The 49th hour: analysis of a follow-up medication and vaccine dispensing field test

Anthrax response plans, exercises, and assessments over the past decade have focused almost exclusively on the first 48 hours of the public health response following a jurisdiction-wide exposure and provision of an initial 10-day supply of antibiotics from the Strategic National Stockpile (SNS). But mass dispensing of the subsequent 50-day course of antibiotics and administration of the 3-dose vaccine series have received considerably less attention, although these follow-up activities may prove even more complex. In 2014, the Philadelphia Department of Public Health (PDPH) made its first foray into this next frontier of mass prophylaxis planning by: (1) researching patient safety and adherence considerations relevant to the antibiotics in the SNS; (2) designing a model for a second-visit antibiotic and vaccine point of dispensing (POD), including development of an enhanced screening protocol that assumes a higher level of medical responsibility; and (3) field testing this model during a real seasonal influenza vaccination clinic to assess throughput and accuracy and to evaluate the resources needed to operationalize this model. While the observations and data presented here provide some framework for local long-term mass prophylaxis planning efforts, many areas remain undefined, including the distribution of responsibilities among the public health and healthcare communities to ensure patient safety. In addition to presenting findings, the larger intent of this article is to initiate a dialogue with other stakeholders at the local, state, and federal levels to advance long-term mass prophylaxis planning.