An ounce of prevention is a ton of work: mass antibiotic prophylaxis for anthrax, New York City, 2001

Abstract

Protocols for mass antibiotic prophylaxis against anthrax were under development in New York City beginning in early 1999. This groundwork allowed the city's Department of Health to rapidly respond in 2001 to six situations in which cases were identified or anthrax spores were found. The key aspects of planning and lessons learned from each of these mass prophylaxis operations are reviewed. Antibiotic distribution was facilitated by limiting medical histories to issues relevant to prescribing prophylactic antibiotic therapy, formatting medical records to facilitate rapid decision making, and separating each component activity into discrete work stations. Successful implementation of mass prophylaxis operations was characterized by clarity of mission and eligibility criteria, well-defined lines of authority and responsibilities, effective communication, collaboration among city agencies (including law enforcement), and coordination of staffing and supplies. This model can be adapted for future planning needs including possible attacks with other bioterrorism agents, such as smallpox.

Figure 1

Point of distribution (POD) site organizational chart. OEM, Mayor’s Office of Emergency Management; PIC, physician-in-charge; Epi, epidemiologic; DOH, Department of Health. Dotted boxes = areas of responsibility; dotted lines = shared communications.*For operational purposes, the epidemiologic team leader reported to the PIC.

Figure 2

Two (A, B) point of distribution site floor plans. Epi, epidemiologic; invest, investigation; admin, administration; eval, evaluation; Disp., Dispensing; Reg, registration. B, floor plan of POD proper. The verification, epidemiology investigation, and criminal investigation sections are located before the POD proper. The mental health and briefing sections are also located outside the POD proper.