In the Event of Bioterrorism: A Parent's Guide to Preparedness

According to the American Acadamy of Pediatrics, experts believe children may be disproportionately affected by chemical or biological agents, if they are exposed, for the following 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 children breathe faster than adults. These factors may result in children absorbing a larger dose of chemical or biological agents than an adult would. It is harder to make a diagnosis of exposure 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.

If a biological weapon is ever released, it could take days for symptoms to develop and for the biological agent to be identified. Once symptoms are present, hospitals and government health departments will notice an increase in specific disease or symptom outbreaks. They will determine the cause of the epidemic and deploy available antibiotics or vaccines, if they exist, to treat and prevent the spread of disease.

Currently, all doctors, hospitals and medical facilities are on high alert for any unusual disease outbreak that could be caused by suspected biologic agents.

There are approximately six agents that experts suspect would be used in a bioterrorist attack. Most believe that anthrax and plague are among the most likely to be used. Currently, the federal government plans no widespread use or distribution of anthrax or smallpox vaccines, but the policy is under continual review.

Recognizing the Symptoms

Anthrax
Symptoms of disease vary depending on how the disease was contracted, but usually occur within 7 days of exposure. The serious forms of human anthrax are inhalation anthrax, cutaneous anthrax, and intestinal anthrax. Initial symptoms of inhalation anthrax infection may resemble a common cold. After several days, the symptoms may progress to severe breathing problems and shock. Inhalation anthrax is often fatal. The intestinal disease form of anthrax may follow the consumption of contaminated food and is characterized by an acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, and fever are followed by abdominal pain, vomiting of blood, and severe diarrhea. Direct person-to-person spread of anthrax is extremely unlikely, if it occurs at all. There is no need to immunize or treat contacts of persons ill with anthrax, such as household contacts, friends, or coworkers, unless they also were also exposed to the same source of infection.

• Foodborne botulism occurs when a person ingests pre-formed toxin that leads to illness within a few hours to days. Foodborne botulism is a public health emergency because the contaminated food may still be available to other persons besides the patient. Symptoms begin within 6 hours to 2 weeks (most commonly between 12 and 36 hours) after eating toxin-containing food.
• Infant botulism occurs in a small number of susceptible infants each year who harbor C. botulinum in their intestinal tract.
• Wound botulism occurs when wounds are infected with C. botulinum that secretes the toxin.

The first signs of illness in pneumonic plague are fever, headache, weakness, and cough productive of bloody or watery sputum. The pneumonia progresses over 2 to 4 days and may cause septic shock and, without early treatment, death.

Initial symptoms include high fever, fatigue, and head and back aches. A characteristic rash, most prominent on the face, arms, and legs, follows in 2 to 3 days. The rash starts with flat red lesions that evolve at the same rate. Lesions become pus-filled and begin to crust early in the second week. Scabs develop and then separate and fall off after about 3 to 4 weeks. The majority of patients with smallpox recover, but death occurs in up to 30 percent of cases.

If an epidemic occurs, parents should react as follows:

• Limit Exposure
  Parents should limit their and their children's exposure to infected individuals (if the disease can be transmitted person-to-person).
• Prepare for a Possible Quarantine
  Prepare as if a hurricane or blizzard were coming. You should have a supply of water, flashlights, fuel and food. In the event of an epidemic, a government-mandated quarantine or home stay is possible, depending on the agent used, and could range from one to three weeks. Access to grocery and drug stores may be limited during that time.
• Update Your Phone Book
  Place the phone number of local hospitals and city, county or state public health department in a prominent place. Public health departments will be monitoring disease outbreaks and will make recommendations about what precautions families should take. Health departments and other government agencies will decide whether to recommend children stay home from school. They will also advise families where to go for smallpox immunizations or for antibiotics that are used to prevent certain epidemics.
• Have a First Aid Kit
  Keep a first aid kit with antiseptic, bandages, anti-diarrhea medication and over-the-counter pain killers. Also, create a card with all the children's key medical information, such as medication schedule and food or drug allergies.

What not to do in case of an epidemic:

• Don't Hoard Antibiotics
  Of the suspected biologic agents that would cause widespread disease, three (anthrax, plague and tularemia) could be treated with antibiotics. But don't call the family doctor for a prescription. Antibiotics quickly expire, dosages vary and the timing of when to take antibiotics and for how long varies depending on the biologic agent used in an attack. For instance, in the case of anthrax, antibiotics must be administered before symptoms appear, and in the case of plague, antibiotic treatment must continue for seven days following last exposure. The federal government already has a stockpile of antibiotics that will be deployed to infected areas in the event of an attack.
• Don't Bother with a Face Mask
  They won't keep disease microbes away. They are usually used to keep medical personnel from wiping their noses with their hands, which often carry infectious agents. The masks were seen in New York City to keep air-borne dust and asbestos particles out of noses and throats.
• Don't Lose Your Cool
  Most importantly, as parents, do not panic or overeact. Rest assured, government agencies have been working hard to put systems and reporting processes in place to quickly identify any emerging epidemic that could be caused by a bioterrorist.

Sources:

American Acadamy of Pediatrics, National Network of Immunization Information, Johns Hopkins University's Center for Civilian Biodefense Studies, The Center for Disease Control