An initial report issued by the Centers for Disease Control and Prevention (CDC) in March reported outbreaks in 14 states: Arizona, Connecticut, Florida, Georgia, Indiana, Mississippi, New York, Ohio, Oregon, Pennsylvania, Texas, Virginia, Washington and West Virginia.
Since then, another 13 states have joined the list, says the CDC. The new states are: Alabama, Alaska, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Minnesota, Missouri, New Hampshire, and New Jersey. Similar rashes have also been reported in Canada.
Although the number of reported rashes is growing, "there's still no evidence for a common cause for all of the reports," CDC spokesman Mike Groutt says. "Investigations have identified causes for some of the rashes occurring in some of the schools. Regardless of the cause of the rashes, including those of unknown origin, reports indicate that they are self-limiting and affected children have few if any accompanying signs or symptoms."
No single cause has been identified, and the CDC emphasizes there's no evidence that all of the rashes are linked. Officials have also been quick to point out that rashes are common among schoolchildren and can be caused by a variety of factors. They include medications, dry or sensitive skin, eczema, allergies, viral infections and environmental factors.
However, the recent spate of rashes have raised concern because they've occurred simultaneously in various locales across the nation. They also began in the wake of Sept. 11 and subsequent anthrax attacks.
Between October 2001 and May 2002, rashes were reported among groups of schoolchildren at about 110 U.S. elementary, middle and high schools. The number of children affected at each school ranged from five to 274 (or less than 1 percent to 47 percent of the student population). Girls accounted for varying proportions of the affected -- from 33 percent to 100 percent.
The rashes themselves also had varied characteristics. Most children reported an itchy, sunburn-like rash on the cheeks and arms, a burning sensation on the skin or a hive-like reaction that moved from one part of the body to another. They tended to go away on their own, either within in an hour or sometimes not for more than a month.
Some states have managed to track down a cause. In New York, an outbreak among 242 elementary and middle-school students (representing 7 percent of the population of their school district) between January and April was determined to be the result of parvovirus B19, which causes fifth disease, an infection of red blood cells. Alaska, Illinois, Kentucky, Minnesota, and Mississippi have also had cases associated with parvovirus B19.
Other outbreaks might be psychogenic -- a response to seeing another child with a rash.
For the meantime, the CDC seems to be playing it cool, emphasizing the rashes do go away on their own and that most children don't have any other, more disruptive symptoms. The organization "is continuing to monitor reports of groups of schoolchildren with rashes and is providing technical assistance to state and local health departments," the researchers report in tomorrow's issue of the CDC publication Morbidity and Mortality Weekly Report.
What To Do
The outbreaks are likely to end as the school year closes. Learn more about school health from the Centers for Disease Control and Prevention. Also, the New York State Department of Health has a primer on fifth disease.