Background: Biosurveillance to detect rashes for bioterrorism is critical for early resource mobilization within the public health sector. Child care center (CCC) attendance has long been recognized as an early, independent predictor for diseases, but CCCs are currently not part of statewide disease surveillance. The Michigan Child Care Related Infections Surveillance Program (MCRISP) is an independent, online reporting network of local CCCs that was created to fill this gap. Use of CCC syndromic surveillance to report on pediatric exanthema has not been previously reported in the United States. Our study objective was to describe the effectiveness of MCRISP to report pediatric rashes over a four-year period.
Methods: MCRISP collates real-time syndromic illness reports from local county CCCs (n=30). All CCCs report daily counts of children sick at CCCs or absent who have been reported ill by parents. Illness symptoms and demographics are requested on each report, including child age range, daily facility enrollment, and action taken by CCC. Reporters can mark illness categories for suspected symptoms, including rashes and update reports if physician diagnoses are available. We extracted reports of rash between 10/2014 through 12/2018. Data were analyzed using descriptive statistics.
Results: A total of 329 rash cases were extracted from a total of 11,065 individual illness reports. Children ages 13-35 months had the highest occurrence of rashes (44.2%, n= 145), followed by 36-59 months (43.9%, n = 144), 0-12 months (10.9%, n=36) and Kindergarten/1stgrade (0.91%, n=3). CCC’s reported rashes consistent with Hand-Foot-Mouth disease (52.13%, n=171); hives (6.71%,n=22); nonspecific rash with fever (5.18%, n= 17); roseola (3.66%, n=12); viral exanthem (3.05%, n=10); scarlet fever (2.74%, n=9); impetigo (2.44%, n=8); varicella (1.22%, n = 4); pinworms (0.91%, n=3); and ringworm (0.61%, n=2). Overall, 15.5% (n=51) of cases resulted in the child being seen by a medical provider; 22.5% (n=74) of CCC children were sent home. Most rash cases (63.2%, n=208) were reported by parents via phone.
Conclusion: An online child care surveillance network has the potential to act as a sentinel system for outbreaks of pediatric exanthema in real-time. This warrants further investigation as a sentinel signal for resource allocation and advanced public health preparedness.