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  • Children are more likely than adults to have severe illness following a biological exposure.
  • Vulnerabilities, such as a lack of pediatric expertise, equipment, or facilities within disaster planning and EMS systems, could be exacerbated by a terrorist attack involving children.
  • Antibiotics that are infrequently used in children, such as tetracyclines and fluoroquinolones, may be the drugs of choice for children in the setting of bioterrorism.
  • Infection control practices should be employed since secondary transmission is likely with biological agents such as plague, smallpox, and hemorrhagic fevers.


Pediatric needs in the planning, preparation, and response to biological disasters or acts of terrorism is essential.1 Nearly all child health professionals can benefit from bioterrorism disaster training and education.2 Children remain potential victims of biological terrorism. In recent years, children have been specific targets of terrorists' acts.3 Consequently, it is necessary to address the needs of pediatric patients after a potential terrorist or disaster incident.


Specific to bioterrorism, more fulminant infectious diseases are possible in children because of immunologic immaturity and a more permeable blood–brain barrier. Furthermore, many drugs used to treat illness from bioagents were historically avoided during childhood because of potential developmental toxicity. Finally, it is anticipated that specific vulnerabilities such as lack of pediatric expertise, equipment, or facilities within disaster planning and EMS systems might be exacerbated by a terrorist attack involving children.4


In contrast to a chemical attack, a covert biological attack will simulate a natural outbreak, with an incubation period rather than producing immediate mass casualties.5 The Centers for Disease Control and Prevention (CDC) has developed a list of “critical agents for health preparedness” that encompasses organisms with the most potentially devastating consequences that would require the most critical medical responses if released by a bioterrorist.6 According to this classification scheme, the highest overall public health impact and requirement for intensive preparedness as well as intervention would stem from an aerosolized release of:


  • Variola virus (smallpox).
  • Bacillus anthracis (anthrax).
  • Yersinia pestis (plague).
  • Clostridia botulinum (botulism).
  • Francisella tularensis (tularemia).
  • Filoviridae/Arenaviridae, such as Ebola, Marburg, or Lassa fever viruses that produce hemorrhagic fevers.


Each of these identified agents will be discussed in the following paragraphs. The remaining agents are identified in Table 68–1.

Table Graphic Jump Location
Table 68-1. Critical Biological Agent Categories for Public Health Preparedness

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