COLLIN COUNTY HEALTH CARE SERVICES
Epidemiology and Surveillance
825 N. McDonald St, Suite 130  McKinney, Texas 75069
972-548-4707
MURIEL MARSHALL, DO, DrPH
HEALTH AUTHORITY
JAWAID ASGHAR, MBBS, MHA
CHIEF EPIDEMIOLOGIST
HEALTH ALERT—INFLUENZA WITH RASH
March 31, 2015
Since March 2015, multiple states have notified CDC of patients with morbilliform rash and laboratoryconfirmed influenza (primarily influenza B), without laboratory evidence of measles. Rash has
historically been a rare complication of influenza. An alert was recently sent out to physicians and
health care personnel through Epi-X regarding this issue.
Collin County Health Care Services continues to investigate suspected cases of measles. Due to the risks
associated with measles cases, it is essential to determine whether a patient is a potential source of
measles infection so that the necessary precautions are taken to prevent further spread of measles.
Information about patients with influenza-associated rash during the 2014 – 2015 influenza season is
requested to determine the prevalence of cases, understand the clinical syndrome, and explore risk factors.
To assist CDC in case finding, we ask that any patients meeting the following case definition be reported
to Collin County Health Care Services.
1) Presence of morbilliform (i.e. maculopapular) rash AND
2) Laboratory-confirmed influenza (by rapid diagnostic test, fluorescent antibody test, enzyme
immunoassay test, RT-PCR test, or viral culture) AND
3) Negative measles testing (by IgG, IgM antibody serology or RT-PCR test) AND
4) Onset of both rash and influenza-like illness on or after October 1, 2014
Influenza like illness is defined as fever (temperature of 100oF [37.8oC] or greater), and cough or sore
throat without a known cause apart from influenza. Healthcare providers should notify Collin County
Health Care Services when evaluating patients with acute rash and influenza-like illness and consider
adding influenza testing to their normal diagnostic evaluation. Please contact Collin County Health Care
Services, Epidemiology Department, at 972-548-4707 to report suspected cases.
Disease Reporting Requirements/Statute: Several Texas laws (Health & Safety Code, Chapters 81, 84,
and 87) require specific information regarding notifiable conditions be provided to DSHS. Health care
providers, hospitals, laboratories, schools, childcare facilities and others are required to report patients
who are suspected of having measles (Chapter 97, Title 25, Texas Administrative Code ).
In Texas, suspicion of measles is required to be reported immediately.
Do not wait for laboratory confirmation to report measles suspects.
Measles reports should be made to Collin County Health Care Services, available 24/7 at
(972)548-4707.