Pediatric Terrorism and Disaster Preparedness: Table 4.3

Table 4.3. Diagnostic Procedures, Isolation Precautions, Treatment, and Postexposure Prophylaxis for Selected Bioterrorist Agents in Children

Agent	Incubation Period	Diagnostic Specimens and Procedures	Isolation Precautions	Treatment	Postexposure Prophylaxis^a	Comments
Alphaviruses (VEE, EEE, and WEE)	2-10 days	Cerebrospinal fluid (CSF) for viral isolation, antibody detection in CSF and acute and convalescent serum	Standard; respiratory precautions for WEE virus	Supportive	Protection from mosquito vectors
Anthrax	1-60 days	Gram stain of buffy coat, CSF, pleural fluid, swab of skin lesion; culture of blood, CSF, pleural fluid, skin biopsy	Standard; contact for skin lesions	Ciprofloxacin^b or doxycycline^c; combine with one or two additional antimicrobial agents for inhalational, gastrointestinal (GI), or oropharyngeal disease^d	Ciprofloxacin^b, doxycycline^c, or amoxicillin^e; anthrax vaccine	Additional antimicrobial agents to be used for inhalational, GI, or oropharyngeal disease include rifampin, vancomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, and clarithromycin
Botulism	Foodborne: 2 hr-8 days Inhalational: 24-72 hr	Toxin detection from serum, feces, enema fluid, gastric fluid, vomitus, or suspected food samples; culture of feces or gastric sections; nerve conduction testing	Standard	Supportive care; mechanical ventilation and parenteral nutrition may be required; equine botulism antitoxin given as soon as possible (CDC)^f		Type-specific antitoxin should be administered when possible; antitoxin prevents additional nerve damage but does not reverse existing paralysis
Brucellosis	5-60 days	Culture of blood or bone marrow; acute and convalescent serum for antibody testing	Standard; contact for draining skin lesions	Doxycycline^c and rifampin; if younger than 8 yr old, use TMP-SMX	Doxycycline^c and rifampin	TMP-SMX may substitute for rifampin with doxycycline
Plague	2-4 days	Culture or fluorescent antibody staining of blood, sputum, lymph node aspirate	Droplet	Streptomycin sulfate or gentamicin sulfate; doxycycline^c or tetracycline^c	Doxycycline^c; tetracycline^c	TMP-SMX is an alternative; chloramphenicol for meningitis
Q fever	10-40 days	Acute and convalescent serum samples	Standard	Doxycycline^c or tetracycline^c	Doxycycline^c or tetracycline^c	Chloramphenicol is an alternative for treatment or prophylaxis
Smallpox	7-19 days	Culture of pharyngeal swab of skin lesions	Airborne, contact	Supportive care	Vaccine if administered within 4 days
Staphylococcal enterotoxin B	3-12 hr	Serum, urine, and respiratory secretions for toxin; acute and convalescent serum for antibodies	Standard	Supportive care	None available
Ricin	4-8 hr	Serum and/or respiratory secretions for enzyme immunoassay	Standard	Supportive care; gastric lavage and cathartics if toxin is ingested	Protective mask
Viral hemorrhagic fevers	6-17 days	Culture and/or antigen detection of blood and other body tissues^g; serum for acute and convalescent antibody detection	Standard, droplet, and contact precautions^h	Ribavarin IV for Lassa fever; plasma from convalescent patients for Argentinean hemorrhagic fever; supportive care

Notes: EEE = Eastern equine encephalitis; VEE = Venezuelan equine encephalitis; WEE = Western equine encephalitis.

^a Prophylaxis should be administered only after consultation with public health officials and only in situations in which exposure is highly likely. The duration of prophylaxis has not been determined for most agents.
^b If susceptibility is unknown or indicates resistance to other agents. Ciprofloxacin is not licensed by the Food and Drug Administration (FDA) for use in people younger than 18 yr but is indicated for potentially serious or life-threatening infections.
^c Tetracyclines, including doxycycline, are not approved by the FDA for this indication and are usually contraindicated for children younger than 8 yr, but treatment is warranted for selected serious infections.
^d Treatment should be administered parenterally initially but may be changed to oral therapy for cutaneous infection without dissemination.
^e Amoxicillin may be used as prophylaxis only if the organism is known to be susceptible.
^f Botulism antitoxin must be obtained from the Centers for Disease Control and Prevention (CDC) Drug Service, 404-639-3670 (weekdays, 8 am to 4:30 pm) or 404-639-2888 (weekends, nights, holidays).
^g Isolation should be attempted only under Biosafety Level-4 conditions.
^h Because of the risk of nosocomial transmission, the State health department and the CDC should be contacted for specific advice about management and diagnosis of suspected cases.

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