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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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Related in: MedlinePlus

Decision tree for 100,000 pregnant women based on an assumption of an aerosolized, point source, overt attack with Coxiella burnetii (postexposure prophylaxis [PEP] with 160/800 mg trimethoprim-sulfamethoxazole 2×/d for duration of pregnancy, assuming 82% efficacy and 100% exposure.) PEP-related adverse events are not included in this figure. The “No PEP” segment of the tree contains the same branches and nodes as seen in the “With PEP” section, but uses different probabilities for certain variables. *The outcome of the unborn child is included in pregnant women illness estimates: low birth weight newborns were included in “Total Illness” estimates, and abortions/newborn deaths were included in all 3 outcome categories. QFS, Q fever fatigue syndrome.
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Figure 3: Decision tree for 100,000 pregnant women based on an assumption of an aerosolized, point source, overt attack with Coxiella burnetii (postexposure prophylaxis [PEP] with 160/800 mg trimethoprim-sulfamethoxazole 2×/d for duration of pregnancy, assuming 82% efficacy and 100% exposure.) PEP-related adverse events are not included in this figure. The “No PEP” segment of the tree contains the same branches and nodes as seen in the “With PEP” section, but uses different probabilities for certain variables. *The outcome of the unborn child is included in pregnant women illness estimates: low birth weight newborns were included in “Total Illness” estimates, and abortions/newborn deaths were included in all 3 outcome categories. 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 100,000 pregnant women based on an assumption of an aerosolized, point source, overt attack with Coxiella burnetii (postexposure prophylaxis [PEP] with 160/800 mg trimethoprim-sulfamethoxazole 2×/d for duration of pregnancy, assuming 82% efficacy and 100% exposure.) PEP-related adverse events are not included in this figure. The “No PEP” segment of the tree contains the same branches and nodes as seen in the “With PEP” section, but uses different probabilities for certain variables. *The outcome of the unborn child is included in pregnant women illness estimates: low birth weight newborns were included in “Total Illness” estimates, and abortions/newborn deaths were included in all 3 outcome categories. QFS, Q fever fatigue syndrome.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 3: Decision tree for 100,000 pregnant women based on an assumption of an aerosolized, point source, overt attack with Coxiella burnetii (postexposure prophylaxis [PEP] with 160/800 mg trimethoprim-sulfamethoxazole 2×/d for duration of pregnancy, assuming 82% efficacy and 100% exposure.) PEP-related adverse events are not included in this figure. The “No PEP” segment of the tree contains the same branches and nodes as seen in the “With PEP” section, but uses different probabilities for certain variables. *The outcome of the unborn child is included in pregnant women illness estimates: low birth weight newborns were included in “Total Illness” estimates, and abortions/newborn deaths were included in all 3 outcome categories. 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