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Costantino V, Bahl P, Doolan C, de Silva C, Heslop D, Chen X, Lim S, MacIntyre CR. Modeling on the Effects of Deliberate Release of Aerosolized Inhalational Bacillus anthracis (Anthrax) on an Australian Population. Health Secur 2023; 21:61-69. [PMID: 36695665 DOI: 10.1089/hs.2022.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
This study aimed to determine optimal mitigation strategies in the event of an aerosolized attack with Bacillus anthracis, a category A bioterrorism agent with a case fatality rate of nearly 100% if inhaled and untreated. To simulate the effect of an anthrax attack, we used a plume dispersion model for Sydney, Australia, accounting for weather conditions. We determined the radius of exposure in different sizes of attack scenarios by spore quantity released per second. Estimations of different spore concentrations were then used to calculate the exposed population to inform a Susceptible-Exposed-Infected-Recovered (SEIR) deterministic mathematical model. Results are shown as estimates of the total number of exposed and infected people, along with the burden of disease, to quantify the amount of vaccination and antibiotics doses needed for stockpiles. For the worst-case scenario, over 500,000 people could be exposed and over 300,000 infected. The number of deaths depends closely on timing to start postexposure prophylaxis. Vaccination used as a postexposure prophylaxis in conjunction with antibiotics is the most effective mitigation strategy to reduce deaths after an aerosolized attack and is more effective when the response starts early (2 days after release) and has high adherence, while it makes only a small difference when started late (after 10 days).
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Affiliation(s)
- Valentina Costantino
- Valentina Costantino, PhD, is a Postdoctoral Research Associate; in the Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Prateek Bahl
- Prateek Bahl, PhD, is a Postdoctoral Research Associate; at the School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, Australia
| | - Con Doolan
- Con Doolan, PhD, is a Professor and Associate Dean (Academic Programs); at the School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, Australia
| | - Charitha de Silva
- Charitha de Silva, PhD, is a Lecturer; at the School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, Australia
| | - David Heslop
- David Heslop, PhD, MPH, is an Associate Professor, School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Xin Chen
- Xin Chen, PhD, is a Postdoctoral Research Associate; in the Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Samsung Lim
- Samsung Lim, MA, PhD, is an Associate Professor, School of Civil and Environmental Engineering, University of New South Wales, Sydney, Australia
| | - Chandini Raina MacIntyre
- Chandini Raina MacIntyre, MBBS, MAE, PhD, is a Professor and Head; in the Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia.,Chandini Raina MacIntyre is also a Professor, College of Health Solutions and College of Public Service and Community Solutions, Arizona State University, Tempe, AZ
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Mogi A, Sasaki H, Nakashima Y, Chinen S, Ishizu M, Tanaka T, Takata T, Takamatsu Y. Efficacy of oral levofloxacin monotherapy against low-risk FN in patients with malignant lymphoma who received chemotherapy using the CHOP regimen. J Clin Exp Hematop 2020; 60:73-77. [PMID: 32779614 PMCID: PMC7596912 DOI: 10.3960/jslrt.20008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The safety and feasibility of oral fluoroquinolone monotherapy in patients with low-risk febrile neutropenia (FN) were demonstrated in recent studies. Levofloxacin (LVFX) is a commonly prescribed antibiotic; however, evidence for its efficacy against FN is limited. Therefore, in this study, we retrospectively investigated the efficacy of LVFX against low-risk FN in patients with malignant lymphoma at our institution. Treatment success was defined as recovery from fever and neutropenia without alteration of the initial regimen. We recruited 29 patients between January 2013 and December 2018. The median age of the cohort was 64 (range: 21–87) years; 13 (44.8%) were aged over 65 years. In total, 22 patients had diffuse large B-cell lymphoma (DLBCL). Therapy was successful in 24 (82.8%) patients, whereas 5 had treatment failure requiring a change from LVFX to intravenous broad-spectrum antibacterial agents. No deaths related to FN were observed. Two patients required FN-related chemotherapy dose reduction in subsequent cycles. Although this cohort comprised many elderly patients, our study confirmed the efficacy of LVFX in patients with low-risk FN. This may improve the treatment of low-risk FN and malignant lymphoma.
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Affiliation(s)
- Ai Mogi
- Division of Medical Oncology, Hematology and Infection Disease, Department of Internal Medicine, Fukuoka University, Fukuoka, Japan
| | - Hidenori Sasaki
- Division of Medical Oncology, Hematology and Infection Disease, Department of Internal Medicine, Fukuoka University, Fukuoka, Japan
| | - Yuta Nakashima
- Division of Medical Oncology, Hematology and Infection Disease, Department of Internal Medicine, Fukuoka University, Fukuoka, Japan
| | - Shotaro Chinen
- Division of Medical Oncology, Hematology and Infection Disease, Department of Internal Medicine, Fukuoka University, Fukuoka, Japan
| | - Masanao Ishizu
- Division of Medical Oncology, Hematology and Infection Disease, Department of Internal Medicine, Fukuoka University, Fukuoka, Japan
| | - Toshihiro Tanaka
- Division of Medical Oncology, Hematology and Infection Disease, Department of Internal Medicine, Fukuoka University, Fukuoka, Japan
| | - Tohru Takata
- Division of Medical Oncology, Hematology and Infection Disease, Department of Internal Medicine, Fukuoka University, Fukuoka, Japan
| | - Yasushi Takamatsu
- Division of Medical Oncology, Hematology and Infection Disease, Department of Internal Medicine, Fukuoka University, Fukuoka, Japan
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Ponraj M, Dubashi B, Harish BH, Kayal S, Cyriac SL, Pattnaik J, Ranjith K, Pillai US, Jadhav N, Matta KK, Singh J, Jaffa E, Prakash B. Cefepime vs. cefoperazone/sulbactam in combination with amikacin as empirical antibiotic therapy in febrile neutropenia. Support Care Cancer 2018; 26:3899-3908. [DOI: 10.1007/s00520-018-4260-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 05/06/2018] [Indexed: 01/06/2023]
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Ferreira JN, Correia LRBR, Oliveira RMD, Watanabe SN, Possari JF, Lima AFC. Managing febrile neutropenia in adult cancer patients: an integrative review of the literature. Rev Bras Enferm 2017; 70:1301-1308. [DOI: 10.1590/0034-7167-2016-0247] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/02/2016] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To analyze the interventions performed by health professionals with a view to managing chemotherapy-induced febrile neutropenia. Method: Integrative literature review, the sample of 12 primary articles was selected from the following databases: LILACS, SciELO, BVS, PubMed, CINAHL and Web of Science. Results: There was a prevalence of studies, realized by doctors, focused on pharmacological treatment and on the association of methods for greater diagnostic accuracy of febrile neutropenia. A study was found on pharmaceutical management regarding antibiotic dosing efficacy and a study indicating that nurses could contribute to the identification of elderly patients who would benefit from prophylactic use of growth factor. Conclusion: There was a shortage of studies involving the participation of other health professionals, besides the doctors, and a knowledge gap regarding interprofessional practice in the management of interventions specific to their area of specialism, joint interventions and non-pharmacological interventions.
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