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Journal of Public Health Advance Access first published online on September 15, 2009
This version published online on September 25, 2009
Journal of Public Health, doi:10.1093/pubmed/fdp088
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© The Author 2009, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved

Challenges in investigating transient rash illness in nursery children


K. Paranthaman, Specialist Registrar in Public Health1
S. Pooransingh, Consultant in Communicable Disease Control1
N. McCarthy, Consultant in Communicable Disease Control1
P. Saunders, Head of Environmental Health and Risk Assessment2
E. Haworth, Director and Consultant Regional Epidemiologist1

1 Thames Valley Health Protection Unit, John Eccles House, Robert Robinson Avenue, Oxford Science Park, Oxford OX4 4GP, UK
2 Chemical Hazards and Poisons Division, Chilton, Didcot OX11 0RQ, UK


Address correspondence to Dr K. Paranthaman, E-mail: karthikeyan_doc{at}yahoo.co.uk


  Abstract

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.

Keywords: chemical contamination, children, day care centres, epidemiology, outbreak, rash illness

The original published version of this paper was incorrect as the Food Standards Agency was spelled incorrectly in the Acknowledgements section. Oxford Journals apologise for this error.


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