Prevention of inhalational anthrax in the US outbreak
Prevention of inhalational anthrax in the US outbreak
复制标题
DOI：
10.1126/science.1068474
复制
发表时间：
2002-03-08
期刊：
影响因子：
56.9
通讯作者：
Blades, N
中科院分区：
文献类型：
--
作者：
Brookmeyer, R;Blades, N
2001年秋季美国炭疽病爆发是由于炭疽芽孢杆菌孢子的故意传播（1）。为了应对疫情，公共卫生当局建议某些人群进行为期60天的抗菌预防（AP）方案（2）。目前还没有关于使用抗AP的人吸入炭疽病例的报告。我们报告的统计分析的结果，估计吸入性炭疽病的情况下，可能已经防止了AP。第一个集群的情况下，发生在两名雇员的佛罗里达媒体出版公司，虽然既没有可能的接触源（污染的信件），也没有暴露的日期已被确定。第二组两例病例发生在新泽西的邮政工人中。第三组4例病例发生在华盛顿特区的邮政工人中。第二组和第三组病例的暴露源是通过几个邮政设施处理的寄给华盛顿特区政府官员的受污染信件。通过流行病学调查估计了这三个集群病例的症状出现日期（3）（图1A）。报告的另外三个病例不属于这三个群组。公共卫生官员建议可能接触AP的人，包括以下三组：（i）在佛罗里达的媒体出版公司工作或访问该公司的人，（ii）新泽西两个邮政设施的工人，（iii）华盛顿邮政设施的工人。关键的想法是，从一组观察到的病例只是可能发生的病例的一小部分，因为它们的潜伏期短于接触和使用AP之间的时间间隔。潜伏期分布F（t）是指如果个体接受了足以致病的孢子剂量但未接受AP，则在暴露后t天内出现症状的概率。如果N是接受足够剂量孢子导致疾病的个体数量，X是在暴露后T天内发病的病例数量，此时暴露个体开始AP，则可以使用关系式XNF（T）
The anthrax outbreak in the United States in fall 2001 resulted from the intentional dissemination of Bacillus anthracis spores (1). In response to the outbreak, public health authorities recommended that some groups of individuals undergo a 60-day regimen of antimicrobial prophylaxis (AP)(2). There have been no reported cases of inhalational anthrax among persons using AP. We report the results of a statistical analysis to estimate the number of cases of inhalational anthrax that may have been prevented by AP.The first cluster of cases occurred in two employees of a Florida media-publishing company, although neither the likely source of exposure (a contaminated letter) nor the date of exposure has been identified. A second cluster of two cases occurred among postal workers in New Jersey. A third cluster of four cases occurred among postal workers in Washington, DC The source of exposure for the second and third clusters was a contaminated letter (s) sent to a government official (s) in Washington, DC, processed through several postal facilities. The dates of onset of symptoms for the cases from these three clusters have been estimated through epidemiological investigation (3)(Fig. 1A). Three additional cases have been reported that do not fall into these three clusters. Public health officials recommended AP for persons presumptively exposed, which included the following three groups:(i) persons who worked at or visited the media-publishing company in Florida,(ii) workers at two postal facilities in New Jersey,(iii) and workers at a postal facility in Washington, DC A statistical model can be used to estimate the numbers of cases of inhalational anthrax prevented by AP among persons in these three groups using information about dates of exposure, symptom onset, AP, and the incubation period. The key idea is that the observed cases from a group are only a fraction of those that would have occurred, because they are the ones with incubation periods shorter than the time interval between exposure and use of AP. The incubation period distribution, F (t), is the probability of onset of symptoms within t days of exposure if an individual received sufficient dose of spores to cause disease but did not receive AP. If N is the number of individuals who received a sufficient dose of spores to cause disease and X is the number of cases who had disease onset within T days after exposure, at which point exposed individuals began AP, the relation X NF (T) can be used