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A Review of Malaria, Diphtheria, and Botulism Medication Distributions by CDC Port Health Stations From May 2006 to
Lily Rubin1, Jennifer Fowler, Srikar Ranga
1Author Affiliations: Division of Global Migration Health, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Kirley, Dr Rubin, Dr Fowler, Mr Tchan, Dr Pacheco, Dr Preston, Dr Akinkugbe, Dr Kinzer, Dr Alvarado-Ramy, Dr Brown, Dr Gertz); Epidemiology Elective Program, National Center for State, Tribal, Local and Territorial Public Health Infrastructure and Workforce, Centers for Disease Control and Prevention, Atlanta, Georgia (Rubin); Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia (Mr Ranga, Dr Waltenburg); and Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee (Mr Ranga).
Objectives:
The Centers for Disease Control and Prevention (CDC) maintains a formulary of biologic agents and drugs not available commercially in the United States. For a subset of these (botulism and diphtheria antitoxins and, until 2022, intravenous artesunate for severe malaria), distribution is coordinated through CDC port health stations (PHS), located mainly at major US international airports. CDC aims for these drugs to reach their destinations within 8 hours of release authorization. We analyzed CDC records to identify areas for efficiency improvement.
Design:
We queried records detailing drug distributions from PHS that occurred May 2006 to February 2024, including timing of release authorization and delivery, geographic origins and destinations, mode of transportation, and patient characteristics and outcomes. We conducted descriptive and multivariate analyses to identify variables that may have delayed delivery.
Setting:
CDC port health stations.
Main Outcome Measures:
Time from release authorization to drug delivery.
Results:
CDC PHS distributed 2912 drug shipments between May 2006 and February 2024 via 17 distribution sites to 54 jurisdictions across the US and 3 countries. Of 850 shipments for which data were available (those occurring December 2019 or later), 83% (n = 702/850) occurred within 8 hours of authorization. Commercial air transport (compared to other types of transport) (aOR: 11.43, 95% confidence interval [CI]: 6.94-18.81, P < .001) and release authorization time (outside of vs within routine work hours) (aOR: 5.10, 95% CI: 3.31-7.86, P < .001) were significantly associated with delays.
Conclusions:
CDC PHS facilitated emergency distributions of life-saving drugs for botulism, diphtheria, and severe malaria to locations throughout the US mostly within 8 hours of authorization. Staffing, distribution locations, and expanded options for ground transportation are important considerations that may minimize delays.
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