Pediatric aspects of bioterrorism

Abstract

Potential microbes for bioterrorism threats include Bacillus anthrax, Yersinia pestis, Francisella tularemia, Clostridium botulinum, variola virus and hemorrhagic fever viruses such as Ebola. This review covers selective topics associated with anthrax and smallpox, such as epidemiology, pathogenesis, clinical presentation, diagnosis, prevention, and therapy, as well as approaches for clinical management of children in suspected exposure to anthrax and smallpox. Information is lacking regarding weaponized anthrax spores, including LD50, optimal management, alternatives for antibiotic-resistant strains and use of genetically modified strains to escape vaccine protection. The recent US outbreak in 2001 highlights the following features: case fatality rates of 45%, no secondary cases among household contacts of the inhalation anthrax subjects and no cases of anthrax among individuals on antibiotic prophylaxis. Regarding smallpox, discussions have concerned the identification of first response individuals and vaccination of such individuals; however, smallpox vaccine is associated with mortality and morbidity, and current issues include principles and procedures associated with vaccination.