IOM: States, locals should decide where to store anthrax drugs

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Sep 30, 2011 (CIDRAP News) – Positioning supplies of antibiotics in communities has been proposed as the next step to prepare for a Bacillus anthracis attack, and state and local public health officials are in the best position to determine where and how they should be stored, an Institute of Medicine (IOM) expert group reported today.

Antibiotics are the cornerstone of the government's response to a B anthracis attack, because they can help prevent death in people who have inhaled anthrax spores, which can travel long distances. The government has plenty of antibiotics in the Strategic National Stockpile (SNS), but it faces the complex task of deciding how to get them to people when needed as quickly as possible.

Currently, the plan for deploying antibiotics following a large-scale B anthracis attack relies on delivery from state stockpiles to regional distribution points, with the goal of getting them to people who need them within 48 hours of the decision to mobilize the medications.

The IOM expert committee weighed three different "prepositioning" strategies that it said could help lighten the burden on current dispensing systems: forward-deploying antibiotics near dispensing locations, storing them at dispensing locations such as workplaces and healthcare facilities, and predispensing them to individuals with a standard prescription or a "MedKit" that should only be opened after an attack.

The 359-page report was commissioned by the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the US Department of Health and Human Services (HHS) and appears on the IOM's Web site. Chaired by Dr Robert Bass of the Maryland Institute for Emergency Medical Services System, the 16-member committee that produced the report began its work in October 2010. The group's four meetings included two open sessions and a 2-day public workshop.

The panel considered the benefits and costs of each strategy, as well how locations have different risks of attack and dispensing capabilities. According to the report, some of the group's concerns and deliberations were influenced by challenges encountered during the distribution of the 2009 H1N1 pandemic influenza vaccine.

State, local, and tribal health officials should work with federal authorities to assess the different options and decide on the best and speediest strategy, the group recommended. However, they advised against broad use of home storage, citing possible antibiotic misuse and higher costs of administering such systems.

The committee found limited evidence that developing a MedKit approved by the US Food and Drug Administration (FDA) would lower the risk of inappropriate use, but suggested that targeted personal stockpiling might be helpful for some groups, such as for first responders, healthcare workers, people who play other critical roles, and those who can't travel to antibiotic dispensing sites because of medical conditions.

The report contains detailed guidance to help policymakers and public health officials assess the benefits of different prepositioning strategies, such as factors to consider in gauging the risk of an attack and the ability to quickly detect one.

Among other findings, the group noted that prepositioning a single type or class of antibiotic would reduce the flexibility to respond to a resistant B anthracis strain. In examining the limited scientific data on inhalational anthrax incubation times, they said the most probable minimum period is about 4 days, and that the current goal of completing prophylaxis distribution is appropriate, so long as the interval from exposure to prophylaxis is no longer than 96 hours.

Additional recommendations include developing national guidance for public-private coordination on prepositioning activities, distribution, and dispensing. The experts also urged HHS to conduct more research to address uncertainty over prepositioning issues, particularly in the areas of epidemiology, clinical issues, logistics, behavior and demographics, safety, and cost-effectiveness.

See also:

Sep 30 IOM report

Sep 30 National Academies press release

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