To blunt anthrax attack, mail carriers to get antibiotics

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Oct 2, 2008 (CIDRAP News) – Federal health officials yesterday announced a plan to supply mail carriers with antibiotics so they will be protected and prepared to deliver the drugs to others in case of an anthrax attack.

The program will start with a $500,000 pilot project involving carriers in Minneapolis and St. Paul, which were chosen because of their extensive bioterrorism preparations, according to an Associated Press (AP) report yesterday.

"In an anthrax attack, time is of the essence," Health and Human Services (HHS) Secretary Mike Leavitt said in a news release. "By providing advance protection to letter carriers who volunteer to deliver antibiotics in an affected community, we can gain the benefits of the unique capabilities of the Postal Service to get much needed medicine to those who need it quickly."

Inhalational anthrax is usually fatal unless the patient is treated with antibiotics early. In 2001, five people died and 17 others got sick after envelopes containing anthrax spores were sent to several media offices and two US senators.

In recent years, HHS and the Postal Service ran exercises in which mail carriers in Seattle, Philadelphia, and Boston delivered empty pill bottles and explanatory fliers to residents. Carriers paired up with police officers to distribute the items, the AP reported. William Raub, Leavitt's senior science adviser, said that 50 carriers reached about 53,000 Philadelphia households in 8 hours, according to the story.

The tests were part of the Cities Readiness Initiative (CRI), a federally funded effort to equip 72 major cities with the ability to deliver antibiotics to their entire populations within 48 hours, in the name of bioterrorism preparedness.

According to the AP, the Postal Service and its unions told the government that carriers who volunteered to deliver antibiotics in an anthrax emergency would need assurances that they and their families would be protected. That led to the idea of giving carriers a supply of doxycycline to keep at home for themselves and their families. In an emergency, they could start taking the drug while the government brought in supplies that the carriers would deliver to residents.

In Minneapolis and St. Paul, about 700 carriers who deliver to homes in 20 ZIP codes are eligible for the pilot project, the AP reported. Medical teams will screen volunteers to make sure it would be safe for them to take doxycycline. The carriers also will have to be sufficiently fit to wear masks to protect them against anthrax while walking their routes, the story said.

Volunteers will receive extensive education and will be instructed not to use their doxycycline for any reason other than an anthrax emergency, according to the AP.

If the Minnesota pilot project works well, the program could be offered to other cities starting next year, the story said.

Leavitt and Homeland Security Secretary Michael Chertoff took steps yesterday to clear the way for mail carriers to legally receive the antibiotics, according to the HHS release. The two officials made an emergency declaration, which permits the Food and Drug Administration to consider issuing an Emergency Use Authorization, required under federal law for distribution of the drugs.

In a related action, Leavitt issued a declaration under the Public Readiness and Emergency Preparedness Act that provides liability protection for activities related to the use of measures to prepare for and respond to an anthrax attack, HHS announced. The protection covers activities ranging from development and manufacture of countermeasures to administering and using them.

In other related news, Emergent BioSolutions Inc. announced yesterday it had signed a contract to deliver another 14.5 million doses of BioThrax, the only US-licensed anthrax vaccine, to HHS for the Strategic National Stockpile. The total value of the contract will be between $364 million and $404 million, depending on whether the company can supply vaccine with a 4-year shelf life.

The company, based in Rockville, Md., is scheduled to start delivering the vaccine in the third quarter of 2009 and to finish 2 years later, according to a news release. The firm has been supplying BioThrax to the government under a $448 million contract for 18.75 million doses, with deliveries expected to continue until shipments under the new contract start.

See also:

Oct 1 HHS news release
http://www.hhs.gov/news/press/2008pres/10/20081001a.html

Oct 1 Emergent BioSolutions news release
http://investors.emergentbiosolutions.com/phoenix.zhtml?c=202582&p=irol-newsArticle&ID=1204156

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