Evaluation of public health interventions for Anthrax: a report to the secretary's council on Public Health Preparedness.

To aid in understanding how best to respond to a bioterror anthrax attack, we analyze a system of differential equations that includes a disease progression model, a set of spatially distributed queues for distributing antibiotics, and vaccination (pre-event and/or post-event). We derive approximate expressions for the number of casualties as a function of key parameters and management levers, including the time at which the attack is detected, the number of days to distribute antibiotics, the adherence to prophylactic antibiotics, and the fraction of the population that is preimmunized. We compare a variety of public health intervention policies in the event of a hypothetical anthrax attack in a large metropolitan area. Modeling assumptions were decided by the Anthrax Modeling Working Group of the Secretary's Council on Public Health Preparedness. Our results highlight the primary importance of rapid antibiotic distribution and lead us to argue for ensuring post-attack surge capacity to rapidly produce enough anthrax vaccine for an additional 100 million people.