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Caterpillar-Associated Rashes in Children ? Hillsborough County, Florida, 2011
March 30, 2012 / 61(12);209-211
In March and April 2011, the Hillsborough County Health Department (HCHD) Epidemiology Department (Tampa, Florida) investigated three clusters of rash illness linked to the white-marked tussock moth caterpillar among persons at two child care centers and one elementary school. At least 23 children and one adult were affected; most had direct contact with caterpillars...
On March 30, 2011, a local elementary school in Hillsborough County reported a cluster of rash illnesses to HCHD. Among the initial four cases of rash, one child received a diagnosis of molluscum contagiosum, one of viral rash, and two siblings received a diagnosis of varicella... By April 6, an additional eight cases of a mild pruritic rash were reported among children at the school. No systemic signs of illness, such as fever, were reported...
On April 5, a second rash illness cluster was reported to HCHD by a local child care facility located within 2 miles of the elementary school. The facility reported a mild pruritic rash in three of 34 children and one of three staff members, all with an onset of April 5...The description of the caterpillars was consistent with the white-marked tussock moth caterpillar, which ranges through much of the eastern United States and as far west as Texas and Colorado...
On April 7, 2011, another child care facility called...The affected child reportedly had captured a caterpillar from the facility playground and likely had touched the caterpillar. Her pruritic rash was located on her abdomen. An additional seven children in the facility also experienced pruritic rashes on their abdomens...
For the three facilities experiencing outbreaks of rash illnesses in 2011, recommendations included 1) preventing contact between the children and caterpillars or cocoons, 2) notifying parents of the risks associated with caterpillar exposure, and 3) power-washing playground equipment to remove the caterpillars, cocoons, and their hairs...
Reported by
David Atrubin, MPH, Lea Wansbrough, MPH, Kelly Cruse, MPH, CHES, Danielle Stanek, DVM, Carina Blackmore, DVM, PhD, Florida Dept of Health. Corresponding contributor: Carina Blackmore,
Editorial Note
The 2011 clusters of caterpillar- and cocoon-associated dermatitis follow the pattern of similar outbreaks at child care facilities that were investigated in Hillsborough County in the spring of 2004 and 2005... Attack rates for rash among children at the three facilities ranged from 12.6% to 21.7%. The affected children did not experience an immediate reaction, but rather a self-limiting pruritic, papular rash with distribution on the abdomen, chest, back, arms, or legs... Area physicians variously diagnosed the children as suffering from varicella, scabies, flea bites, mosquito bites, scarlet fever, fifth disease, contact dermatitis, or nonspecific viral rash. As a result of these misdiagnoses, the children often were treated inappropriately and excluded from child care unnecessarily...
The scientific literature clearly documents the ability of tussock moth caterpillars to cause rashes after physical contact. These include accounts of seven persons who developed rashes after handling the white-marked tussock moth caterpillar in Minnesota in 1921. In 2000, the Douglas-fir tussock moth caterpillar was the cause of rash illnesses in Boy Scouts at a summer camp in New Mexico.
The pathologic mechanism of caterpillar-associated rash is not understood entirely and depends on the caterpillar species... Additionally, when caterpillars and cocoons are in high density, particularly susceptible persons can develop a rash when the hairs become airborne. In these situations, the rash might not occur on the area of the skin where caterpillar or cocoon contact occurred; several children at the Florida facilities had rash on the abdomen and back.
Several other types of stinging caterpillars are common in Florida, including the io moth caterpillar, the saddleback caterpillar, and the puss caterpillar. Contact with these caterpillars often will cause a more severe sting for which the pain will be apparent immediately to the victim. In contrast, the white-marked tussock moth produces delayed, minor irritation. Time from exposure to onset of rash is likely minutes to hours, similar to the onset time reported after exposure to other species of tussock moths. Treatment recommendations include placing adhesive tape over the affected area and repeatedly stripping the tape off to help remove the tiny hairs, washing the area with soap and water, applying ice packs to reduce the stinging sensation, and applying a topical, low potency steroid cream. If the eyes are involved; the person has a history of hay fever, asthma, or allergies; or allergic reactions develop, a health-care provider should be contacted.
In light of these outbreaks, exposure to caterpillars and their cocoons should be considered when investigating rash illness outbreaks of unknown etiology during times of the year when the insect larvae are common. Factors that raise suspicion of a caterpillar-cocoon?associated outbreak, especially among children, include 1) mild pruritic rash on the abdomen, chest, back, arms, or legs that is not accompanied by fever; 2) pruritic rash outbreaks that have varied physician diagnoses; and 3) most importantly, the presence of caterpillars and cocoons known to cause pruritic rash combined with the opportunity for exposure.
March 30, 2012 / 61(12);209-211
In March and April 2011, the Hillsborough County Health Department (HCHD) Epidemiology Department (Tampa, Florida) investigated three clusters of rash illness linked to the white-marked tussock moth caterpillar among persons at two child care centers and one elementary school. At least 23 children and one adult were affected; most had direct contact with caterpillars...
On March 30, 2011, a local elementary school in Hillsborough County reported a cluster of rash illnesses to HCHD. Among the initial four cases of rash, one child received a diagnosis of molluscum contagiosum, one of viral rash, and two siblings received a diagnosis of varicella... By April 6, an additional eight cases of a mild pruritic rash were reported among children at the school. No systemic signs of illness, such as fever, were reported...
On April 5, a second rash illness cluster was reported to HCHD by a local child care facility located within 2 miles of the elementary school. The facility reported a mild pruritic rash in three of 34 children and one of three staff members, all with an onset of April 5...The description of the caterpillars was consistent with the white-marked tussock moth caterpillar, which ranges through much of the eastern United States and as far west as Texas and Colorado...
On April 7, 2011, another child care facility called...The affected child reportedly had captured a caterpillar from the facility playground and likely had touched the caterpillar. Her pruritic rash was located on her abdomen. An additional seven children in the facility also experienced pruritic rashes on their abdomens...
For the three facilities experiencing outbreaks of rash illnesses in 2011, recommendations included 1) preventing contact between the children and caterpillars or cocoons, 2) notifying parents of the risks associated with caterpillar exposure, and 3) power-washing playground equipment to remove the caterpillars, cocoons, and their hairs...
Reported by
David Atrubin, MPH, Lea Wansbrough, MPH, Kelly Cruse, MPH, CHES, Danielle Stanek, DVM, Carina Blackmore, DVM, PhD, Florida Dept of Health. Corresponding contributor: Carina Blackmore,
Editorial Note
The 2011 clusters of caterpillar- and cocoon-associated dermatitis follow the pattern of similar outbreaks at child care facilities that were investigated in Hillsborough County in the spring of 2004 and 2005... Attack rates for rash among children at the three facilities ranged from 12.6% to 21.7%. The affected children did not experience an immediate reaction, but rather a self-limiting pruritic, papular rash with distribution on the abdomen, chest, back, arms, or legs... Area physicians variously diagnosed the children as suffering from varicella, scabies, flea bites, mosquito bites, scarlet fever, fifth disease, contact dermatitis, or nonspecific viral rash. As a result of these misdiagnoses, the children often were treated inappropriately and excluded from child care unnecessarily...
The scientific literature clearly documents the ability of tussock moth caterpillars to cause rashes after physical contact. These include accounts of seven persons who developed rashes after handling the white-marked tussock moth caterpillar in Minnesota in 1921. In 2000, the Douglas-fir tussock moth caterpillar was the cause of rash illnesses in Boy Scouts at a summer camp in New Mexico.
The pathologic mechanism of caterpillar-associated rash is not understood entirely and depends on the caterpillar species... Additionally, when caterpillars and cocoons are in high density, particularly susceptible persons can develop a rash when the hairs become airborne. In these situations, the rash might not occur on the area of the skin where caterpillar or cocoon contact occurred; several children at the Florida facilities had rash on the abdomen and back.
Several other types of stinging caterpillars are common in Florida, including the io moth caterpillar, the saddleback caterpillar, and the puss caterpillar. Contact with these caterpillars often will cause a more severe sting for which the pain will be apparent immediately to the victim. In contrast, the white-marked tussock moth produces delayed, minor irritation. Time from exposure to onset of rash is likely minutes to hours, similar to the onset time reported after exposure to other species of tussock moths. Treatment recommendations include placing adhesive tape over the affected area and repeatedly stripping the tape off to help remove the tiny hairs, washing the area with soap and water, applying ice packs to reduce the stinging sensation, and applying a topical, low potency steroid cream. If the eyes are involved; the person has a history of hay fever, asthma, or allergies; or allergic reactions develop, a health-care provider should be contacted.
In light of these outbreaks, exposure to caterpillars and their cocoons should be considered when investigating rash illness outbreaks of unknown etiology during times of the year when the insect larvae are common. Factors that raise suspicion of a caterpillar-cocoon?associated outbreak, especially among children, include 1) mild pruritic rash on the abdomen, chest, back, arms, or legs that is not accompanied by fever; 2) pruritic rash outbreaks that have varied physician diagnoses; and 3) most importantly, the presence of caterpillars and cocoons known to cause pruritic rash combined with the opportunity for exposure.
