Difficulties in diagnosing anthrax may lead to dangerous delays in caring for children infected with the often-deadly disease, according to a report by CHP/PCOR researchers with the Stanford-UCSF Evidence-based Practice Center. Treating pediatric anthrax is also a special challenge because most currently recommended therapies have not been widely used to treat children with the disease. The anthrax report was prepared for the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ).

Since anthrax exposure occurs rarely in the United States and most of the recent cases have been naturally occurring, clinicians may not have first-hand knowledge about the disease and might have difficulty diagnosing it. In addition, symptoms of pediatric anthrax can be easily confused with those of more common illnesses; for example, inhalational anthrax has symptoms similar to influenza. Also, there is little evidence about the effectiveness in children of interventions currently recommended for adults.

"This report provides important information for dealing with exposure of children to anthrax," said AHRQ Director Carolyn M. Clancy, M.D. "It analyzes what is currently known about how this terrible disease affects children and identifies research needed to make us more effective in protecting our children from anthrax."

The researchers -- led by CHP/PCOR research associate Dena Bravata, MD, MS -- found very little published evidence about the efficacy of treating children who have anthrax with newer antibiotics such as ciprofloxacin. They also found no reports of using anthrax vaccine for children. The report calls for more current research on the effectiveness in children of non-antibiotic therapies that have been used with considerable success in the past, such as anthrax antiserum and drainage of fluid from the lung cavity.

Anthrax typically is contracted by direct contact with a bacterium found in infected farm animals and usually is not transmissible from one person to another. The three principal types of anthrax are cutaneous (contracted through cuts in the skin), gastrointestinal (ingested from infected meat), and inhalational (breathed in through the lungs). The most widely reported recent cases of anthrax in the United States followed the introduction of bacterial spores into the U.S. mail system in 2001, which resulted in five deaths among 22 cases.

For the AHRQ report, investigators analyzed 62 pediatric cases obtained through an extensive review of the scientific literature. Because case reports of pediatric anthrax are relatively rare, investigators examined cases from as early as 1900 in an effort to maximize the available evidence. More than 50 percent involved children between the ages of 14 and 18; data on younger children, especially those under age 2, were more limited. There were only two cases of inhalational anthrax, the most deadly form of the disease.

The AHRQ report, "Pediatric Anthrax: Implications for Bioterrorism Preparedness," was prepared by AHRQ's Evidence-based Practice Center at Stanford University and the University of California, San Francisco.

This article was produced by the Agency for Healthcare Research and Quality. Internet citation: Anthrax in Children Difficult to Detect and Treat, New Report Finds. Press Release, August 17, 2006. Agency for Healthcare Research and Quality, Rockville, MD.