potassium iodide prepositioning campaign in a jurisdiction within 10 miles of a New Jersey nuclear reactor, for example, researchers were able to determine which communication channels (Internet, television, radio) the public was most likely to use to obtain information and directions (Blando et al., 2008).

Adherence

Adherence to the recommended course of prophylactic antibiotics following an anthrax attack is a major concern. Survey data and evidence from the 2001 anthrax attack suggest adherence is likely to be quite poor. Following that attack, a mass anthrax postexposure prophylaxis campaign was implemented in six areas where exposures had been confirmed. Approximately 10,000 people were recommended to undergo at least 60 days of antibiotic treatment. Follow-up interviews with more than 6,000 of these individuals revealed that while 97 percent had obtained their initial supply of antibiotics, 10 percent had not initiated therapy (Shepard et al., 2002). Only 44 percent of those obtaining the antibiotics had completed the 60-day regimen. Adherence was highest at the Brentwood mail facility in Washington, DC (64 percent), and lowest at the Morgan postal facility in New York City (21 percent). A variety of reasons for nonadherence were cited, including experience with adverse reactions and a perceived low risk of having been exposed. In a separate survey of 245 of the more than 2,000 workers exposed at the Brentwood facility, only 40 percent reported full adherence to their 60-day antibiotic regimen, while 18 percent had completely discontinued the antibiotic at some point, and 42 percent reported stopping and restarting therapy one or more times, skipping days, reducing dosage, or otherwise deviating from the prescribed regimen (Jefferds et al., 2002).

A national opinion poll conducted by researchers at the Harvard School of Public Health raised the concern that while people may obtain MCM at a POD, they may delay starting therapy (SteelFisher et al., 2011). In response to a fictional anthrax attack in their own town, 89 percent of respondents said they would follow recommendations from public health authorities to obtain antibiotics from a local POD within 48 hours. However, 34 percent of individuals who said they would obtain the MCM said they would most likely wait to take them until they knew whether they really had been exposed to anthrax, and 6 percent would wait “for the foreseeable future.” Of those who would most likely not go to the POD, primary reasons included concerns about public officials not being able to control crowds, exposure to anthrax while going to the POD, insufficient supply of antibiotics, and safety of the antibiotics.



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