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Pediatric Terrorism and Disaster Preparedness

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

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Table 4.3. Diagnostic Procedures, Isolation Precautions, Treatment, and Postexposure Prophylaxis for Selected Bioterrorist Agents in Children

Agent Incubation Period Diagnostic Specimens and Procedures Isolation Precautions Treatment Postexposure Prophylaxisa Comments
Alphaviruses (VEE, EEE, and WEE) 2-10 days Cerebrospinal fluid (CSF) for viral isolation, antibody detection in CSF and acute and convalescent serum Standard; respiratory precautions for WEE virus Supportive Protection from mosquito vectors  
Anthrax 1-60 days Gram stain of buffy coat, CSF, pleural fluid, swab of skin lesion; culture of blood, CSF, pleural fluid, skin biopsy Standard; contact for skin lesions Ciprofloxacinb or doxycyclinec; combine with one or two additional antimicrobial agents for inhalational, gastrointestinal (GI), or oropharyngeal diseased Ciprofloxacinb, doxycyclinec, or amoxicilline; anthrax vaccine Additional antimicrobial agents to be used for inhalational, GI, or oropharyngeal disease include rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, and clarithromycin
Botulism

Foodborne: 2 hr-8 days
Inhalational: 24-72 hr

 Toxin detection from serum, feces, enema fluid, gastric fluid, vomitus, or suspected food samples; culture of feces or gastric sections; nerve conduction testing Standard Supportive care; mechanical ventilation and parenteral nutrition may be required; equine botulism antitoxin given as soon as possible (CDC)f   Type-specific antitoxin should be administered when possible; antitoxin prevents additional nerve damage but does not reverse existing paralysis
Brucellosis 5-60 days Culture of blood or bone marrow; acute and convalescent serum for antibody testing Standard; contact for draining skin lesions Doxycyclinec and rifampin; if younger than 8 yr old, use TMP-SMX Doxycyclinec and rifampin TMP-SMX may substitute for rifampin with doxycycline
Plague 2-4 days Culture or fluorescent antibody staining of blood, sputum, lymph node aspirate Droplet Streptomycin sulfate or gentamicin sulfate; doxycyclinec or tetracyclinec Doxycyclinec; tetracyclinec TMP-SMX is an alternative; chloramphenicol for meningitis
Q fever 10-40 days Acute and convalescent serum samples Standard Doxycyclinec or tetracyclinec Doxycyclinec or tetracyclinec Chloramphenicol is an alternative for treatment or prophylaxis
Smallpox 7-19 days Culture of pharyngeal swab of skin lesions Airborne, contact Supportive care Vaccine if administered within 4 days  
Staphylococcal enterotoxin B 3-12 hr Serum, urine, and respiratory secretions for toxin; acute and convalescent serum for antibodies Standard Supportive care None available  
Ricin 4-8 hr Serum and/or respiratory secretions for enzyme immunoassay Standard Supportive care; gastric lavage and cathartics if toxin is ingested Protective mask  
Viral hemorrhagic fevers 6-17 days Culture and/or antigen detection of blood and other body tissuesg; serum for acute and convalescent antibody detection Standard, droplet, and contact precautionsh Ribavarin IV for Lassa fever; plasma from convalescent patients for Argentinean hemorrhagic fever; supportive care    

Notes: EEE = Eastern equine encephalitis; VEE = Venezuelan equine encephalitis; WEE = Western equine encephalitis.

a Prophylaxis should be administered only after consultation with public health officials and only in situations in which exposure is highly likely. The duration of prophylaxis has not been determined for most agents.
b If susceptibility is unknown or indicates resistance to other agents. Ciprofloxacin is not licensed by the Food and Drug Administration (FDA) for use in people younger than 18 yr but is indicated for potentially serious or life-threatening infections.
c Tetracyclines, including doxycycline, are not approved by the FDA for this indication and are usually contraindicated for children younger than 8 yr, but treatment is warranted for selected serious infections.
d Treatment should be administered parenterally initially but may be changed to oral therapy for cutaneous infection without dissemination.
e Amoxicillin may be used as prophylaxis only if the organism is known to be susceptible.
f Botulism antitoxin must be obtained from the Centers for Disease Control and Prevention (CDC) Drug Service, 404-639-3670 (weekdays, 8 am to 4:30 pm) or 404-639-2888 (weekends, nights, holidays).
g Isolation should be attempted only under Biosafety Level-4 conditions.
h Because of the risk of nosocomial transmission, the State health department and the CDC should be contacted for specific advice about management and diagnosis of suspected cases.

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