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In 2001, Bacillus anthracis spores were distributed intentionally through the US postal system, causing 22 cases of anthrax, including 5 deaths. Among these was an infant, who was suspected of being exposed during a visit to an office where an anthrax-tainted package was delivered. Although the child fully recovered, imagine what would have happened if more children would have been affected. Children's needs must be considered in advance of an act of bioterrorism.

In response to inquiries from federal partners, the American Academy of Pediatrics (AAP) approved formation of an Anthrax Work Group and an Anthrax Educational Planning Group. The AAP is working with the Centers for Disease Control and Prevention (CDC) to plan a Pediatric Anthrax Clinical Guidelines Meeting.

Pediatricians have recently provided expert guidance on government panels and have testified before Congress.

Countermeasures for Children
The US Strategic National Stockpile (SNS) is the national repository of medical countermeasures (MCMs), such as medications, vaccines, and other critical medical equipment and supplies, that are delivered to state authorities in a public health emergency. To protect the nation's security, the specific contents of the SNS are not shared with the public, although past outbreaks have shed light on what is missing, particularly where children are concerned.

Given the extraordinary morbidity of inhalation anthrax, the overarching AAP recommendations regarding the use of anthrax antimicrobial postexposure prophylaxis in children are as follows:
  • The SNS or other pre-deployed cache should always include an adequate supply of medication (eg, doxycycline/ciprofloxacin) in liquid/suspension form. Guidelines for extemporaneous oral liquid formulation of crushed solid tablets or opened capsules could be developed and tested as alternatives to current pediatric formulations.
  • Ciprofloxacin and doxycycline tablets should be manufactured in smaller tablet sizes to facilitate accurate milligram/kilogram dosing in small children.
  • Pediatricians should receive adequate public health training about the approved protocols for administering countermeasures to children.
  • An approved written protocol for MCM distribution should undergo prospective simulated testing to ensure that it achieves efficient and accurate administration to children during a disaster.
  • Development of semi-solid or other liquid formulations of medication for the SNS should be explored (eg, a gel or paste, powder, chewable or orally disintegrating tablets, or orally dissolving film strip).
  • Disaster Preparedness Advisory Council and Anthrax Work Group experts will continue working with federal agencies to ensure the needs of children are considered with regard to medical countermeasures.