Bioterrorism Attacks Involving Pediatric Patients: Preparedness and Early Recognition Are Critical

Points and Pearls Excerpt

• Children are particularly vulnerable to bioterrorism agents, due to their smaller size, developmental immaturity, behavioral characteristics, increased minute ventilation, and decreased physiologic reserve.
• The symptoms associated with most bioterrorism agents can be difficult to differentiate from those of common childhood illnesses, as most biological weapons are associated with clinical presentations that mimic nonspecific febrile illnesses.
• The United States Centers for Disease Control and Prevention (CDC) has designated the highest-risk bioterrorism agents as Category A agents. Diseases caused by these agents include, anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fevers.
• Anthrax (Bacillus anthracis) can infect patients via 3 routes of infectivity, depending on where the spores deposit: (1) cutaneous, (2) inhalational, and (3) gastrointestinal. The inhalational form is the form most associated with bioterrorism and should be considered in the setting of mediastinitis demonstrated by fever, shortness of breath, chest pain, and a widened mediastinum with pleural effusions on chest x-ray.

Most Important References

• Adalja AA, Toner E, Inglesby TV. Clinical management of potential bioterrorism-related conditions. N Engl J Med. 2015;372(10):954-962. (Review) DOI: http://dx.doi.org/10.1056/NEJMra1409755 
• Pediatric Terrorism and Disaster Preparedness: A Resource for Pediatricians. Foltin GL, Schonfeld DJ, Shannon MW. Elk Grove Village: American Academy of Pediatrics; 2006. (Resource document) https://archive.ahrq.gov/research/pedprep/pedresource.pdf
• Thompson J, Rehn M, Lossius HM, et al. Risks to emergency medical responders at terrorist incidents: a narrative review of the medical literature. Crit Care. 2014;18(5):521-521. (Review) DOI: http://dx.doi.org/10.1186/s13054-014-0521-1
• Bradley JS, Peacock G, Krug SE, et al. Pediatric anthrax clinical management. Pediatrics. 2014;133(5):e1411-e1436. (Review, expert recommendations) DOI: http://dx.doi.org/10.1542/peds.2014-0563
• Michael WS, Julia AM. Chemical-biological terrorism and its impact on children. Pediatrics. 2006;118(3):1267-1278. (Review) DOI: http://dx.doi.org/10.1542/peds.2006-1700