Investigation of deaths from ill-defined causes and probable scarlet fever outbreak among schoolchildren, São João del-Rei, 2023

Investigación de muertes por causas mal definidas y probable brote de escarlatina en escolares, São João del-Rei, Brasil, 2023

Objective:  To investigate deaths from ill-defined causes and a probable scarlet fever outbreak among schoolchildren in São João del-Rei between September and October 2023.

Methods:  This was a descriptive study of children hospitalized with sepsis symptoms and a case series of schoolchildren with pharyngotonsillitis and scarlet fever. Data from medical records and interviews were used to calculate absolute frequencies and measures of central tendency.

Results:   Six healthy children (1-10 years old, of White/mixed race skin color) were hospitalized with sepsis symptoms, presenting fever, purpura, bruising, and odynophagia. Streptococcus sp. was identified in oropharyngeal swabs in three of the six children, but blood cultures were negative. Three children died, three were discharged, and two attended the same school. Among the schoolchildren, 873 records of absenteeism were identified; of these, 212 met the definition of pharyngotonsillitis and 87 were interviewed. Of the 87,7 also met the criteria for scarlet fever, 47 were female, and 78 were aged 5-13 years. Symptoms included malaise (62/87), throat plaques (49/87), and body rash (26/87). Antibiotics (58/75) and analgesics/antipyretics (32/75) were prescribed for treatment. During renovations at the school, small poorly ventilated adapted containers were used as classrooms. Twelve students did not use individual drinking glasses, and 53/87 did not use masks when symptomatic.

Conclusions:  Suspected invasive streptococcal disease deaths were caused by septic shock, without confirmation of the etiological agent. Streptococcus sp. may have contributed to the probable scarlet fever outbreak. Recommendations were made to alert the population and professionals about hygiene practices and staying away from school, in addition to training health teams to diagnose and manage re-emerging diseases.

Keywords:
Epidemiology; Scarlet Fever; Observational Study; Students; Respiratory Tract Diseases