1. Childhood Exanthemata
Dr. Philip G. Murphy
Consultant Microbiologist,
AMNCH,Tallaght.

2. Aetiology Exanthem = exterior rash Measles Rubella
Varicella (chickenpox)
Scarlet fever
Parvovirus
HH6
(Kawasaki Disease)
Other childhood fevers:Mumps, Whooping cough, Diphtheria
NSROC

3. Measles Rubeola (RNA morbillivirus)
Incubation: 7-14 d
Prodrome: d before rash
fever, malaise, coryza, sneezycough,
Koplik spots1-3 d before rash
Rash: day 4-7 of illness
starts behind ears, forehead, around mouth
dusky red, florid maculopapular rash spreads over trunk and limbs. Lasts 5 d.
Infectivity: prodrome to 4 d after the rash
Transmission: respiratory droplet or direct contact
Complications: ears & OM,
lungs & pneumonia
conjunctivitis
CNS encephalitis at d 10, SSPE after several years

4. Measles
Highly contagious acute viral illness caused by a paramyxovirus, genus Morbillivirus
One of the leading causes of child mortality in developing countries % of all deaths of children < 5 years.
Measles eradication possible – no longer endemic in U.S.
Europe: Outbreaks reported in Germany 1996, 1999 and 2000, Netherlands 1999 (2600 cases and 3 deaths).

5. Measles vaccination Measles vaccination in Ireland since 1985
Vaccination rates of 95% necessary to eliminate spread
Vaccination coverage of 70 – 80% at 24 months of age in the Eastern Regional Health Authority
Outbreak of measles occurred between December 1999 and July Majority of cases in TCH catchment area.

7. Eastern Regional Health Authority

8. Number (%) Total number attending TCH 355 Number admitted to TCH 111
Underlying chronic or acute illnesses (26)
Number admitted to ICU (11)
Mortality
Range Median
Inpatient stay
ICU stay

9. MMR Status of Measles Cases in Northern Area Health Board (n=567):

10. Indication for admission

11. Symptoms and Signs 95% 95% 84% Number Of Patients 54% 40% 39% 33% 8%
54% % % % 8%
Apnoea
Exanthem
Cough
Vomiting
Otitis Media
Febrile Seizure
Pyrexia
Conjunctivitis
Diarrhoea

12. Control Public Health Outbreak Control Team set up by NDSC
Measles/Mumps/Rubella (MMR) vaccination
Brought forward to 12 months of age
Given at 6 months in our area
Repeated at 15 months
Second MMR brought forward to 4 years of age
Opportunistic vaccination in schools and creche
Recalled non-attenders
Press releases

17. Future Oireachtais Committee Report
Co-ordinator to oversee vaccine program
Dedicated administrative and nursing staff
Modernisation of Civil Registration Service
Personal public service number
Improved IT at health board level
Vaccine information statements to parents
Continuous immunisation campaigns in media until rate > 95%
Guidelines for future outbreaks

18. Varicella (chickenpox, shingles)
Incubation: d
Prodrome: 1 d before rash
fever, malaise
Rash: oval macule progressing to macule and then pustules which heal and crust. Appears as crops centrally then peripherally
Other: may be marked fever for 2-3 d., then settles
Infectivity: 5d before to 5 d after the rash
Transmission: respiratory droplet or direct contact
Complications:Rare:encephalitis after 10d
pneumonia especially immune suppressed
20 bacterial skin infection
Shingles
Diagnosis: EM, CFT
Treatment: aciclovir, topical disinfectants, ZIG if immune suppressed

19. Rubella Incubation: 14-23 d Prodrome: none or mild fever1d before rash
Rash: none or for 1-3 d a pink macular rash on face and trunk
otherwise well
sub-occipital lymphadenopathy
arthralgia /polyarthritis in older child or adult
rarely thrombocytopaenia
Infectivity: 7d before to 5 d after the rash
Transmission: respiratory droplet or direct contact
Complications: in utero - congenital rubella syndrome,
deafness,cataracts, cardiac abnormalities hepatomegaly, splenomegaly, purpura. 30% mortality.
25% if exposure in first 4months, 60-80% in 1st month
rarely encephalitis at 10d

20. Kawasaki Disease Unknown aetiology ?? Infective fever, rash,
conjunctivitis, hand/feet dorsae induration
stomatitis, strawberry tongue, lymphadenopathy
coronary artery narrowing - aneurysm, thrombosis and MI
desquamation in recovery
Rx: Immuneglobulin

21. Erythema infectiosum (Fifth Disease, Slapped ckeek syndrome)
Parvovirus B19, ssDNA, 22 nm diameter
Rash on cheeks, flitting and later lace-like on trunk
More severe in adults with arthritis and lymphadenopathy
benign course and rare complications
transient marrow depression and rarely aplastic crisis

22. Exanthem subitum Roseola infantum;Sixth Disease
Human Herpes virus 6
commonly seroconversion by 2 years
3-5 d fever, urti
20% exanthem: classic maculopapular rash
common in CNS
but ? Role in multiple sclerosis

23. Scarlet fever Aetiology; Streptococcus pyogenes (Group A)
Pathogenesis: erythrogenic toxin
Incubation: 1-3 d
Prodrome: 1-2 d fever,sorethroat,headache,flushed cheeks
Rash: punctate erythematous central and blanches
Signs: circumoral palor, strawberry tongue, desquamation post rash
Infectivity: up to 3 weeks or 24h after pen
Transmission: respiratory
Complications: septicaemia, endocarditis, OM, Quinsy
rheumatic fever, acute nephritis