Prophylaxis after exposure to Coxiella burnetii.
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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.
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Affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA. claire_moodie@hotmail.com
ABSTRACT
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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%). Related in: MedlinePlus |
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Mentions: The threshold point is defined as the probability of exposure to C. burnetii where the risk for adverse events equals the benefit of PEP use. Figure 4 illustrates the general population threshold points (run at 2 different drug efficacy values) for total cases of illness averted for the primary, less, and more virulent scenarios. The x-intercept on these graphs is the probability of exposure to C. burnetii at which the total number of cases of illness averted because of PEP use is equal to the number of moderate PEP-related adverse events. Therefore, for any probability of exposure greater than the stated threshold value, PEP would prevent more cases of illness than the number of adverse events PEP would cause. As Figure 4 illustrates, the less virulent or more virulent scenarios affect the estimated number of cases but do not greatly affect the threshold probabilities of exposure. For further analyses, refer to Appendix Tables 2, 3, and 4 to review univariate sensitivity analyses on various variables used in the risk/benefit scenarios. These tables show which variables have the greatest independent influence on the respective outcomes and how modifications to the input values impacts the estimated number of cases averted. |
View Article: PubMed Central - PubMed
Affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia, USA. claire_moodie@hotmail.com