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Causes of morbilliform rash in a highly immunised English population

¹ Public Health Laboratory Service, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK
² Cambridgeshire and Peterborough Public Health Network, Hinchingbrooke Business Park, Huntingdon, Cambridgeshire PE29 6FH, UK
³ Suffolk Public Health Network, Communicable Disease Control Team, PO Box 170, St Clement’s, Foxhall Road, Ipswich IP3 8LS, UK
⁴ Public Health Laboratory Service, Enteric, Respiratory, and Neurological Virus Laboratory, Central Public Health Laboratory, 61 Colindale Avenue, London NW9 5HT, UK
⁵ Public Health & Clinical Microbiology Laboratory, Box 236, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QW, UK

Correspondence to:
Correspondence to:
Dr M Ramsay, Public Health Laboratory Service, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK;
mramsay{at}phls.org.uk

Aims: To determine the causes of morbilliform rash and fever in a population with high vaccination coverage for measles and rubella.

Methods: Comprehensive laboratory investigation additional to routine oral fluid testing of children presenting to primary care physicians in East Anglia, England.

Results: Laboratory confirmation of infection was obtained in 93 (48%) of 195 children: parvovirus B19 in 34 (17%); group A streptococcus in 30 (15%); human herpesvirus type 6 in 11 (6%); enterovirus in nine (5%); adenovirus in seven (4%); and group C streptococcus in six (3%) (four individuals tested positive for two agents). None had measles or rubella.

Conclusions: Oral fluid testing to cover infections additional to measles and rubella aids clinical management and is likely to maintain uptake of testing, which is essential for measles and rubella surveillance in highly immunised low incidence populations.

Keywords: rash; immunisation; surveillance; parvovirus B19; group A streptococcus; human herpesvirus type 6

Abbreviations: GAS, group A streptococci; GCS, group C streptococci; HHV, human herpesvirus; PCR, polymerase chain reaction

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