title: Etiologies of rash and fever illnesses in Campinas, Brazil.
abstract: BACKGROUND
  Few population-based studies of infectious etiologies of fever-rash illnesses have been conducted. This study reports on enhanced febrile-rash illness surveillance in Campinas, Brazil, a setting of low measles and rubella virus transmission.
  
  
  METHODS
  Cases of febrile-rash illnesses in individuals aged <40 years that occurred during the period 1 May 2003-30 May 2004 were reported. Blood samples were collected for laboratory diagnostic confirmation, which included testing for adenovirus, dengue virus, Epstein-Barr virus (EBV), enterovirus, human herpes virus 6 (HHV6), measles virus, parvovirus-B19, Rickettsia rickettsii, rubella virus, and group A streptococci (GAS) infections. Notification rates were compared with the prestudy period.
  
  
  RESULTS
  A total of 1248 cases were notified, of which 519 (42%) had laboratory diagnosis. Of these, HHV-6 (312 cases), EBV (66 cases), parvovirus (30 cases), rubella virus (30 cases), and GAS (30 cases) were the most frequent causes of infection. Only 10 rubella cases met the rubella clinical case definition currently in use. Notification rates were higher during the study than in the prestudy period (181 vs 52.3 cases per 100,000 population aged <40 years).
  
  
  CONCLUSIONS
  Stimulating a passive surveillance system enhanced its sensitivity and resulted in additional rubella cases detected. In settings with rubella elimination goals, rubella testing may be considered for all cases of febrile-rash illness, regardless of suspected clinical diagnosis.
authors.affiliation: Santa Casa de São Paulo Medical Sciences University, São Paulo, Brazil.
authors.forename: José Cássio
authors.initials: JC
authors.lastname: de Moraes
authors.forename: Cristiana M
authors.initials: CM
authors.lastname: Toscano
authors.forename: Eliana N C
authors.initials: EN
authors.lastname: de Barros
authors.forename: Brigina
authors.initials: B
authors.lastname: Kemp
authors.forename: Fabio
authors.initials: F
authors.lastname: Lievano
authors.forename: Steven
authors.initials: S
authors.lastname: Jacobson
authors.forename: Ana Maria S
authors.initials: AM
authors.lastname: Afonso
authors.forename: Peter M
authors.initials: PM
authors.lastname: Strebel
authors.forename: K Lisa
authors.initials: KL
authors.lastname: Cairns
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D018563:Disease Notification; D005076:Exanthema / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005334:Fever / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D007223:Infant; D008297:Male; D011159:Population Surveillance; D013997:Time Factors; D014777:Virus Diseases / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult