title: Anticipating demand for emergency health services due to medication-related adverse events after rapid mass prophylaxis campaigns.
abstract: OBJECTIVE
  Mass prophylaxis against infectious disease outbreaks carries the risk of medication-related adverse events (MRAEs). The authors sought to define the relationship between the rapidity of mass prophylaxis dispensing and the subsequent demand for emergency health services due to predictable MRAEs.
  
  
  METHODS
  The authors created a spreadsheet-based computer model that calculates scenario-specific predicted daily MRAE rates from user inputs by applying a probability distribution to the reported timing of MRAEs. A hypothetical two- to ten-day prophylaxis campaign for one million people using recent data from both smallpox vaccination and anthrax chemoprophylaxis campaigns was modeled.
  
  
  RESULTS
  The length of a mass prophylaxis campaign plays an important role in determining the subsequent intensity in emergency services utilization due to real or suspected adverse events. A two-day smallpox vaccination scenario would produce an estimated 32,000 medical encounters and 1,960 hospitalizations, peaking at 5,246 health care encounters six days after the start of the campaign; in contrast, a ten-day campaign would lead to 41% lower peak surge, with a maximum of 3,106 encounters on the busiest day, ten days after initiation of the campaign. MRAEs with longer lead times, such as those associated with anthrax chemoprophylaxis, exhibit less variability based on campaign length (e.g., 124 out of an estimated 1,400 hospitalizations on day 20 after a two-day campaign versus 103 on day 24 after a ten-day campaign).
  
  
  CONCLUSIONS
  The duration of a mass prophylaxis campaign may have a substantial impact on the timing and peak number of clinically significant MRAEs, with very short campaigns overwhelming existing emergency department (ED) capacity to treat real or suspected medication-related injuries. While better reporting of both incidence and timing of MRAEs in future prophylaxis campaigns should improve the application of this model to community-based emergency preparedness planning, these results highlight the need for coordination between public health and emergency medicine planning for infectious disease outbreaks to avoid preventable surges in ED utilization.
authors.affiliation: Department of Public Health, Weill Medical College of Cornell University, New York, NY, USA. nah2005@med.cornell.edu
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Hupert
authors.forename: Daniel
authors.initials: D
authors.lastname: Wattson
authors.forename: Jason
authors.initials: J
authors.lastname: Cuomo
authors.forename: Samuel
authors.initials: S
authors.lastname: Benson
mesh_terms: D000881:Anthrax / Q000517:prevention & control; D022122:Anthrax Vaccines / Q000009:adverse effects; D018890:Chemoprevention / Q000009:adverse effects*; D004196:Disease Outbreaks / Q000517:prevention & control*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D006801:Humans; D008962:Models, Theoretical; D020380:Needs Assessment; D012899:Smallpox / Q000517:prevention & control; D012900:Smallpox Vaccine / Q000009:adverse effects; D014481:United States
chemical_list: D022122:Anthrax Vaccines; D012900:Smallpox Vaccine