Bioterrorism: What can parents do?

© St. Petersburg Times,
published October 11, 2001

After the terrorist attacks on the United States, the media carried reports that the FBI had found a manual about crop-dusting planes among a suspected terrorist's belongings. Investigators confirmed that at least one of the hijackers had visited airfields inquiring about crop dusters. This renewed concerns about the possible use of biologic agents -- notably smallpox and anthrax -- as a weapon of terror against Americans.

Because there are so many unprotected children and adults, is it possible that terrorists could use these weapons to start widespread epidemics and public panic?

First, let's learn a little about the potential enemy. Smallpox was a highly contagious human disease caused by the virus viriolae. The infection is spread from person to person by the inhalation of virus-contaminated air droplets or aerosols. Transmission usually occurs only after the patient develops a fever and rash.

Historically, one out of three people who contracted the disease died, although modern intensive care may reduce death rates. Symptoms begin seven to 17 days after exposure to the virus and consist first of fever, headache and generalized fatigue. A rash then appears, similar to chicken pox, usually starting on the face and legs and quickly spreading to the rest of the body. The painful sores are deeper than chicken pox and leave pitted scars. The disease becomes communicable from the time the rash appears until all scabs from the sores have disappeared, which could be two or three weeks.

Although there is no treatment for the disease, a vaccine against smallpox provides excellent protection and serves to stop the spread of the disease. In 1967 the World Health Organization embarked on an extensive program to immunize everyone in the world, and because of this effort, the last known case of smallpox occurred in Somalia in 1977. By 1980, the World Health Organization certified that smallpox had been eradicated from the planet.

In 1972 the mandatory smallpox vaccine requirement for American children was dropped because many youngsters were experiencing side effects while they had almost no risk of getting smallpox. Production of the vaccine was stopped, and remaining samples of the virus were safely stored in secure facilities at the Centers for Disease Control and Prevention in Atlanta, and the Institute for Viral Preparations in Koltsovo, Russia.

While many vaccines must be given weeks or months before a person is exposed to infection, smallpox vaccine is different. It protects a person even when given two to three days after exposure to the disease and may prevent a fatal outcome even when given as late as four to five days after exposure.

Even before Sept. 11, the Centers for Disease Control realized the possibility that the smallpox virus could fall into the wrong hands. Because national vaccine stocks were sufficient to immunize only 6-million to 7-million persons, in 1999 the government awarded a private company the contract to begin producing a new smallpox vaccine using modern cell-culture technique (the technology that was used to produce the existing vaccine is now outdated). Forty-million doses are expected to be produced by 2004. This new vaccine will be held in reserve and released only if there is clear evidence that the disease has resurfaced and those in the United States are at risk of acquiring infection.

Anthrax, an infectious disease caused by the spore-forming bacterium Bacillus anthracis, affects mostly farm animals (cattle, goats, pigs, sheep and horses). The form of the disease that a bioterrorist attack might produce is inhalational anthrax where anthrax spores are inhaled into the lungs. As early as a day or two after exposure or as late as seven weeks afterward, the spores begin to grow rapidly and the victim develops fever, has difficulty breathing and feels miserable. Death typically occurs within a few days after these symptoms begin if the person doesn't receive medical treatment soon after exposure, which consists of antibiotics.

Humans can also get anthrax through a break in the skin from direct contact with infected animals. The type that infects the skin begins with a reddish-brown sore that breaks open and then forms a dark scab. The symptoms that follow include internal bleeding, muscle pain, headache, fever, nausea and vomiting. About 20 percent of untreated cases of this type of anthrax will result in death.

Unlike smallpox, anthrax is not contagious. Healthy children who come into contact with persons sick with anthrax cannot acquire the disease. The anthrax vaccine, designed to prevent anthrax bacteria from producing their potentially fatal toxins, was cleared by the FDA in 1970 and has been administered since then to military personnel as well as others at risk of contracting the disease, including veterinarians and laboratory workers. The vaccine is not recommended for people younger than 18 years of age.

Given the attacks upon civilians that took place on Sept. 11, it is reasonable for citizens to feel anxious about their personal safety and the safety of their children. So, what can parents do? First, parents should make sure that their children are completely immunized, since a natural infection with a vaccine-preventable disease will weaken a child's immunity for a period of weeks afterward.

Second, they should maintain good nutrition in their youngsters, encourage exercise and reduce obesity. This has helped to decrease mortality rates greatly over many of the world's past ills, including smallpox and measles.

Third, they should not demand smallpox vaccine for the kids or begin to stockpile antibiotics for their family. The government maintains a national stockpile of antibiotics that can be delivered to an area in need anywhere in the United States within six hours. The American Academy of Pediatrics issued a statement indicating that they will closely monitor the situation and, if things change, re-evaluate the benefits and risks of reintroducing the smallpox vaccine into a child's routine immunization schedule.

Unfortunately, there is little else parents can do in advance to protect themselves and their family from a bioterrorist attack. We all should feel secure, however, that the Centers for Disease Control and other agencies of the federal government are responding to this potential threat. We will undoubtedly see requests for spending additional tax dollars to combat bioterrorism. Most scientists say it would be extremely difficult to pull off a successful biological attack, considering how tough it is to acquire, process and use these deadly toxins.

But they also argue that equipping the health care system to handle such a scenario would be well worth the expense. Furthermore, by strengthening our public health and medical care systems, we will make ourselves a less attractive target to would-be perpetrators.

We are now worried that terrorists could add chemical and biological weapons to their arsenal of arms, and that, one day, make good on their threats. After the tragic events of Sept. 11, no one wants to be caught asleep at the switch.

Bruce A. Epstein practiced pediatrics in St. Petersburg for 26 years. This column will appear monthly and is moving to Pulse, our new guide to health and medicine each Tuesday inside Floridian. Dr. Epstein's columns also appear online at the Web site www.kidsgrowth.com, which he edits.

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