Pediatric Terrorism and Disaster Preparedness: A ... - PHE Home

treatment for plague meningitis. Antimicrobial treatment should be continued for 7–10 days or
until several days after fever breaks. Drainage of abscessed buboes may be necessary; drainage
material is infectious until effective antimicrobial therapy has been given.
Control measures. In addition to standard precautions, droplet precautions are indicated for all
patients with suspected plague until pneumonia is excluded and appropriate therapy has been
started. Special air handling is not indicated. In patients with pneumonic plague, droplet
precautions should be continued for 48 hours after appropriate treatment has been started.
Postexposure prophylaxis should begin after confirmed or suspected exposure to Y. pestis and for
postexposure management of health care workers and others who have had unprotected face-toface
contact with symptomatic patients. In children, prophylactic treatment with doxycycline (5
mg/kg/day, divided BID) or ciprofloxacin (20–30 mg/kg/day divided BID) is recommended and
should be continued for 7 days after exposure or until exposure can be excluded. Household
members and other people with intimate exposure to a patient with plague should report any
fever or other illness to their physician.
Currently, no vaccine for plague is commercially available in the United States. Information
concerning the availability of plague vaccines is available from the Division of Vector-Borne
Infectious Diseases of the CDC.
Reporting. State public health authorities should be notified immediately of any suspected cases
of plague in people. Initial suspicion of a bioterrorist event involving Y. pestis will likely involve
identification of more than one case in a nonendemic area. If this occurs, immediately contact
your local and State health departments and hospital infection control practitioner. If they are
unavailable, contact the CDC at 770-488-7100.
For additional information, see http://jama.ama-assn.org/cgi/content/short/283/17/2281.
Smallpox
Variola, the virus that causes smallpox, is a member of the Poxviridae family (genus
Orthopoxvirus). These DNA viruses are among the largest and most complex viruses known, and
they differ from most other DNA viruses by multiplying in the cytoplasm. Monkeypox, vaccinia,
and cowpox are other members of the genus and can cause zoonotic infection of people, but they
usually do not spread from person to person. People are the only natural reservoir for variola
virus. For additional information, see http://www.bt.cdc.gov/agent/smallpox/index.asp.
In 1980, the World Health Organization (WHO) declared that smallpox (variola) had been
successfully eradicated worldwide. The last naturally occurring case of smallpox occurred in
Somalia in 1977, followed by two cases attributable to laboratory exposure in 1978. The United
States discontinued routine childhood immunization against smallpox in 1971 and routine
immunization of health care workers in 1976. The U.S. military continued to immunize military
personnel until 1990. Since 1980, the vaccine has been recommended only for people working
with nonvariola orthopoxviruses. Two WHO reference laboratories were authorized to maintain
stocks of variola virus. There is increasing concern that the virus and the expertise to use it as a
weapon of bioterrorism may have been misappropriated.
71