Screening for Anthrax Postexposure Antibiotic Prophylaxis-The New York City Approach.

Individuals exposed to spores of B. anthracis must take a course of antibiotics as postexposure prophylaxis (PEP) to prevent inhalation anthrax. During an anthrax event, public health authorities are responsible for conducting dispensing operations to offer PEP to exposed individuals. Jurisdictions have developed antibiotic PEP screening algorithms to determine which antibiotic is appropriate for each individual. Variability exists with regard to screening questions and dispensing decisions based on responses to those questions. It is likely that individuals with similar profiles will receive different antibiotics based solely on the jurisdiction in which they receive their PEP. This lack of consistency among jurisdictions may lead to a loss of confidence in the public health response among the public, the healthcare community, the media, and government leaders, which could compromise the response itself. We present New York City's planning assumptions, screening algorithm, a rationale for our screening questions, and our reasons for excluding screening questions asked by other jurisdictions. We hope that our efforts may assist others in developing and refining their algorithms and associated public messaging and encourage standardization with neighboring jurisdictions where appropriate.

Protecting the Public from H1N1 through Points of Dispensing (PODs).

In fall 2009, the New York City Department of Health and Mental Hygiene (DOHMH) operated 58 points of dispensing (PODs) over 5 weekends to provide influenza A (H1N1) 2009 monovalent vaccination to New Yorkers. Up to 7 sites were opened each day across the 5 boroughs, with almost 50,000 New Yorkers being vaccinated. The policies and protocols used were based on those developed for New York City's POD Plan, the cornerstone of the city's mass prophylaxis planning. Before the H1N1 experience, NYC had not opened more than 5 PODs simultaneously and had only experienced the higher patient volume seen with the H1N1 PODs on 1 prior occasion. Therefore, DOHMH identified factors that contributed to the success of POD operations, as well as areas for improvement to inform future mass prophylaxis planning and response. Though this was a relatively small-scale, preplanned operation, during which a maximum of 7 PODs were operated on a given day, the findings have implications for larger-scale mass prophylaxis planning for emergencies.

Public compliance with mass prophylaxis guidance.

In 2008, the New York City Department of Health and Mental Hygiene (NYC DOHMH) conducted a series of 8 focus groups to determine what improvements could be made to existing plans to ensure that the public would adhere to instructions issued during an emergency that required mass antibiotic distribution following an aerosolized anthrax attack. Discussion focused on perceptions surrounding public health emergencies, overall point-of dispensing (POD) strategy, willingness to pick up medications for others, and additional information that participants would need before and during an emergency. Participation in each group ranged from 7 to 10 members. Most participants indicated a willingness to actively participate in emergency response and to follow directions issued by authorities. Some said they would wait to see how others reacted to medication being provided before taking theirs. Participants expressed a universal desire for education on both dispensing plans and diseases before an incident occurs. They expressed concerns about anxiety levels among the public and maintaining adequate security at dispensing sites, though they felt that NYC's plans were generally realistic. The most trusted sources identified to disseminate information were the mayor, the city health commissioner, and a local cable news channel. While many participants indicated they would use the internet to find information during an emergency, multiple delivery methods must be used to ensure the broadest reach within the community, as not everyone has internet access. Health authorities must partner with the public before, during, and after an emergency to achieve the best possible outcomes from a response effort that relies greatly on public cooperation.