1. Overview of Auxiliary Distribution Plan NYC Department of Health and Mental Hygiene November 15, 2011

2. Inhalational Anthrax Pathogenesis of Disease  Bacillus anthracis spores are inhaled and deposited deep into the lungs  Spores are carried to the lymph nodes in the lungs where they germinate, or develop into active bacteria  B. anthracis causes injury and infection of the lymph nodes in the lungs. This leads to infection in the bloodstream and in the lung tissue. Incubation period = 1-5 days (up to 8 weeks) Clinical Manifestations  Early phase – fever, malaise, mild cough, chest pain  Acute phase – within 3-5 days – increasing fever, difficulty breathing, hypoxia, and hypotension  Death can occur within 24 hours of onset of acute phase

3. Inhalational Anthrax (Cont’d) Transmission – no human to human transmission Treatment  Limited experience with treatment, no controlled trials  Ciprofloxacin or doxycycline plus 1-2 additional antibiotics  Case fatality rate ~ 75% with antibiotics (once an individual develops disease, it is very difficult to treat) Post Exposure Prophylaxis (PEP)  Provision of medications to prevent an individual who is exposed to a disease from actually developing disease  Ciprofloxacin or doxycycline +/- vaccine

4. NYC Response to an Anthrax Event A citywide release of anthrax would be a catastrophic event. The entire city would be placed in an emergency response mode. DOHMH is responsible for providing antibiotic prophylaxis to the entire population of NYC  Antibiotics will be provided free of charge  Antibiotics must be provided to the entire population within 48 hours

5. DOHMH Mass Prophylaxis Planning Points of Dispensing (PODs): temporary emergency sites where individuals may obtain medication for themselves and others Auxiliary Distribution Plan (ADP): distribution of medication directly to facilities that serve vulnerable populations

6. Points of Dispensing PODs will be located throughout all 5 boroughs of NYC, within walking distance of most residents An individual may pick up medication for him/herself and up to 5 others (Designee Pick Up Policy)

7. Auxiliary Distribution Plan Vulnerable populations may not be able to attend PODs and may not have someone to pick up medications for them Staff who serve vulnerable populations may not be able to attend PODs if they are needed to maintain operations at their facilities DOHMH will partner with agencies that serve certain vulnerable populations  DOHMH will send medications directly to the facilities  Facilities will be responsible for dispensing medications to their residents and staff  Facilities must sign a Memorandum of Understanding (MOU) with DOHMH