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Challenges in investigating transient rash illness in nursery children
K Paranthaman1, S Pooransingh, N McCarthy
1Thames Valley Health Protection Unit, John Eccles House, Robert Robinson Avenue, Oxford Science Park, Oxford, UK. karthikeyan_doc@yahoo.co.uk
Insights
A 2007 outbreak of transient rashes in 164 children across six nurseries was linked to on-site prepared meals. Biogenic amines are suspected, highlighting the need for prompt public health reporting of unexplained childhood symptoms.
Area of Science:
- Public Health
- Epidemiology
- Food Safety
Background:
- A parent reported a child's transient rash after nursery lunch in Oxfordshire in October 2007.
- Similar incidents escalated investigations by the Thames Valley Health Protection Unit (TVHPU) across England.
Purpose of the Study:
- To investigate the cause of unexplained transient rashes in children attending nurseries.
- To identify the aetiology of the reported incidents through epidemiological and food tracing methods.
Main Methods:
- Conducted a detailed epidemiological investigation.
- Performed food tracing to identify the source of the illness.
Main Results:
- Eleven incidents affected 164 children in six nurseries between July and November 2007.
- Symptoms included transient rashes on the mouth and hands, strongly associated with on-site prepared meals.
- Biogenic amines (e.g., histamine) were suggested as a potential cause, though not confirmed by food sample testing.
Conclusions:
- The incidents revealed underreporting of unexplained symptoms in nurseries to public health authorities.
- Timely notification is crucial for prompt investigation, cause identification, and prevention of future outbreaks.
Introduction:
In October 2007, the Thames Valley Health Protection Unit (TVHPU) was notified by a parent that her child developed a transient rash after eating lunch at a nursery in Oxfordshire. An initial investigation undertaken by TVHPU was escalated when similar incidents were reported in nurseries in other parts of England.
Methods:
A detailed epidemiological and food tracing investigation was conducted to ascertain the aetiology.
Results:
Investigations revealed 11 incidents affecting 164 children between July and November 2007 in six nurseries operated by two companies. The symptoms included a transient rash around the mouth and hands of children who ate meals prepared on site by the nurseries. Consumption of the lunch main course appeared to be a strong aetiological factor. Expert opinion pointed to biogenic amines (e.g. histamine) as a possible cause for the symptoms displayed, but there was insufficient evidence to support testing of food samples.
Conclusion:
The incident highlighted significant gaps in reporting of unexplained symptoms among children in nurseries, indicating that such incidents do not always come to the attention of public health authorities. Timely notification to HPUs will enable prompt investigation, increase the likelihood of identifying the cause and inform appropriate responses to prevent future incidents.
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