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RASH ILLNESS OUTBREAKS IN SCHOOL-AGED CHILDREN

Since October 2001, the Centers for Disease Control and Prevention (CDC) has identified 14 states (AZ, CT, FL, GA, IN, MS, NY, OH, OR, PA, TX, VA, WA, and WV) reporting rash illnesses among school-aged children. In Missouri, there is one outbreak of rash illness in school-aged children currently being investigated. The reports from other states are occurring primarily in elementary schools, but have involved a few middle and high school students. The number of affected students ranges from less than 10 to more than 600 per state. A few teachers/staff have been affected, but rarely parents or siblings. The rash description varies in each event, and they have not been attributed to a defined etiology. In the majority of reports, the rash is highly pruritic but the children are afebrile, with no other associated signs/symptoms. The duration of the rash varies from a few hours to as long as 2 weeks, but appears to be self-limiting. There have been no reports of secondary transmission, but the occurrence of in-school "sympathy" cases has been noted. Diagnoses have included viral exanthem, contact or atopic dermatitis, and eczema.

A small outbreak reported at a middle school in Randolph County has involved 11 sixth graders who reportedly developed a red, macular, often pruritic rash which generally involved the extremities and, in some children, the area of the neck. Three of the 11 children were diagnosed with urticaria or hives, and 1 was diagnosed with atypical Fifth disease. None of the children were reported to have fever or any other additional signs/symptoms of illness. Active surveillance conducted by the Randolph County Health Department of other schools, day care centers, and physicians in the area did not find any additional rash illness cases. An environmental assessment of the school that the affected children attend did not find any potential cause of the rashes.

Local public health agencies that become aware of rash illness outbreaks in school-aged children should contact the DHSS Office of Surveillance at 800-392-0272 and obtain a questionnaire to collect basic information on the outbreak. On the basis of this information, a decision can then be made regarding the need to undertake further evaluation, which might include obtaining clinical specimens and environmental samples for laboratory testing.

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