Anthrax and Smallpox

What You Need to Know

With recent events in the United States and around the world, many parents are worried and want to know how to keep their children safe from terrorism, especially germ warfare attacks.

Preying on these parent's fears, many internet sites are selling an 'Anthrax cure' and gas masks. In addition to being unnecessary in most cases, stockpiling Cipro or giving it to your child can have harmful effects.

According to the Center for Disease Control and Prevention, "Based on what we know right now, there is no need for people to take any extraordinary actions or steps. They should not go to a doctor or hospital unless they are sick. They should not buy and horde medicines or antibiotics. They should not buy gas masks."

Commonly asked questions from parents include:

Was my child immunized against smallpox?

In most cases, no. Routine smallpox immunizations in the United States stopped in 1971, so if your child was born after this time, then he didn't receive the smallpox vaccine. You can look for the characteristic scar at the site of immunization if you are interested to see if you yourself or your older child was immunized, although that doesn't necessarily mean that you are immune. A single dose of the smallpox vaccine, as most people received, does not give life long immunity.

Can my child get the smallpox or anthrax vaccine?

No. While there are vaccines against both smallpox and anthrax, they are not available commercially to the general public and are kept in government stockpiles and for use by the military and high risk personal, like health care workers who are voluntarily receiving the smallpox vaccine.

Also, the American Academy of Pediatrics recommends that 'the general public, particularly children, should not receive the vaccine prior to an outbreak.'

I have heard that Cipro is an effective treatment for anthrax. Should I get a prescription filled for my child just in case?

In general, we advise against prescribing Cipro 'just in case'. The CDC has an emergency supply of antibiotics readily available for distribution if treatment is required.

Taking it 'just in case' is potentially dangerous, because if Cipro, or any antibiotic, is used unnecessarily, then it makes it more likely that a bacteria could become resistant. This would make it harder to treat a real infection. And all medications, especially antibiotics, have the potential to cause side effects, inluding diarrhea and allergic reactions.

It could also lead to a shortage, so that patients who needed the drug for other more common infections, could not get it. There are already reports that some drug wholesalers are running low on their supply of Cipro.

And while Cipro and fluroquinolones are widely used in adults, their use in children is limited to post-exposure treatment of inhalational anthrax, where the 'risk-benefit assessment indicates that administration of ciprofloxacin to pediatric patients is appropriate.' (source 2001 PDR) But in other situations, such as giving Cipro to your child 'just in case', the risk-benefit assessment wouldn't be so favorable, since there really isn't a benefit.

If my Pediatrician won't prescribe Cipro, should I just order some over the Internet?

This is also not recommended. These sites that sell the pills do not screen for possible risk factors that make it likely that someone will have side effects from taking Cipro, including patients also taking theophylline, phenytoin, sulfonylurea, or warfarin.

And there is the substantial cost to patients. At about $5 a pill, the recommended course of one pill every twelve hours for two months after exposure, would cost almost $600.

And the quality, source and actual contents of the antibiotic are not always known when you buy drugs from an Internet site that doesn't require a prescription. Some of these drugs are from overseas, are stored improperly or may be contaminated.

Do I need to get gas masks for my family?

No. To even be effective, since you wouldn't have warning of an attack, you would have to wear it all of the time. Most experts believe that 'gas mask panic buying is an 'over-reaction.'