School Rash Investigation

Presented by:

Kristy M. Bolen, MPA

Fivco Regional Epidemiologist

Investigation Team

Little Sandy District Health DepartmentLloyd Miller, DirectorHeidi Fosson, Preparedness PlannerHenry Sturgill, EnvironmentalistJeff Barker, EnvironmentalistEllen Blevins, Nursing SupervisorRita Sexton, School Nurse

Investigation Team

Regional EpidemiologistKristy Bolen

Department of Public HealthDavid JonesDr. Nato TarkhashviliDr. Doug ThoroughmanColleen Kaelin

BALLARD

CARLISLE

GRAVES

McCRACKEN

FULTON

HICKMAN

CRITTENDEN

CALDWELL

TRIGG

LYON

LIVINGSTON

MARSHALL

MCLEAN

HENDERSON

UNION

WEBSTER

HOPKINS

CHRISTIAN

WOODFORD

BOONE

GALLATIN

CARROLLTRIMBLE

PENDLETON

OWEN

KENTON

GRANT

CAMPBELL

BOYLE

FAYETTE

JESSA’’ MINE

MERCER

WASHINGTON

ANDERSONGARRARD

SPENCER

SHELBY

HENRYOLDHAM

HARRISON

SCOTTFRANKLIN

NELSON

BULLITT

JEFFERSON

GRAYSON

HARDIN

BRECKINRIDGE

MEADE

MARION

HART

EDMONSON

BARREN

LARUE

CALLOWAY

SIMPSON

TODD

BUTLERMUHLENBERG

LOGAN

ALLEN

WARREN

HANCOCK

DAVIESS

OHIO

METCALFRUSSELL

ADAIR

CLINTON

CUMBERLAND

MONROE

CASEY

PULASKI

WAYNE

McCREARY

TAYLOR

GREEN

NICHOLAS

BOURBON

BELL

JACKSON

LAUREL

ROCKCASTLE

KNOX

LINCOLN

CLAY

WHITLEY

OWSLEY

ESTILLMADISON

KNOTT

PERRY

LETCHERLESLIE

HARLAN

LEE FLOYD

BREATHITT PIKE

POWELL

BOYD

MORGAN

JOHNSON MARTIN

WOLFE MAGOFFIN

MONTGOMERYCLARK MENIFEE

GREENUP

CARTER

ELLIOTTLAWRENCE

BATH

Map of Kentucky Counties and Area Development Districts= Area Development District Boundaries

BRACKEN

MASONLEWIS

FLEMING

ROBERTSON

ROWAN

Tri-State Preparedness Planners & Epidemiologists Group

OhioWest

Virginia

Carter County Demographics

Population26,889 (2000 Census)

County School systemTwo Middle & High SchoolsSix Elementary SchoolsTotal District Enrollment 4,771 (2003-2004)

Timeline of Investigation

January 5, 2005Regional Epidemiologist is contacted by Little

Sandy District Health Department (LSDHD) Four female students had left East Carter High

School (ECHS) with a rash One student had went to the Emergency

Department with a severe reaction Regional Epidemiologist planned to visit LSDHD

and ECHS next morning to investigate

Timeline of Investigation

January 6, 2005Team from LSDHD & Epidemiologist visit

ECHS Inspect classrooms & common areas Talk to school nurse & office staff about students

who left on the 5th

Interview female student who comes in with rash while we are still in building

Timeline of Investigation

January 6, 2005Epidemiologist prepares questionnaire for

distribution to students at ECHS with rashLSDHD calls later that afternoon to report 40

students have left ECHS with rashSchool officials cancel classes for Friday to

“disinfect” the schoolContact DPH, set up meeting for next

morning

Timeline of Investigation

January 7, 2005Epidemiologist meets with LSDHD & DPH

team (David and Nato)Entire team visits ECHS to inspect building &

talk to maintenance staff Asks about cleaning products used everyday &

over Christmas break Acquires MSDS sheets on products used

regularly Acquires Orkin’s number (sprayed over break) Looked at heating/cooling system

Timeline of Investigation

January 7, 2005School nurse begins to report East Carter

Middle School (ECMS) students are coming in with same rash

Investigation team visits ECMS Takes pictures & blood samples (from staff)

Team finalizes questionnaire to distribute to students who’ve left with rash or students that leave Monday with rash

Timeline of Investigation

January 10, 2005No cases reported over weekendBy days end 100 students have checked out

of both schools 29 students from ECHS 71 students from ECMS

Regional Epidemiologist plans to return next day to enter completed questionnaires

Timeline of Investigation

January 11, 2005By days end 49 students have checked out of

five schools in the district 20 students from ECHS 14 students from ECMS 2 students from Upper Tygart Elementary 11 students from West Carter High School 2 students from West Carter Middle School

School officials decide to close schools until January 18th

Timeline of Investigation

January 11, 2005 Media “blitz” begins

Calls received from local station & Lexington station Regional Epidemiologist becomes PIO for case

Phone conference with DPH officials Dr. Kraig Humbaugh, Dr. Barry Wainscott, Dr. Doug

Thoroughman, David & Nato Set time for update next morning

ECHS plays basketball game against another area high school

Creates an issue for media to focus on

Timeline of Investigation

January 12, 2005 Team creates Information sheet

Sheets sent to surrounding Regional Epidemiologists to distribute to their counties

Sheets also sent to area hospitals

Completed questionnaires are entered & first “Epi-Curve” is produced

During phone conference with DPH decide that Dr. Thoroughman, Colleen Kaelin, David and Nato will visit next day to meet with school officials & staff

East Carter High & Middle School Rash Cases Reported per Day

05

1015202530354045505560657075

1/5 1/6 1/7 1/8 1/9 1/10 1/11 1/12 1/13

Date

Cases

ECMS ECHS

Timeline of Investigation

January 13, 2005 Investigation team meets with school officials

& staff Assure school that it is safe to open on Tuesday

Continue to enter questionnaires into database

Timeline of Investigation

January 14, 2005Final media interviews

Assure public that its safe for children to returnDecide not to call students that didn’t return

questionnaire Did not want to “stir-up” issue again

Timeline of Investigation

January 18, 2005Students return to school

1 case at ECHS 1 case at ECMS 3 cases at three different elementary schools

January 21, 2005 Investigation is closed

No definitive cause found Lack of questionnaires returned MMWR Article

Lessons Learned

“In the midst of difficulty, lies opportunity.”

- Albert Einstein

Lessons Learned

Showed how beneficial regional epidemiologists are in an incidentTeam worked well togetherNo territorial issues

Showed how beneficial partnerships are to an investigationWest Virginia & Ohio partnersDPH Partners

Lessons Learned

Misconception of our jobsExpectation versus realityAllowed community to see what our true

function in an incident is Communication is key

With community (through media)With School officials (local and area wide)With DPH

Lessons Learned

Need to delegate one or two people to answer phone questions from public

Contact notebook is a necessityDidn’t have fax numbers for other Regional

Epidemiologists or area physiciansDidn’t have area school contact informationDidn’t have media contact information

Lessons Learned

Need to contact media firstProvide them with information sheetDon’t let them dictate the story

Data needs to be collected as soon as possibleLost chance to collect data when schools

closed

Conclusion

Even though a thorough investigation was conducted, no cause for the rash was discovered

Lessons learned helped with next investigation (February)

A good test of emergency plans & procedures