Rashes among schoolchildren - 14 states, October 4, 2001 - February 27, 2002.
Fourteen states (Arizona, Connecticut, Florida, Georgia, Indiana, Mississippi, New York, Ohio, Oregon, Pennsylvania, Texas, Virginia, Washington, and West Virginia) have reported investigations of multiple schoolchildren who have developed rashes. This report summarizes the investigation by state and local health departments of these rashes, which have occurred during October 2001 through February 2002, and provides examples for four states. Preliminary findings indicate that further investigation is needed to determine whether a common etiology for these rashes exists. The first reported incident occurred October 4, 2001, in Indiana, followed by cases in Virginia that began November 20. Subsequent cases of rashes began in late January and occurred as recently as February 21. Rashes have been reported primarily from elementary schools but also among students in a few middle and high schools. The number of affected students in each state ranges from <10 to approximately 600. A few teachers and school staff have been affected, but rarely parents or siblings. Characteristics of the rashes vary, but onset has generally been acute, typically with maculopapular erythematous lesions - possibly in a reticulated pattern - on the face, neck, hands, or arms; duration of the rash varied but in most reports it was highly pruritic. The rashes were not attributed to a defined environmental exposure or infectious agent. Children with rashes were afebrile and usually had no other associated signs or symptoms. The rashes lasted from a few hours to 2 weeks and appeared to be self-limiting. Secondary transmission has not been reported, but in-school "sympathy" cases have reportedly occurred. Diagnoses by clinicians who have examined children have included viral exanthem, contact or atopic dermatitis, eczema, chemical exposure, impetigo, and poison ivy. Approximately 40 serum samples collected in four states have been PCR or IgM negative for parvovirus B19 (1); 22 nasal swab samples have been negative for enterovirus. Environmental assessments have not identified environmental causes.