ANTHRAX/BIOTERRORISM Q&A

Is general information available about bioterrorism?

Education is your best weapon against bioterrorism. Parents can familiarize themselves with recommendations by the American Academy of Pediatrics, and check out the Academy's "Family Readiness Kit" for disasters. It's a good idea to have a supply of bottled water, non-perishable food and other necessities put aside in case of any disaster, natural or man-made. In addition, parents can check out the U.S. Centers for Disease Control and Prevention Web site at www.cdc.gov or contact local public health agencies to find out the status of preparations at different levels of government.

How can I talk to my children effectively about the threat of bioterrorism?

It is important to allow children to express their fears and concerns and to communicate to them that they are safe. Given what they may have seen on television, children need to know that parents, health care providers and the government are doing everything they can to protect children from harm. Keeping family routines intact also will help children feel safe. In addition, watching too much media coverage of bioterrorism can be traumatizing. It is unwise to let children view footage of traumatic events such as news about anthrax outbreaks. The AAP has provided more tips on communicating with your children about disasters and terrorism at www.aap.org/advocacy/releases/disastercomm.htm.

What are federal health officials doing about the threat of bioterrorism?

The CDC has been working with state and local health departments, law enforcement officials, and other local and federal agencies to investigate possible anthrax exposures in the United States. Response teams of specialists have been formed by the CDC and have been dispatched to Florida, New York City, Washington, D.C., and other areas. In Atlanta, CDC officials continue to work from a 24-hour Operations Center. The Operations Center includes approximately 50 work stations equipped with state-of-the-art information systems, phone lines and fax machines. The Operations Center also is responding to calls each day from the public. More than 50 CDC laboratories have processed hundreds of specimens. The CDC also has offered extra training for physicians and other health care professionals in diagnosing and treating anthrax.

Are children at a greater risk from chemical or biological attacks than adults?

Perhaps. Experts believe children may be disproportionately affected by chemical or biological agents, if they are exposed, for several reasons. Children may be more likely to have skin cuts or scrapes through which germs can enter the body. For their body weight, children have a greater skin surface than adults, and they breathe faster than adults. Both factors may result in their absorbing a larger dose of these agents. It is harder to make a diagnosis in young children, because they cannot report what has happened to them and how they are feeling. In addition, some antibiotics and other treatments have not been studied as well in children as in adults.

Federal health officials feel that anthrax and smallpox are two of the most likely types of biological agents. But there are other germs with potential to be used as agents, including those causing plague, botulism, tularemia and Ebola virus. It's important to remember that these are only theoretical risks. You can get more information on these from the CDC at www.bt.cdc.gov.

What is anthrax?

Anthrax is an acute infectious disease caused by bacteria. The organism is contracted through the skin, lungs or gastrointestinal system.

What are the clinical forms of anthrax?

Skin (cutaneous) anthrax is the most common type, and is usually not fatal unless left untreated. Cutaneous anthrax occurs most commonly in agricultural and industrial workers who come into contact with infected animals or animal products — although more recently, cases of cutaneous anthrax have resulted from exposure to spores sent through the mail. The earliest symptom is a small sore on the skin, which blisters and then within one to two days becomes an ulcer with a black scab. Lung (inhalation) anthrax is rare, and results from breathing in anthrax spores. Inhalation anthrax is usually fatal unless treated early. Early symptoms are similar to flu or an upper respiratory tract infection. Gastrointestinal anthrax also is rare, and usually occurs after eating contaminated, undercooked meat. Death rates from gastrointestinal anthrax range from 25 percent to 60 percent.

Is anthrax more severe in children than adults?

Anthrax affects adults and children the same way — skin, lung or gastrointestinal. Children may be more likely to suffer side effects from some of the antibiotics used to prevent or treat the disease.

If I have anthrax, can my child contract it from me?

No. Anthrax is not transmitted from person to person.

What would happen if my child were exposed to anthrax?

If your child is exposed to anthrax, your physician will initially prescribe ciprofloxacin or doxycycline in consultation with public health officials. These drugs may cause significant side effects in children. Therefore, if lab tests show the anthrax to which your child was exposed is killed by amoxicillin, your child may be switched to that drug instead. Giving antibiotics to a child who has not been examined by a physician could do more harm than good, since it could mask symptoms of other serious illnesses. In addition, widespread use of these antibiotics could lead to drug-resistant bacteria, which could make the medicines ineffective for those who truly need them. Parents should rely on pediatricians and public health officials to advise them of treatment options in the event of exposure in their community.

Contact your child's pediatrician or health care provider immediately. Early diagnosis is the key to successful treatment. In the case of inhalation anthrax, antibiotics are only effective if begun before serious symptoms appear. If anthrax exposure is confirmed, your child's physician will begin treatment in consultation with local public health authorities.

Anthrax vaccine has not been studied in children, and is not recommended for people younger than 18 years of age. At this time, anthrax vaccine is available only to people in the military.

No. Influenza vaccination should not be considered a way to avoid confusing influenza disease with suspected anthrax illness for several reasons. First, symptoms such as fever, body aches and headaches are common to many different infections, besides influenza and anthrax. Since the majority of such illnesses are not caused by influenza (or anthrax), influenza vaccination will not prevent many such cases of illness. Second, influenza vaccine is not 100 percent protective and some people who have been vaccinated will still develop influenza. If people who have received influenza vaccine develop flu-like symptoms, it will still be much more likely they have influenza or another virus infection than anthrax. Finally, the CDC recommends that influenza vaccine supplies available during October should be targeted preferentially to health care workers, people (including children) with certain chronic medical conditions and the elderly who are at high risk for developing serious complications from influenza. Reducing influenza vaccine coverage of these groups could lead to an increase in hospitalization and deaths. There simply will not be enough influenza vaccine available to vaccinate everyone. The vaccine that is available should be given to those who are at highest risk of becoming severely ill if they get influenza.

No. The AAP and the CDC recommend that you do not obtain antibiotics for your children, either through prescriptions or any other means, unless the public health authorities have told you to do so in the face of documented exposure to anthrax.

Smallpox is a viral illness that occurs only in humans. Thanks to a worldwide immunization program, smallpox is no longer a naturally occurring disease. The last known case occurred in Somalia in 1977, and in May 1980, the World Health Organization certified that the world was free of smallpox cases. During the smallpox era, about 30 percent of infected people died. The only known samples of smallpox virus are kept for research purposes in secure facilities at the CDC in Atlanta and the Institute for Viral Preparations in Russia. Although there is no proof, there is concern that terrorists might have acquired samples of smallpox as well.

Smallpox can easily be spread from person to person. Several clinical features can help pediatricians differentiate chickenpox from smallpox. The rash from smallpox is typically most prominent on the face and extremities, and happens all at once — while the rash from chickenpox is most prominent on the trunk and develops over several days. In addition, multiple smallpox lesions are often found on the palms of hands and soles of feet, which is unusual in chickenpox. Smallpox lesions are deeper than chickenpox lesions and often produce scars.

There are no specific medicines proven to cure smallpox.

No. Smallpox vaccine is not available commercially in the United States. The U.S. Public Health Service does maintain an emergency stockpile of smallpox vaccine. Your health care provider or pediatrician cannot get the vaccine.