Investigation of a Mysterious Rash at the West School in Napoleon, Ohio
Schmalzried, Hans D., Feister, Wayne A., Journal of School Health
Rashes can be caused by many different exposures, including those to cosmetics, clothing, jewelry, chemical agents, fungal infection, insect bites, sexually transmitted disease, mites, poisonous plants, and ingestion of certain foods. The etiology of a rash is often difficult to determine. Sensitivity to irritants causing rashes varies widely among individuals.[1,2]
Because it is on the outside of the body, skin makes an irritating rash quickly noticeable. Skin rashes usually are accompanied by other symptoms such as itching, swelling, and, rarely, pain. Skin rashes with itching are very uncomfortable. They also can be embarrassing if they appear on normally unclothed skin. In rare cases, serious diseases can result from exposure to certain toxic substances. However, most skin irritations only cause minor discomfort. That is not to minimize their effects, since they can be quite bothersome.
On Friday morning, November 8, 1996, the Henry County/Napoleon City Health Commissioner received a call from the Assistant Superintendent of Napoleon City Schools, who reported that six of the fifth graders at West Elementary School had developed an unusual rash. He said that a few of these students had faces so swollen that they were barely recognizable. He was concerned about the situation, and he worried that students might go into anaphylactic: shock, have some sequela, or possibly spread the rash to others.
As the conversation continued between the health commissioner and the assistant superintendent, staff found that four of the affected students had been seen by the same physician, who believed that an airborne irritant was causing the rash. The physician recommended that the assistant superintendent have the health department test for toxic irritants in the air and the surfaces of the desks and counter tops in three of the fifth grade classrooms. Following the advice of the local physician, the classrooms were vacated and classes were set up in the gymnasium.
The health commissioner arranged to meet that afternoon with the school system's school nurse, who alone serves 2,502 students in four buildings. She reported on recent changes to the school building and environment, which included remodeling, classroom computer installation, shrubbery removal, unusually warm weather, and student recess at a new location. In addition, because some foods are known to cause allergic reactions with rashes, for the preceding two weeks the school lunch menu had been reviewed for foods known to cause reactions. No known foods that could cause a rash were identified.
While at the school, the health commissioner interviewed the principal and the custodian, who led the group about the building. Their inspection began with a walk-through of the fifth grade classrooms, which revealed nothing unusual. The custodian reported that the heating system had been activated at least three weeks prior to the outbreak. Because piped hot water supplied heat for the building, air movement was confined to each room. Heat exchanger blowers in each room were inspected and found clean. Since improperly used cleaning products can cause rashes and other health problems, those products were also reviewed. The custodian said that he had changed cleaning products about three months earlier and had not changed cleaning procedures. As part of the building's renovation, a poison ivy shrub had recently been removed, but it had not been close to any classrooms and was disposed properly.
The custodian also described the construction and remodeling taking place at the school. Renovations included removal of the playground blacktop, which was being replaced with chipped rubber, and the kitchen was being enlarged.
As part of his investigation, the health commissioner interviewed some students who were experiencing symptoms. Some affected students reported symptoms four days earlier consequently, interviews focused on student activities or events that took place either at or away from school the preceding five days. …