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<td height="30px"><span class="title"><a name="h1" id="h1"></a>Pediatric Terrorism and Disaster Preparedness </span></td>
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<td><div id="centerContent"><p><strong>Public Health Emergency Preparedness</strong></p> <div class="headnote">
<p>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.</p>
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<p>Please go to <a href="https://www.ahrq.gov/">www.ahrq.gov</a> for current information.</p></div>
<h3>Table 4.3. Diagnostic Procedures, Isolation Precautions, Treatment, and Postexposure Prophylaxis for Selected Bioterrorist Agents in Children</h3>
<table border="1" cellspacing="0" cellpadding="2" width="95%">
<tr valign="top">
<th scope="col" width="15%">Agent</th>
<th scope="col" width="10%">Incubation Period</th>
<th scope="col" width="15%">Diagnostic Specimens and Procedures </th>
<th scope="col" width="10%">Isolation Precautions</th>
<th scope="col" width="15%">Treatment</th>
<th scope="col"width="15%">Postexposure Prophylaxis<sup><a href="#notea">a</a></sup> </th>
<th scope="col" width="20%">Comments</th>
</tr>
<tr valign="top">
<td scope="row">Alphaviruses (VEE, EEE, and WEE)</td>
<td width="10%">2-10 days</td>
<td width="15%">Cerebrospinal fluid (CSF) for viral isolation, antibody detection in CSF and acute and convalescent serum </td>
<td width="10%">Standard; respiratory precautions for WEE virus</td>
<td width="15%">Supportive</td>
<td width="15%">Protection from mosquito vectors</td>
<td width="20%">&nbsp; </td>
</tr>
<tr valign="top">
<td scope="row">Anthrax</td>
<td width="10%">1-60 days</td>
<td width="15%">Gram stain of buffy coat, CSF, pleural fluid, swab of skin lesion; culture of blood, CSF, pleural fluid, skin biopsy</td>
<td width="10%">Standard; contact for skin lesions</td>
<td width="15%">Ciprofloxacin<sup><a href="#noteb">b</a></sup> or doxycycline<sup><a href="#notec">c</a></sup>; combine with one or two additional antimicrobial agents for inhalational, gastrointestinal (GI), or oropharyngeal disease<sup><a href="#noted">d</a></sup> </td>
<td width="15%">Ciprofloxacin<sup><a href="#noteb">b</a></sup>, doxycycline<sup><a href="#notec">c</a></sup>, or amoxicillin<sup><a href="#notee">e</a></sup>; anthrax vaccine</td>
<td width="20%">Additional antimicrobial agents to be used for inhalational, GI, or oropharyngeal disease include rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, and clarithromycin</td>
</tr>
<tr valign="top">
<td scope="row">Botulism </td>
<td width="10%"><p>Foodborne: 2 hr-8 days<br />
Inhalational: 24-72 hr</p></td>
<td width="15%">Toxin detection from serum, feces, enema fluid, gastric fluid, vomitus, or suspected food samples; culture of feces or gastric sections; nerve conduction testing</td>
<td width="10%">Standard</td>
<td width="15%">Supportive care; mechanical ventilation and parenteral nutrition may be required; equine botulism antitoxin given as soon as possible (CDC)<sup><a href="#notef">f</a></sup></td>
<td width="15%">&nbsp; </td>
<td width="20%">Type-specific antitoxin should be administered when possible; antitoxin prevents additional nerve damage but does not reverse existing paralysis</td>
</tr>
<tr valign="top">
<td scope="row">Brucellosis</td>
<td width="10%">5-60 days</td>
<td width="15%">Culture of blood or bone marrow; acute and convalescent serum for antibody testing </td>
<td width="10%">Standard; contact for draining skin lesions</td>
<td width="15%">Doxycycline<sup><a href="#notec">c</a></sup> and rifampin; if younger than 8 yr old, use TMP-SMX</td>
<td width="15%">Doxycycline<sup><a href="#notec">c</a></sup> and rifampin</td>
<td width="20%">TMP-SMX may substitute for rifampin with doxycycline</td>
</tr>
<tr valign="top">
<td scope="row">Plague</td>
<td width="10%">2-4 days</td>
<td width="15%">Culture or fluorescent antibody staining of blood, sputum, lymph node aspirate</td>
<td width="10%">Droplet</td>
<td width="15%">Streptomycin sulfate or gentamicin sulfate; doxycycline<sup><a href="#notec">c</a></sup> or tetracycline<sup><a href="#notec">c</a></sup></td>
<td width="15%">Doxycycline<sup><a href="#notec">c</a></sup>; tetracycline<sup><a href="#notec">c</a></sup></td>
<td width="20%">TMP-SMX is an alternative; chloramphenicol for meningitis</td>
</tr>
<tr valign="top">
<td scope="row">Q fever</td>
<td width="10%">10-40 days</td>
<td width="15%">Acute and convalescent serum samples</td>
<td width="10%">Standard</td>
<td width="15%">Doxycycline<sup><a href="#notec">c</a></sup> or tetracycline<sup><a href="#notec">c</a></sup></td>
<td width="15%">Doxycycline<sup><a href="#notec">c</a></sup> or tetracycline<sup><a href="#notec">c</a></sup></td>
<td width="20%">Chloramphenicol is an alternative for treatment or prophylaxis</td>
</tr>
<tr valign="top">
<td scope="row">Smallpox</td>
<td width="10%">7-19 days</td>
<td width="15%">Culture of pharyngeal swab of skin lesions</td>
<td width="10%">Airborne, contact</td>
<td width="15%">Supportive care</td>
<td width="15%">Vaccine if administered within 4 days</td>
<td width="20%">&nbsp; </td>
</tr>
<tr valign="top">
<td scope="row">Staphylococcal enterotoxin B</td>
<td width="10%">3-12 hr</td>
<td width="15%">Serum, urine, and respiratory secretions for toxin; acute and convalescent serum for antibodies</td>
<td width="10%">Standard</td>
<td width="15%">Supportive care</td>
<td width="15%">None available</td>
<td width="20%">&nbsp; </td>
</tr>
<tr valign="top">
<td scope="row">Ricin</td>
<td width="10%">4-8 hr</td>
<td width="15%">Serum and/or respiratory secretions for enzyme immunoassay</td>
<td width="10%">Standard</td>
<td width="15%">Supportive care; gastric lavage and cathartics if toxin is ingested</td>
<td width="15%">Protective mask</td>
<td width="20%">&nbsp; </td>
</tr>
<tr valign="top">
<td scope="row">Viral hemorrhagic fevers</td>
<td width="10%">6-17 days</td>
<td width="15%">Culture and/or antigen detection of blood and other body tissues<sup><a href="#noteg">g</a></sup>; serum for acute and convalescent antibody detection</td>
<td width="10%">Standard, droplet, and contact precautions<sup><a href="#noteh">h</a></sup></td>
<td width="15%">Ribavarin IV for Lassa fever; plasma from convalescent patients for Argentinean hemorrhagic fever; supportive care</td>
<td width="15%">&nbsp; </td>
<td width="20%">&nbsp; </td>
</tr>
</table>
<p class="size2"><strong>Notes:</strong> EEE = Eastern equine encephalitis; VEE = Venezuelan equine encephalitis; WEE = Western equine encephalitis.</p>
<p class="size2"><a id="notea" name="notea"></a><sup>a</sup> 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.<br />
<a id="noteb" name="noteb"></a><sup>b</sup> 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.<br />
<a id="notec" name="notec"></a><sup>c</sup> 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.<br />
<a id="noted" name="noted"></a><sup>d</sup> Treatment should be administered parenterally initially but may be changed to oral therapy for cutaneous infection without dissemination.<br />
<a id="notee" name="notee"></a><sup>e</sup> Amoxicillin may be used as prophylaxis only if the organism is known to be susceptible.<br />
<a id="notef" name="notef"></a><sup>f</sup> 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).<br />
<a id="noteg" name="noteg"></a><sup>g</sup> Isolation should be attempted only under Biosafety Level-4 conditions. <br />
<a id="noteh" name="noteh"></a><sup>h</sup> 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.</p>
<p class="size2"><a href="pedchap4c.htm#Tab4.3">Return to Document</a></p>
<div class="footnote">
<p> The information on this page is archived and provided for reference purposes only.</p></div>
<p>&nbsp;</p>
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