at the Summit session or in the comment box below. This session will be recorded and posted on the Summit learning portal for those not able to attend in-person.

About Raymond Puerini

Raymond Puerini, MPH, is a Senior Program Analyst on the Environmental Health, Pandemic Preparedness, and Catastrophic Response team at NACCHO. His work includes sharing best practices for the distribution and dispensing of medical countermeasures and developing policy and guidance to support strategic national stockpile responses. Twitter: @Are_You_Ray_Dy

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