Addressing the Risk from Inhaled Anthrax Using Quantitative Microbial Risk Assessment. E. R. Janus, Ann Arbor, MI
Intentional bioterrorist attacks involving the distribution of Bacillus anthracis (anthrax endospores) through the U.S. Postal Service have become an unfortunate reality. Recent advances in the field of quantitative microbial risk assessment (QMRA) provide guidance for characterization of the health risk from these releases. To achieve this goal, while still minimizing uncertainty, many unique challenges to the risk analysis process must be overcome – some of these are listed next. Estimating indoor exposures from intentional release of biological warfare agents requires identification of an air dispersion model capable of characterizing micro-zone indoor spaces over a number of days. A time period of several days is necessary to account for potential repeated exposures that office workers or remediation workers might encounter from a surreptitious intentional release. Although median lethal doses for inhaled anthrax endospores have been reported earlier, it is crucial to understand how low-level exposures can lead to infection among sensitive subpopulations, such as those with predisposing respiratory conditions. Along these lines, it is desirable to establish "infectious reference doses" (iRfDs) for a wide variety of subpopulations to reduce uncertainty in risk estimates. Promising modeling technology has been introduced recently that could help establish pharmacokinetic lung dosimetry models that are specific to inhaled anthrax endospores. Finally, it would be most useful to describe both exposure and resultant risk in a probabilistic fashion to allow maximal flexibility in both selecting and ranking remediation and treatment options. This report outlines the challenges to estimating risk from inhaled anthrax and discusses possible solutions and strategies to minimize the uncertainty in these estimates. Acknowledgements are due to the US Army Center for Health Promotion and Preventive Medicine, where I was employed when this research was done.
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