title: Predicting hospital surge after a large-scale anthrax attack: a model-based analysis of CDC's cities readiness initiative prophylaxis recommendations.
abstract: BACKGROUND
  A CRI-compliant prophylaxis campaign starting 2 days after exposure would protect from 86% to 87% of exposed individuals from illness (assuming, in the base case, 90% antibiotic effectiveness and a 95% attack rate). Each additional day needed to complete the campaign would result in, on average, 2.4% to 2.9% more hospitalizations in the exposed population; each additional day's delay to initiating prophylaxis beyond 2 days would result in 5.2% to 6.5% additional hospitalizations. These population protection estimates vary roughly proportionally to antibiotic effectiveness but are relatively insensitive to variations in anthrax incubation period.
  
  
  CONCLUSIONS
  . Delays in detecting and initiating response to large-scale, covert aerosol anthrax releases in a major city would render even highly effective CRI-compliant mass prophylaxis campaigns unable to prevent unsustainable levels of surge hospitalizations. Although outcomes may improve with more rapid epidemiological identification of affected subpopulations and increased collaboration across regional public health and hospital systems, these findings support an increased focus on prevention of this public health threat.
authors.affiliation: Department of Medicine, Weill Medical College of Cornell University, New York, 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: Eric
authors.initials: E
authors.lastname: Hollingsworth
authors.forename: Kristof
authors.initials: K
authors.lastname: Neukermans
authors.forename: Wei
authors.initials: W
authors.lastname: Xiong
mesh_terms: D000881:Anthrax / Q000453:epidemiology / Q000517:prevention & control*; D023482:Bioterrorism; D002487:Centers for Disease Control and Prevention, U.S.; D002959:Civil Defense; D003198:Computer Simulation; D003661:Decision Support Techniques; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D006801:Humans; D008962:Models, Theoretical; D016730:Program Development; D015397:Program Evaluation; D011634:Public Health / Q000706:statistics & numerical data; D055872:Surge Capacity / Q000592:standards / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology