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July 1989, Vol 143, No. 7 >
Article | July 1989

Epidemiology of a Cluster of Henoch-Schonlein Purpura FREE

Thomas A. Farley, MD; Sheila Gillespie, MSN; Madjid Rasoulpour, MD; Narda Tolentino, MSPH; James L. Hadler, MD, MPH; Eugene Hurwitz, MD
[+] Author Affiliations

Accepted for publication March 6, 1989.

Presented in part at the 1988 Epidemic Intelligence Service Conference, Centers for Disease Control, Atlanta, Ga, April 18, 1988.

Reprints not available.


Am J Dis Child. 1989;143(7):798-803. doi:10.1001/archpedi.1989.02150190048019.
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• We investigated a case cluster of Henoch-Schönlein purpura that occurred in Connecticut during the fall and winter of 1987-1988. In Hartford County, where the case finding was most complete, 16 children were identified with disease onset during the 7-month cluster period (incidence, 1.7 cases per 10000 children per year) compared with only 3 children with disease onset during the preceding 7 months. The incidence in Hartford County was higher among urban (4.8/10 000) and Hispanic (8.6/10 000) children and children in lower socioeconomic groups (6.9/10 000) than among suburban children or children in higher socioeconomic or different racial groups (0.9 to 1.1 per 10000). We performed a case-control study involving 14 of the 16 case children from Hartford County, 10 case children from nearby areas, and 47 control children matched to the case children by age and race. Case children were more likely than control children to have had a sore throat during the month before the onset of Henoch-Schönlein purpura (52% vs 22%; odds ratio, 3.8; 95% confidence interval, 1.1 to 13). This difference and other smaller differences between case and control children suggest that the cluster may have been caused by person-to-person spread of an infectious agent of the respiratory tract to susceptible hosts. To our knowledge this is the first report of a cluster of Henoch-Schónlein purpura, and it provides clues for a better understanding of the etiology and epidemiology of the disease.

(AJDC. 1989;143:798-803)

REFERENCES

1 +
Silber DL.  Henoch-Schoenlein syndrome . Pediatr Clin North Am . 1972;;19:1061-1070.
2 +
Allen DM, Diamond LK, Howell DA.  Anaphylactoid purpura in children (Schönlein-Henoch syndrome) . AJDC . 1960;;99:833-854.
3 +
Sterky G, Thilen A.  A study on the onset and prognosis of acute vascular purpura (the Schölein-Henoch syndrome) in children . Acta Paediatr Scand . 1960;;49:217-229.
4 +
Counahan R, Winterborn MH, White RHR, et al.  Prognosis of Henoch-Schönlein nephritis in children . Br Med J . 1977;;2:11-14.
5 +
Saulsbury FT.  IgA rheumatoid factor in Henoch-Schölein purpura . J Pediatr . 1986;;108:71-76.
6 +
Casanueva B, Rodriguez-Valverde V, Merino J, Arias M, Garcia-Fuentes M.  Increased IgA-producing cells in the blood of patients with active Henoch-Schönlein purpura . Arthr Rheum . 1983;; 26:854-860.
7 +
British Medical Association.  Henoch-Schönlein purpura . Br Med J . 1977;;1.190.
8 +
Beeching NJ, Gruer LD, Findlay CD, Geddes AM.  A case of Henoch-Schönlein purpura syndrome following oral ampicillin . J Antimicrob Chemother . 1982;;10:479-482.
9 +
Sussman M, Jones JH, Almeida JD, Lachman PJ.  Deficiency of the second component of complement associated with anaphylactoid purpura and presence of mycoplasma in serum . Clin Exp Immunol . 1973;;14:531-539.
10 +
Gower RG, Sausker WF, Kohler PF, Thome GE, Mclntosh RM.  Small vessel vasculitis caused by hepatitis B virus immune complexes . J Allergy Clin Immunol . 1978;;62:222-228.
11 +
Bull PW, Scott JT, Breathnach SM.  HenochSchönlein purpura associated with legionnaires' disease . Br Med J . 1987;;294:220.
12 +
Lefrere J, Couroce A, Muller J, Clark M, Soulier J.  Human parvovirus and purpura . Lancet . 1985;;2:730.
13 +
Rothman KJ. Modern Epidemiology . Boston, Mass: Little Brown & Co Inc; 1986;.
14 +
Robins J, Greenland S, Breslow NE.  A general estimator for the variance of the Mantel-Haenszel odds ratio . Am J Epidemiol . 1986;; 124:719-723.
15 +
Fine RN. Renal transplantation in children . In: Chatterjee SN, ed. Organ Transplantation . Littleton, Mass: John Wright-PSG Inc; 1982;:243-267.
16 +
Donckerwolcke RA, Chantler C, Broyer MJC.  Paediatric dialysis . In: Drukker W, Parsons FM, Maher JF, eds. Replacement of Renal Function by Dialysis . 2nd ed. Dordrecht, the Netherlands: Martinus Nijhoff Publishers; 1983;:514-535.
17 +
Nielsen HE.  Epidemiology of Schönlein-Henoch purpura . Acta Paediatr Scand . 1988;; 77:125-131.
18 +
Bywaters EGL, Isdale I, Kempton JJ.  Schönlein-Henoch purpura: evidence for a group A β-hemolytic streptococcal aetiology . Q J Med . 1957;;102:161-175.
19 +
Meadow SR, Glasgow EF, White RHR, Moncrieff MW, Cameron JS, Ogg CS.  Schönlein-Henoch nephritis . Q J Med . 1972;;41:241-258.
20 +
Lofters WS, Pineo GF, Luke KH, Yaworsky RG.  Henoch-Schönlein purpura occurring in three members of a family . Can Med Assoc J . 1973;;109:46-48.
21 +
Vernier RL, Worthen HG, Peterson RD, Colle E, Good RA.  Anaphylactoid purpura, I: pathology of the skin and kidney and frequency of streptococcal infection . Pediatrics . 1961;;27:181-193.
22 +
Trystad CW, Stiehm ER.  Elevated serum IgA globulin in anaphylactoid purpura . Pediatrics . 1971;;47:1023-1028.
23 +
Levinsky RJ, Barratt TM.  IgA immune complexes in Henoch-Schönlein purpura . Lancet . 1979;;2:1100-1103.
24 +
Nakamoto Y, Asano Y, Dohi K, et al.  Primary IgA glomerulonephritis and Schönlein-Henoch purpura nephritis: clinicopathological and immunohistochemical characteristics . Q J Med . 1978;; 47:495-516.
25 +
Tsai CC, Giangiacomo J, Zuckner J.  Dermal IgA deposits in Henoch Schönlein purpura and Berger's nephritis . Lancet . 1975;;1:342-343.
26 +
Stevenson JAS, Leong LA, Cohen AH, Borden WA.  Henoch-Schönlein purpura: simultaneous demonstration of IgA deposits in involved skin, intestine, and kidney . Arch Pathol Lab Med . 1982;; 106:192-195.
27 +
Gairdner D.  The Schönlein-Henoch syndrome (anaphylactoid purpura) . Q J Med . 1948;; 17:95-122.
28 +
Ayoub EM, Hoyer J.  Anaphylactoid purpura: streptoccal antibody titers and β1C-globulin levels . J Pediatr . 1969;;75:193-201.

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References

1 +
Silber DL.  Henoch-Schoenlein syndrome . Pediatr Clin North Am . 1972;;19:1061-1070.
2 +
Allen DM, Diamond LK, Howell DA.  Anaphylactoid purpura in children (Schönlein-Henoch syndrome) . AJDC . 1960;;99:833-854.
3 +
Sterky G, Thilen A.  A study on the onset and prognosis of acute vascular purpura (the Schölein-Henoch syndrome) in children . Acta Paediatr Scand . 1960;;49:217-229.
4 +
Counahan R, Winterborn MH, White RHR, et al.  Prognosis of Henoch-Schönlein nephritis in children . Br Med J . 1977;;2:11-14.
5 +
Saulsbury FT.  IgA rheumatoid factor in Henoch-Schölein purpura . J Pediatr . 1986;;108:71-76.
6 +
Casanueva B, Rodriguez-Valverde V, Merino J, Arias M, Garcia-Fuentes M.  Increased IgA-producing cells in the blood of patients with active Henoch-Schönlein purpura . Arthr Rheum . 1983;; 26:854-860.
7 +
British Medical Association.  Henoch-Schönlein purpura . Br Med J . 1977;;1.190.
8 +
Beeching NJ, Gruer LD, Findlay CD, Geddes AM.  A case of Henoch-Schönlein purpura syndrome following oral ampicillin . J Antimicrob Chemother . 1982;;10:479-482.
9 +
Sussman M, Jones JH, Almeida JD, Lachman PJ.  Deficiency of the second component of complement associated with anaphylactoid purpura and presence of mycoplasma in serum . Clin Exp Immunol . 1973;;14:531-539.
10 +
Gower RG, Sausker WF, Kohler PF, Thome GE, Mclntosh RM.  Small vessel vasculitis caused by hepatitis B virus immune complexes . J Allergy Clin Immunol . 1978;;62:222-228.
11 +
Bull PW, Scott JT, Breathnach SM.  HenochSchönlein purpura associated with legionnaires' disease . Br Med J . 1987;;294:220.
12 +
Lefrere J, Couroce A, Muller J, Clark M, Soulier J.  Human parvovirus and purpura . Lancet . 1985;;2:730.
13 +
Rothman KJ. Modern Epidemiology . Boston, Mass: Little Brown & Co Inc; 1986;.
14 +
Robins J, Greenland S, Breslow NE.  A general estimator for the variance of the Mantel-Haenszel odds ratio . Am J Epidemiol . 1986;; 124:719-723.
15 +
Fine RN. Renal transplantation in children . In: Chatterjee SN, ed. Organ Transplantation . Littleton, Mass: John Wright-PSG Inc; 1982;:243-267.
16 +
Donckerwolcke RA, Chantler C, Broyer MJC.  Paediatric dialysis . In: Drukker W, Parsons FM, Maher JF, eds. Replacement of Renal Function by Dialysis . 2nd ed. Dordrecht, the Netherlands: Martinus Nijhoff Publishers; 1983;:514-535.
17 +
Nielsen HE.  Epidemiology of Schönlein-Henoch purpura . Acta Paediatr Scand . 1988;; 77:125-131.
18 +
Bywaters EGL, Isdale I, Kempton JJ.  Schönlein-Henoch purpura: evidence for a group A β-hemolytic streptococcal aetiology . Q J Med . 1957;;102:161-175.
19 +
Meadow SR, Glasgow EF, White RHR, Moncrieff MW, Cameron JS, Ogg CS.  Schönlein-Henoch nephritis . Q J Med . 1972;;41:241-258.
20 +
Lofters WS, Pineo GF, Luke KH, Yaworsky RG.  Henoch-Schönlein purpura occurring in three members of a family . Can Med Assoc J . 1973;;109:46-48.
21 +
Vernier RL, Worthen HG, Peterson RD, Colle E, Good RA.  Anaphylactoid purpura, I: pathology of the skin and kidney and frequency of streptococcal infection . Pediatrics . 1961;;27:181-193.
22 +
Trystad CW, Stiehm ER.  Elevated serum IgA globulin in anaphylactoid purpura . Pediatrics . 1971;;47:1023-1028.
23 +
Levinsky RJ, Barratt TM.  IgA immune complexes in Henoch-Schönlein purpura . Lancet . 1979;;2:1100-1103.
24 +
Nakamoto Y, Asano Y, Dohi K, et al.  Primary IgA glomerulonephritis and Schönlein-Henoch purpura nephritis: clinicopathological and immunohistochemical characteristics . Q J Med . 1978;; 47:495-516.
25 +
Tsai CC, Giangiacomo J, Zuckner J.  Dermal IgA deposits in Henoch Schönlein purpura and Berger's nephritis . Lancet . 1975;;1:342-343.
26 +
Stevenson JAS, Leong LA, Cohen AH, Borden WA.  Henoch-Schönlein purpura: simultaneous demonstration of IgA deposits in involved skin, intestine, and kidney . Arch Pathol Lab Med . 1982;; 106:192-195.
27 +
Gairdner D.  The Schönlein-Henoch syndrome (anaphylactoid purpura) . Q J Med . 1948;; 17:95-122.
28 +
Ayoub EM, Hoyer J.  Anaphylactoid purpura: streptoccal antibody titers and β1C-globulin levels . J Pediatr . 1969;;75:193-201.

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