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St. Louis will be part of bioterrorism study

ST. LOUIS POST-DISPATCH | March 28, 2006
By Bill Lambrecht

WASHINGTON — The Centers for Disease Control and Prevention is planning to place antibiotics in 5,000 homes in the St. Louis area in a first-of-its kind test to learn how people would handle drugs given them to prepare for a bioterrorism attack.

Starting next month, some 20,000 people will be screened to see which households receive "MedKits" that contain antibiotics for each member of the family.

Households will be randomly selected from three groups: public health responders such as firefighters; workers at a single, as yet unidentified corporation; and recipients of publicly funded health care at clinics. The drugs would be distributed at no cost.

The pilot project is aimed at finding the best way to distribute drugs in case of emergencies and whether people would store the drugs properly and save them
for when they are needed.

"This is an important project that not only helps us prepare in this area, but
also helps inform national policy," said Bruce Clements, director of the Center for Emergency Response and Terrorism in the Missouri Department of Health and Senior Service.

The state will play a significant role in the federally sponsored project. The study area has not been pinned down but will include St. Louis, St. Louis County, probably St. Charles County and perhaps more of the metropolitan area, Clements said. Illinois communities will not be involved.

Clements said St. Louis was chosen because of its national reputation in bioterrorism preparedness gained from pioneering research at both Washington University and St. Louis University.

The CDC published the broad outlines for its Home MedKit Evaluation Study on Feb. 23 in the Federal Register. No further public announcement has been made.

Existence of the project was first disclosed this week by Government Security News, a New York-based magazine.

CDC spokesman Von Roebuck described the study as "still a work in progress" and
promised more details soon.

He added, "The whole idea is that if we ever had an emergency situation - say it involved smallpox - we would be able, whatever the location, to augment what
states could do."

The antibiotics in question were chosen for their capacity to prevent infections in the event of exposure to dangerous bacteria. They will be distributed in see-through bags along with instructions on how to use them.

The MedKits will contain either Doxycycline or Ciprofloxacin, better known as Cipro. Doxycycline is often mentioned as a treatment for anthrax, among other bacteria. Cipro also could be used to ward off infections from a variety of intentionally introduced agents, including plague, smallpox, botulism and tularemia.

Family members will go through medical screening before being chosen. The antibiotics in question have side effects and must be used carefully. For instance, Doxycycline is not to be given children because, among other things, it might discolor their teeth.

The antibiotics would later be checked to see whether families are storing them
properly and keeping them for bioterrorism emergencies. In addition, the study
is designed to "explore attitudes, perceptions and other social and psychological factors" related to the drugs, according to the Federal Register.

Since 9/11 and the anthrax scare that followed, the government has been exploring ways to distribute drugs.

Health and Human Services Secretary Mike Leavitt said in a speech last year that those might include storing caches of pharmaceuticals around the country for use when needed or distributing them via first-responders or perhaps the Postal Service.

He also raised the possibility of putting them in homes, noting that the medications then would be closest to those who need them. But he added that the government needs to better understand whether such a system would work.

Clements observed that the nation has conducted no studies, and therefore has
no data, on the possible pitfalls of placing drugs in homes. "All we have is assumptions. We know that people can be irresponsible with a variety of different drugs. But we don't know whether they would be irresponsible with these drugs. This is cutting-edge research, and we're excited in Missouri to be hosting it," he said.

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