As a weapon choice, anthrax makes sense; relatively easy to produce, relatively easy to deploy and not easily fixable. It would also expend a great deal of response resources to control the actual exposure problem, much less the problem of community fear and demand for treatment regardless actual exposure.
Two recent articles articulate the Centers for Disease Control position and efforts: The addition of more and different countermeasures for anthrax exposure (http://www.cidrap.umn.edu/cidrap/content/bt/anthrax/news/sep1511anthrax.html) and a recommendation for testing or anthrax vaccine in pediatric individuals (http://www.cidrap.umn.edu/cidrap/content/bt/anthrax/news/sep2211anthrax.html).
Vaccine testing in the pediatric community will be problematic. For the front line public health workers, it will be an invisible effort at some university setting. What these issues do suggest, is the locality specific planning need to include three massive segments:
- The logistics only exercise of providing antibiotics to the area population within 48 hours. For my service area, that population is a half million, including commuting workers, visitors and residents. This will require an all out effort of the entire first responder community, any public health assets, state support and the Strategic National Stockpile assets.
- The second phase will require additional concerted efforts. If the epidemiological system can narrow the foci of exposure, those persons in the plume will require an additional 50 days of medication. I can only assume that more rigorous medical screening for medication choice and management will be in place. In any event, there will be a significant fatigue factor in the public health responders as demonstrated in the extended H1N1 campaign.
- Last, when reviewing the article for potential pediatric testing, that the provision of anthrax vaccination will be provided to the population. After an actual event, I suspect that vaccine uptake will be significant. The issue on the public health effort will be based on demand for vaccine, priorities of the vaccination program versus day-to-day activities and if any additional personnel will be available.
Those first two days will be fast and loose with rules, medication volumes and methods. After that, even with ten days to provide medication to the exposed group, it is my belief that more professional rigor will be in place. Certainly for any vaccination program of long duration we will require significant nursing staff. Extension into the Emergency Medical Services ranks for vaccinators will be difficult since there will continue to be accident and injuries. Could active duty medical personnel be used? Only of the significant laws are set aside.
The scope of the potential problem is not insurmountable. The planning effort will and has already been demonstrated to provide support to daily activities in local health departments.