Some infectious agents have the potential to be used in acts of bioterrorism. Because the threat of biological terrorism continues and children are likely to be affected disproportionately by such acts, pediatricians should be knowledgeable about agents of concern and the surveillance, management and response systems needed to minimize physical and mental trauma to children. The Centers for Disease Control and Prevention (CDC) provides a complete list of biological agents and other bioterrorism resources. The CDC Hotline at 800/232-4636 offers assistance and advice. Additional details for health professionals can be found in the article Preparation for Terrorist Threats: Biologic and Chemical Agents.

Children and Bioterrorism

Children are particularly vulnerable to biological agents, because they have a more rapid respiratory rate, increased skin permeability, higher ratio of skin surface area to mass, and less fluid reserve compared with adults. Fever, malaise, headache, vomiting, and diarrhea are common early manifestations of illness caused by many bioterrorist agents and other infectious diseases. It can be challenging for clinicians to discriminate between an act of terrorism and a naturally occurring outbreak. Accurate and rapid diagnosis is more difficult in children because of their inability to describe symptoms. Symptoms may appear days after exposure or the adults on whom children depend for their health and safety may become ill or require quarantine during a bioterrorist event.

Agents of bioterrorism are generally not transmitted from person to person. The release of an agent is most likely from a point source. Smallpox, viral hemorrhagic fevers, and pneumonic plague may be highly transmissible from person to person via respiratory droplet and, in some cases, by aerosol spread. Rapidly detecting and isolating patients with an infectious illness related to a biological agent is essential to preventing transmission. However, optimal decontamination strategies for children have been the focus of considerable discussion, and recommendations continue to evolve (see Principles of Pediatric Decontamination). Consideration could be given to decontaminating family members together.

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American Academy of Pediatrics