Editor's Note:
The guidance for the appropriate response to anthrax exposure and the management of different types of anthrax infection (inhalation, cutaneous, gastrointestinal, systemic) in children has just been updated and is summarized here. Expanded guidance is also available on the prevention and management of anthrax exposure and inhalation anthrax in adults and for anthrax during pregnancy and postpartum.
Anthrax in Children
Since the anthrax attacks in 2001, anthrax has remained a major focus of national emergency-preparedness planning. Bacillus anthracis, the bacterium that causes anthrax, is concerning because it can rapidly progress to systemic disease with high mortality if untreated.
If an intentional release of anthrax were to occur, children would require special consideration because the clinical presentation and progression of disease in children may differ from that in adults. Children could be at higher risk of developing systemic disease and/or meningoencephalitis, the symptoms they experience may mimic those of other illnesses, and little is known about the signs and symptoms of anthrax in infants younger than 2 months of age.
To address these issues, the American Academy of Pediatrics and the Centers for Disease Control and Prevention released a report[1] focusing specifically on the clinical needs of children during an anthrax emergency. The report provides the most current guidance on caring for children after an intentional release of B anthracis and includes information on the diagnosis and management of anthrax in pediatric populations, antimicrobial and vaccine use, and treatment options.
Postexposure Prophylaxis
All children exposed to B anthracis spores should receive at least 60 days of antimicrobial prophylaxis with the most effective agents, even if these agents are associated with increased side effects compared with antimicrobials more often used in children.
Oral ciprofloxacin and doxycycline are preferred, or if the strain is susceptible to penicillin, amoxicillin should be used.
In addition to antimicrobials, all exposed children aged 6 weeks and older should receive 3 doses of anthrax vaccine adsorbed (AVA) at 0, 2, and 4 weeks. Children younger than 6 weeks should immediately begin antimicrobial prophylaxis but delay starting the vaccine series until 6 weeks of age. During an event, immunization with AVA should be given priority over routine childhood vaccinations -- they should not be administered at the same time. Routine vaccinations can resume 4 weeks after the last shot of AVA.
Doctors' Happiness Has Not Rebounded as Pandemic Drags On
COMMENTARY
Anthrax in Children: Prevention and Treatment
John S. Bradley, MD; Georgina Peacock, MD, MPH; Steven E. Krug, MD
DisclosuresMay 27, 2014
Editorial Collaboration
Medscape &
Editor's Note: The guidance for the appropriate response to anthrax exposure and the management of different types of anthrax infection (inhalation, cutaneous, gastrointestinal, systemic) in children has just been updated and is summarized here. Expanded guidance is also available on the prevention and management of anthrax exposure and inhalation anthrax in adults and for anthrax during pregnancy and postpartum.
Anthrax in Children
Since the anthrax attacks in 2001, anthrax has remained a major focus of national emergency-preparedness planning. Bacillus anthracis, the bacterium that causes anthrax, is concerning because it can rapidly progress to systemic disease with high mortality if untreated.
If an intentional release of anthrax were to occur, children would require special consideration because the clinical presentation and progression of disease in children may differ from that in adults. Children could be at higher risk of developing systemic disease and/or meningoencephalitis, the symptoms they experience may mimic those of other illnesses, and little is known about the signs and symptoms of anthrax in infants younger than 2 months of age.
To address these issues, the American Academy of Pediatrics and the Centers for Disease Control and Prevention released a report[1] focusing specifically on the clinical needs of children during an anthrax emergency. The report provides the most current guidance on caring for children after an intentional release of B anthracis and includes information on the diagnosis and management of anthrax in pediatric populations, antimicrobial and vaccine use, and treatment options.
Postexposure Prophylaxis
All children exposed to B anthracis spores should receive at least 60 days of antimicrobial prophylaxis with the most effective agents, even if these agents are associated with increased side effects compared with antimicrobials more often used in children.
Oral ciprofloxacin and doxycycline are preferred, or if the strain is susceptible to penicillin, amoxicillin should be used.
In addition to antimicrobials, all exposed children aged 6 weeks and older should receive 3 doses of anthrax vaccine adsorbed (AVA) at 0, 2, and 4 weeks. Children younger than 6 weeks should immediately begin antimicrobial prophylaxis but delay starting the vaccine series until 6 weeks of age. During an event, immunization with AVA should be given priority over routine childhood vaccinations -- they should not be administered at the same time. Routine vaccinations can resume 4 weeks after the last shot of AVA.
Public Information from the CDC and Medscape
Cite this: Anthrax in Children: Prevention and Treatment - Medscape - May 27, 2014.
Tables
References
Authors and Disclosures
Authors and Disclosures
Authors
John S. Bradley, MD
Pediatric Infectious Disease Specialist, Rady Children's Hospital; Chief, Division of Pediatric Diseases, School of Medicine, University of California, San Diego
Disclosure: John S. Bradley, MD, has disclosed no relevant financial relationships.
Georgina Peacock, MD, MPH
Medical Officer, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
Disclosure: Georgina Peacock, MD, MPH, has disclosed no relevant financial relationships.
Steven E. Krug, MD
Professor, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
Disclosure: Steven E. Krug, MD, has disclosed no relevant financial relationships.