For the HHS/DHS Letter to Occupational Health Directors regarding Doxycycline Prescriptions for First Responders
Why now?
The letter from HHS and DHS is the most recent step to assist state and local jurisdictions in their planning efforts. HHS and DHS are committed to partnering with state and local agencies to build and maintain our nation’s readiness for emergencies, which in turn fosters resilient communities. The option described in the letter could help first responders in their own preparedness efforts so that if an anthrax emergency occurred, they would be better prepared to support the community. The prescription discussed in the letter is for a 10-day supply of doxycycline, an antibiotic used to treat anthrax or to prevent illness after exposure to anthrax.
Why just for anthrax – what about other bioterrorism threats?
The Department of Homeland Security rated anthrax one of the top bioterrorism threats to our nation. DHS and HHS encourage all-hazards planning since many preparedness steps are similar regardless of the threat. Taking recommended antibiotics is an effective way to prevent becoming sick from the bacteria if the antibiotics are taken after being exposed to anthrax but before becoming sick – known as post-exposure prophylaxis. So it is important to provide these medical countermeasures quickly after exposure.
Who pays for the medication described in the letter?
Who pays for the medication is up to the jurisdiction. The letter suggests that the medication be paid for by the first responder and stored at home.
Information of health departments
What does this letter mean for the health department?
The letter describes one option that states and local jurisdictions can incorporate into emergency plans to prepare first responders for an anthrax emergency. Public health departments should work with emergency management agencies and first responder organizations to ensure first responders are aware of medical countermeasure distribution plans.
Can a health department or emergency management agency use grant funding to pay for the medication and if so which grant?
If a state or local jurisdiction decided to pursue this option in preparing first responders for an anthrax emergency, the jurisdiction could stipulate that first responder pay for the medication individually or the jurisdiction could use homeland security grant program funding for procurement of medical countermeasures. However, no additional grant funds have been provided for this option.
By having a 10-day supply of this medication at home, are first responders contributing to antibiotic resistance?
Antibiotic resistance is a concern for the inappropriate use of any antibiotic. Because antibiotic resistance is a worldwide health concern, first responders who receive prescriptions to store doxycycline at home should use the antibiotics only when directed by public health officials after an anthrax emergency has been confirmed and only according to the instructions provided with the medicine.
Information for first responders
If I am a first responder, do I need the letter to get this medication?
No. You can request a prescription for doxycycline from your occupational health provider or personal physician without the letter. Writing a prescription remains at the discretion of your healthcare provider. The letter does not mandate that your provider write a prescription. This letter describes reasons occupational health directors may want to consider in writing one. Healthcare providers will weigh the reasons to write a prescription for doxycycline with the risks of prescribing antibiotics. Keep in mind that many community emergency plans will provide anthrax antibiotics and vaccine to first responders before distributing medication or vaccine to the community at large at the time of an event. That standard approaches allow responders to support the community, knowing that your own health is protected.
If my local health department or occupational health provider doesn’t agree with the concept, how do I get the medication?
Many jurisdictions have plans to provide medication and vaccine to first responders immediately after an anthrax attack occurs, before medication or vaccine is distributed to the community at large. Talk with your local health preparedness director or emergency management director to learn about your community’s plans to distribute anthrax antibiotics or vaccine to first responders in an anthrax emergency. The option identified in the letter offers an additional approach. You also can talk with your personal physician about a prescription for doxycycline. Writing a prescription remains at your physician’s discretion. Like your occupational health director, your personal physician will weigh the risks and benefits before deciding whether to write a prescription for you.
Is the government saying I need this medication?
Anthrax antibiotics would be needed only if an anthrax attack occurred in your community. Storing anthrax antibiotics at home is a decision that should be made by the local jurisdiction, the healthcare provider, and the first responder.
What about my family? Why would this apply only to me?
You and members of your family will be able to receive the medicine they need to protect themselves after an anthrax attack in your community. The Centers for Disease Control and Prevention stands ready to provide antibiotics from the Strategic National Stockpile to affected communities within a few hours of health authorities recognizing that there is a need. State and local plans call for all members of an impacted community to receive an initial 10-day supply of antibiotics from local dispensing sites established by the local health department. This initial distribution would be followed by a second distribution of a 50-day supply medication, since a total of 60 days of doxycycline would be needed to prevent or treat anthrax infection. The availability of a home-stored supply for first responders is meant to help the community quickly react to the public safety needs that may require your immediate focus.
