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

and waste should be discarded into biohazard bags and autoclaved, and bedding and clothing
should be washed in hot water with laundry detergent followed by hot-air drying or incinerated.
Vaccination. Postexposure immunization (within 3–4 days of exposure) provides some
protection against disease and significant protection against a fatal outcome. Any person who has
had significant exposure to a patient with confirmed smallpox during the infectious stage of
illness should be immunized as soon after exposure as possible, but within 4 days of first
exposure. Because infected individuals are not contagious until the rash (and/or enanthema)
appears, individuals exposed only during the prodromal period are not at risk.
Vaccinia immune globulin. Vaccinia immune globulin (VIG) prepared from plasma of
immunized individuals was used in the past to prevent or modify smallpox when administered
within 24 hours of a known exposure. Current supplies of VIG are used in the treatment of
complications of smallpox immunization. The CDC is the only source of VIG in the United
States. Supplies may be obtained by calling the CDC Smallpox Vaccine Adverse Events Clinical
Information Line at 877-554-4625 for physicians in civilian medical facilities.
Reporting. Cases of febrile rash illness for which smallpox is being considered in the
differential diagnosis should be reported immediately to local or State health departments. After
evaluation by the State or local health department, if smallpox laboratory diagnostic testing is
considered necessary, the CDC Rash Illness Evaluation Team should be consulted at 770-488-
7100. Laboratory confirmation of smallpox is available only from the CDC. (See Figure 4.8,
evaluating febrile rash illness in patients suspected of having smallpox [algorithm]).
Tularemia
Tularemia is caused by Francisella tularensis, a small, nonmotile, aerobic, gram-negative
coccobacillus. Francisella tularensis is one of the most infectious pathogens known; inoculation
with or inhalation of as few as 10 organisms can cause disease. It is found in diverse animal
hosts and can be recovered from contaminated water, soil, and vegetation. Small mammals,
including voles, mice, water rats, squirrels, rabbits, and hares, are natural reservoirs. They
acquire infection through tick, fly, or mosquito bites and by contact with contaminated
environments. Natural infection in people occurs through bites of infected arthropods; handling
infectious animal tissues or fluids; direct contact with or ingestion of contaminated food, water
or soil; or inhalation of infective aerosols. Person-to-person transmission does not occur.
Aerosol release of F. tularensis as a bioterrorist event would be expected to cause primarily
pleuropneumonitis, but some exposures might result in ocular tularemia, ulceroglandular or
glandular disease, or oropharyngeal disease with cervical lymphadenitis. Release in a densely
populated area would be expected to result in an abrupt onset of large numbers of people with
acute, nonspecific febrile illness beginning 3–5 days later (incubation period is 1–14 days), with
pleuropneumonitis developing in a significant proportion of cases during the ensuing days and
weeks.
Signs and symptoms. Francisella tularensis is a facultative intracellular bacterium that
multiplies within macrophages. Major target organs are the lymph nodes, lungs and pleura,
spleen, liver, and kidney. Bacteremia may be common in early stages. Initial tissue reaction is a
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