Recent intentional and natural disease outbreaks in the United States, such as the 2001 anthrax attacks and the 2003 influenza season, have focused increased attention on the ability of State and local public health authorities to provide affected individuals and communities with rapid, reliable access to prophylactic medications.1-3 In light of the substantial health risks posed by anthrax, influenza, and other bacteria, spores, toxins, or viruses, the U.S. Federal Government has called on all States to devise comprehensive mass prophylaxis plans to ensure that civilian populations have timely access to necessary antibiotics and/or vaccines in the event of future outbreaks.4-6
The last five years have seen a major expansion of Federal assets to assist local public health providers in the planning and execution of mass prophylaxis campaigns for bioterrorism and epidemic outbreak response, including development of the Strategic National Stockpile (SNS), improvement in public health laboratory capabilities, creation of a national Health Alert Network (HAN), and implementation of the Cities Readiness Initiative (CRI).5,7,8 However, none of these assets is intended to replace local first response capabilities or the need for comprehensive local plans for extended mass prophylaxis campaigns in the setting of a bioterrorist attack or natural disease outbreak.9-13
State, county, and local health authorities have been charged with the development of these plans, with financial and technical support of the Department of Health and Human Services Office of Public Health Emergency Preparedness (OPHEP) as well as the Centers for Disease Control and Prevention (CDC). This Planning Guide, which complements the CDC's Strategic National Stockpile Guidebook (especially Chapter 11 on dispensing operations), is intended to assist public health and emergency management officials in this task.5
Section One of this Guide provides an overview of the five components of a mass prophylaxis response to epidemic outbreaks:
The next two sections focus on planning and conducting dispensing operations using specially-designated dispensing clinics, here called Dispensing/Vaccination Centers (DVCs) but also known as Points of Dispensing (PODs). These concepts are then put to work in developing sample antibiotic dispensing and vaccination clinic plans that can be "run" using a separate customizable computer planning model, the Bioterrorism and Epidemic Outbreak Response Model (BERM), developed in conjunction with this planning guide.
The last section describes the implementation of a comprehensive operational structure for dispensing/vaccination clinics based on the National Incident Management System (NIMS).
This Planning Guide is intended for multiple audiences. Section One should be of interest both to officials tasked with developing local response plans and to members of government, industry, academia, the media, and non-governmental organizations (NGOs) who may play important roles in support of these emergency public health activities. Sections Two and Three should be of interest to public health and emergency management planners from the local to national level. Finally, the description of the DVC command structure in Section Four demonstrates the application of NIMS to this critical public health emergency response role and may help non-public health emergency response professionals successfully contribute to DVC operations and management.