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Prophylaxis after exposure to Coxiella burnetii.

Moodie CE, Thompson HA, Meltzer MI, Swerdlow DL - Emerging Infect. Dis. (2008)

Bottom Line: We calculated the threshold points at which the number of PEP-related adverse events was equal to the cases averted.PEP was defined as doxycycline (100 mg 2x/day for 5 days), except for pregnant women, where we assumed a PEP of trimethoprim-sulfamethoxazole (160 mg/800 mg 2x/day) for the duration of the pregnancy.PEP would begin 8-12 days postexposure.

View Article: PubMed Central - PubMed

Affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA. claire_moodie@hotmail.com

ABSTRACT
Coxiella burnetii is a category B bioterrorism agent. We numerically evaluated the risks and benefits from postexposure prophylaxis (PEP) after an intentional release of C. burnetii to the general population, pregnant women, and other high-risk populations. For each group, we constructed a decision tree to estimate illness and deaths averted by use of PEP/100,000 population. We calculated the threshold points at which the number of PEP-related adverse events was equal to the cases averted. PEP was defined as doxycycline (100 mg 2x/day for 5 days), except for pregnant women, where we assumed a PEP of trimethoprim-sulfamethoxazole (160 mg/800 mg 2x/day) for the duration of the pregnancy. PEP would begin 8-12 days postexposure. On the basis of upper-bound probability estimates of PEP-related adverse events for doxycycline, we concluded that the risk for Q fever illness outweighs the risk for antimicrobial drug-related adverse events when the probability of C. burnetii exposure is >or=7% (pregnant women using trimethoprim-sulfamethoxazole = 16%).

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Decision tree for a high-risk population of 100,000 based on an assumption of an aerosolized, point source, overt attack with Coxiella burnetii (postexposure prophylaxis [PEP] with 100 mg doxycycline 2×/d for 5 d, assuming 82% drug efficacy and 100% exposure). PEP-related adverse events are not included in this figure. QFS, Q fever fatigue syndrome.
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Figure 2: Decision tree for a high-risk population of 100,000 based on an assumption of an aerosolized, point source, overt attack with Coxiella burnetii (postexposure prophylaxis [PEP] with 100 mg doxycycline 2×/d for 5 d, assuming 82% drug efficacy and 100% exposure). PEP-related adverse events are not included in this figure. QFS, Q fever fatigue syndrome.

Mentions: To calculate adverse outcomes with and without PEP, we constructed a decision tree for each target group illustrating all possible outcomes after exposure to C. burnetii. The general population and high-risk populations share the same tree structure (Figures 1, 2); the tree for pregnant women incorporates the outcomes for the unborn child (Figure 3). Drug-related side effects are not included in Figures 1–3; however, the number of side effects was calculated per Equation 4 in the Technical Appendix. Total medical cases averted were calculated at 4 arbitrary levels of C. burnetii exposure (100%, 50%, 25%, and 10%).


Prophylaxis after exposure to Coxiella burnetii.

Moodie CE, Thompson HA, Meltzer MI, Swerdlow DL - Emerging Infect. Dis. (2008)

Decision tree for a high-risk population of 100,000 based on an assumption of an aerosolized, point source, overt attack with Coxiella burnetii (postexposure prophylaxis [PEP] with 100 mg doxycycline 2×/d for 5 d, assuming 82% drug efficacy and 100% exposure). PEP-related adverse events are not included in this figure. QFS, Q fever fatigue syndrome.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2609859&req=5

Figure 2: Decision tree for a high-risk population of 100,000 based on an assumption of an aerosolized, point source, overt attack with Coxiella burnetii (postexposure prophylaxis [PEP] with 100 mg doxycycline 2×/d for 5 d, assuming 82% drug efficacy and 100% exposure). PEP-related adverse events are not included in this figure. QFS, Q fever fatigue syndrome.
Mentions: To calculate adverse outcomes with and without PEP, we constructed a decision tree for each target group illustrating all possible outcomes after exposure to C. burnetii. The general population and high-risk populations share the same tree structure (Figures 1, 2); the tree for pregnant women incorporates the outcomes for the unborn child (Figure 3). Drug-related side effects are not included in Figures 1–3; however, the number of side effects was calculated per Equation 4 in the Technical Appendix. Total medical cases averted were calculated at 4 arbitrary levels of C. burnetii exposure (100%, 50%, 25%, and 10%).

Bottom Line: We calculated the threshold points at which the number of PEP-related adverse events was equal to the cases averted.PEP was defined as doxycycline (100 mg 2x/day for 5 days), except for pregnant women, where we assumed a PEP of trimethoprim-sulfamethoxazole (160 mg/800 mg 2x/day) for the duration of the pregnancy.PEP would begin 8-12 days postexposure.

View Article: PubMed Central - PubMed

Affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA. claire_moodie@hotmail.com

ABSTRACT
Coxiella burnetii is a category B bioterrorism agent. We numerically evaluated the risks and benefits from postexposure prophylaxis (PEP) after an intentional release of C. burnetii to the general population, pregnant women, and other high-risk populations. For each group, we constructed a decision tree to estimate illness and deaths averted by use of PEP/100,000 population. We calculated the threshold points at which the number of PEP-related adverse events was equal to the cases averted. PEP was defined as doxycycline (100 mg 2x/day for 5 days), except for pregnant women, where we assumed a PEP of trimethoprim-sulfamethoxazole (160 mg/800 mg 2x/day) for the duration of the pregnancy. PEP would begin 8-12 days postexposure. On the basis of upper-bound probability estimates of PEP-related adverse events for doxycycline, we concluded that the risk for Q fever illness outweighs the risk for antimicrobial drug-related adverse events when the probability of C. burnetii exposure is >or=7% (pregnant women using trimethoprim-sulfamethoxazole = 16%).

Show MeSH
Related in: MedlinePlus