Biological Terrorism and Agents: Disaster Management Resources

The CDC categorizes biological agents as Category A, Category B, or Category C.

• The highest-priority agents are designated as Category A because they have the potential for major public health effects, could cause panic or social disruption and require special action to promote preparedness. Category A agents are transmitted from person-to-person easily and cause high morbidity and mortality rates. Organisms in this category cause anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fevers including Filoviruses (Ebola, Marburg) and Arenaviruses (Lassa and other related viruses). 
• Category B agents are moderately easy to disseminate, cause moderate morbidity and low mortality rates, and require enhanced diagnostic capacity and disease surveillance. Examples include: Alphaviruses or Arboviral Encephalitides; Brucella species (brucellosis); Chlamydophila psittaci (psittacosis); Coxiella burnetii (Q fever);  Burkolderia mallei (glanders); Burkholderia psudomallei (melioidosis); Rickettsia prowazekii (typhus); and toxins/toxic syndrome such as ricin toxin from Ricinus communis [castor beans], epsilon toxin of Clostridium perfringens, and Staphylococcus enterotoxin B. Other category B agents that are foodborne or waterborne safety threats, such as botulism, Escherichia coli O157:H7, salmonellosis, Shigella, and Vibrio cholerae, Cryptoporidum parvum 
• Category C agents include emerging pathogens that could be engineered for mass dissemination because of availability, ease of production and dissemination, and potential for high morbidity and mortality rates and major health effects. Examples include Nipah virus and hantavirus.

As part of the network of health responders, pediatricians need to be able to answer questions, recognize signs of possible exposure to a biological agent, understand first-line response to such attacks and participate in disaster planning to ensure that the needs of children are addressed. Involvement of pediatricians in these activities increases the likelihood that the needs and vulnerabilities of children will be considered. Pediatricians who wish to increase their involvement should consider the following:

• Participate in local activities related to biological terrorism preparedness. The pediatrician can be a valuable resource to public health authorities in issues such as first-responder training and hospital preparedness.
• Work with local child care programs, school systems and camps to develop plans for rapid evacuation, relocation, triage and initial care of children who are in these facilities when an act of biological terrorism occurs.
• Assist families in developing disaster plans and deciding how to talk to children about terrorism and related topics.
• Ensure proper treatment for children exposed to circumstances beyond the scope of normal human experience to mitigate mental health consequences. Helping Children Cope and Adjust After a Disaster is especially important after biological terrorism, as symptoms can develop days to months after the event.

Because victims of biological terrorism may present to a pediatrician's office, there should be consideration of plans and protocols for management of such children on site. Preparation may include the establishment of out-of-building decontamination protocols and isolation of potentially infectious patients from others. During a bioterrorist event, local pediatricians and their staff should maximize their ability to keep the office running smoothly and to provide care.

Every office needs a written emergency or disaster preparedness plan. When a biological or other type of terrorism event is suspected, the office staff should have a plan for how they will handle the potentially large number of clients who may call or arrive at the office without an appointment. The plan needs to address how to triage and sort those who are worried/anxious from those who need care. The plan should also address how office staff will isolate and evaluate children suspected of having an illness related to bioterrorism. For more information refer to the Preparedness Checklist for Pediatric Practices.

Staff should also be educated about Infection Prevention and Control in Pediatric Ambulatory Settings and pediatricians should contact the appropriate state and local health department officials in advance of an event to ensure they understand what might be required in the early evaluation or transportation of a patient.

Many preventive and therapeutic agents recommended for adults exposed or potentially exposed to agents of bioterrorism have not been studied in infants and children, and pediatric doses have not been established or approved by the US Food and Drug Administration for use in children.

Children also may be at risk of unique adverse effects from preventive and therapeutic agents that are recommended for treating exposure to agents of bioterrorism. Further, availability of appropriate pediatric formulations of medical countermeasures may be limited.