Health Alert: Influenza with rash

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Since March 2015, multiple states have notified the Centers for Disease Control of patients with morbilliform rash and laboratory-confirmed influenza (primarily influenza B), without laboratory evidence of measles. Rash has historically been a rare complication of influenza.   An alert was recently sent out to physicians and health care personnel through Epi-X regarding this issue.

Collin County Health Care Services continues to investigate suspected cases of measles.  Due to the risks associated with measles cases, it is essential to determine whether a patient is a potential source of measles infection so that the necessary precautions are taken to prevent further spread of measles.

Information about patients with influenza-associated rash during the 2014–2015 influenza season is requested to determine the prevalence of cases, understand the clinical syndrome, and explore risk factors.

To assist CDC in case finding, we ask that any patients meeting the following case definition be reported to Collin County Health Care Services.

1)    Presence of morbilliform (i.e. maculopapular) rash; and

2)    Laboratory-confirmed influenza (by rapid diagnostic test, fluorescent antibody test, enzyme immunoassay test, RT-PCR test, or viral culture), and

3)    Negative measles testing (by IgG, IgM antibody serology or RT-PCR test), and

4)    Onset of both rash and influenza-like illness on or after October 1, 2014.

Influenza like illness is defined as fever (temperature of 100oF [37.8oC] or greater), and cough or sore throat without a known cause apart from influenza.  Healthcare providers should notify Collin County Health Care Services when evaluating patients with acute rash and influenza-like illness and consider adding influenza testing to their normal diagnostic evaluation.   Please contact Collin County Health Care Services, Epidemiology Department, at 972-548-4707 to report suspected cases.

Disease Reporting Requirements/Statute: Several Texas laws (Health & Safety Code, Chapters 81, 84, and 87) require specific information regarding notifiable conditions be provided to DSHS. Health care providers, hospitals, laboratories, schools, childcare facilities and others are required to report patients who are suspected of having measles  (Chapter 97, Title 25, Texas Administrative Code​ ). 

In Texas, suspicion of measles is required to be reported immediately. Do not wait for laboratory confirmation to report measles suspects. Measles reports should be made to Collin County Health Care Services, available 24/7 at 972-548-4707.