Pediatric anthrax clinical management: executive summary.

The use of Bacillus anthracis as a biological weapon is considered a potential national security threat by the US government. B anthracis has the ability to be used as a biological weapon and to cause anthrax, which can rapidly progress to systemic disease with high mortality in those who are untreated. Therefore, clear plans for managing children after a B anthracis bioterror exposure event must be in place before any intentional release of the agent. This document provides a summary of the guidance contained in the clinical report (appendices cited in this executive summary refer to those in the clinical report) for diagnosis and management of anthrax, including antimicrobial treatment and postexposure prophylaxis (PEP), use of antitoxin, and recommendations for use of anthrax vaccine in neonates, infants, children, adolescents, and young adults up to the age of 21 years (referred to as “children”). Key considerations in a mass B anthracis exposure scenario include the following: 1. Public health authorities will determine the presence and extent of a bioterror event. Information of importance to health care providers and the public will be made available as soon as possible by the Centers for Disease Control and Prevention (CDC), including information posted on the CDC Anthrax Web site: www.cdc.gov/ anthrax. 2. Within 48 hours of exposure to B anthracis spores, public health authorities plan to provide a 10-day course of antimicrobial prophylaxis to the local population, including children likely to have been exposed to spores (Appendix 1). Public health officials will provide information about points of dispensing locations that will distribute antibiotic agents. 3. Within 10 days of exposure, public health authorities plan to further define those who have had a clear and significant exposure and will require an additional 50 days of antimicrobial PEP, as well as beginning the 3-dose anthrax vaccine, anthrax vaccine adsorbed (AVA [BioThrax, Emergent BioSolutions, Rockville, MD]) series for children. Because there are insufficient data for the anthrax vaccine in children, it will be made available under an Investigational New Drug protocol. For children younger than 6 weeks of age (who are not candidates for AVA), antimicrobial prophylaxis should begin immediately, but the vaccine series should be delayed until the child reaches 6 weeks of age. A local adverse event after receiving a previous dose of AVA is not a contraindication to receiving additional doses, although the John S. Bradley, MD, FAAP, FIDSA, FPIDS, Georgina Peacock, MD, MPH, FAAP, Steven E. Krug, MD, FAAP, William A. Bower, MD, FIDSA, Amanda C. Cohn, MD, Dana Meaney-Delman, MD, MPH, FACOG, Andrew T. Pavia, MD, FAAP, FIDSA, and AAP COMMITTEE ON INFECTIOUS DISEASES and DISASTER PREPAREDNESS ADVISORY COUNCIL