Biomedical Engineering Reference
In-Depth Information
with suspected weapons-grade anthrax. Typically,
this drug is not recommended in children under 12
years of age due to reports of adverse effects on
cartilage growth in young animals. However, in the
setting of anthrax disease or exposure, the risk of
contracting or not treating resistant anthrax infec-
tion outweighs the potential for an adverse effect
of ciprofloxacin. For acute infection, ciprofloxacin
is given intravenously in a dose of 10-15mg per
kg every 12 hours up to the adult maximum of
400mg for 60 days. For prophylaxis the same dose
of ciprofloxacin is given orally for up to 60 days
after exposure. Both treatment and prophylaxis
regimens should be changed if the anthrax isolates
are susceptible to penicillin. Appropriate alterna-
tives in this instance include intravenous penicillin
G and oral amoxicillin [17].
When ciprofloxacin is in short supply, doxycy-
cline becomes the drug of choice despite its adverse
effects in children; weakening of bones in infants
and dental staining in children under 8 years of
age. Children over 8 years of age should receive
doxycycline 100mg IV every 12 hours for 60 days
to treat acute infection and the same dose orally for
prophylaxis. Children under 8 years of age should
receive 2.2mg/kg up to 100mg intravenously as
above for acute infection and orally for prophy-
laxis [17].
An inactivated anthrax vaccine, anthrax vaccine
adsorbed, was given experimentally to adults
potentially exposed to anthrax spores in 2001.
Limited data are available to determine the
efficacy of postexposure vaccination. However,
the extended time for potential infection would
possibly give vaccinated persons a chance to mount
some immunity prior to infection. There is no data
regarding safety or efficacy of anthrax vaccine in
children [19].
tiate these infections [16]. Also, routine vaccin-
ation against varicella has markedly reduced the
number of cases in the pediatric population.
Although eradicated as a natural source of infec-
tion in the 1970s, smallpox samples were kept
by the USA and the former Soviet Union. In
response to the terrorist attacks of September
2001, the United States of America began several
steps to mitigate against the threat of smallpox
dissemination, including resumption of a national
smallpox vaccination program. The initial focus
of the program was to vaccinate up to 500,000
public health professionals and hospital personnel
to serve on vaccination response teams. Subse-
quently, attention has turned to developing plans
through the public health infrastructure for mass
vaccination of the entire US population in the event
of a smallpox outbreak. Current recommendations
for mass smallpox vaccination are the same for
children and adults.
Despite this plan, institutions and government
agencies have withheld approval for new pediatric
studies of safety and efficacy for the Wyeth Dryvax
Variola Major vaccine [20]. A systemic review
of major complications and mortality following
smallpox vaccination based on US experience
from 1963 to 1968 did find that infants less than
1 year of age had greater risk for post-vaccinial
encephalitis and generalized vaccinia than other
age groups [21]. Limited data from adult volunteers
suggest that current vaccination risks are equal to
or less than these historical risks [22,23].
10.3.4 Plague
When aerosolized,
Yersinia pestis
, organism
responsible for plague, causes pneumonic plague,
a disease with a 25% mortality rate. Intramus-
cular streptomycin (15mg/kg twice daily up to 1 g)
or intravenous gentamicin (2.5mg/kg three times
daily) are the therapies of choice in children.
However, in the setting of a mass casualty,
it is unlikely that adequate supplies of these
drugs would be available and intravenous therapy
with ciprofloxacin (see anthrax treatment above),
doxycycline (see anthrax treatment above) or
10.3.3 Smallpox
Smallpox has an estimated 30% mortality rate
among unvaccinated children and adults. Clinical
findings among children and adults do not differ
significantly. Varicella (chickenpox) infection in
children can mimic certain features of smallpox
infection. Several resources exist to help differen-
