AMERICAN ACADEMY OF PEDIATRICS Committee on Environmental Health and Committee on Infectious Diseases Chemical-Biological Terrorism and Its Impact on Children: A Subject Review

There is an increasing threat that chemical and biological weapons will be used on a civilian population in an act of domestic terrorism. Casualties among adults and children could be significant in such an event. Federal, state, and local authorities have begun extensive planning to meet a chemical-biological incident by developing methods of rapid identification of potential agents and protocols for management of victims without injury to health care personnel. Because children would be disproportionately affected by a chemical or biological weapons release, pediatricians must assist in planning for a domestic chemical-biological incident. Government agencies should seek input from pediatricians and pediatric subspecialists to ensure that the situations created by multiple pediatric casualties after a chemicalbiological incident are considered. This statement reviews key aspects of chemical-biological agents, the consequences of their use, the potential impact of a chemical-biological attack on children, and issues to consider in disaster planning and management for pediatric patients. ABBREVIATION. CDC, Centers for Disease Control and Prevention. The release of the nerve agent sarin in a Tokyo subway in 1995 focused the world’s attention on the reality of chemical or biological weapons use on a civilian population. In that incident the intentional use of this nerve gas resulted in injury to more than 5000 adults and children, with 12 deaths. In the same year, the Federal Bureau of Investigation uncovered a terrorist effort to release a chlorine gas bomb in the Disneyland theme park in California. Recent confiscations of anthrax bacteria and the plant toxin ricin from US civilians have firmly established chemical and biological terrorism as a growing environmental threat.1 Agents that were created for wartime use are increasingly being sought by civilian groups who seek revenge, publicity, reaction, and chaos.2 According to the Centers for Disease Control and Prevention (CDC), one of the most imminent terrorist threats is the release of a “weaponized” chemical or biological agent.3 Despite international accords such as the Biological and Toxin Weapons Convention of 1972, designed to prevent further proliferation of biological weapons, these and other compounds continue to be developed as weapons of mass destruction.4,5 In response, federal legislation has been created to reduce the possibility of weapons use on civilians.6 There has also been a widespread effort by military, government, and public health officials to initiate appropriate management protocols for mass casualty incidents. A chemical-biological attack would affect civilians of all ages, including children. Events such as the unsuccessful release of a gas bomb at Disneyland indicate that terrorist acts may be directed specifically at children.