Prolonged symptoms are common. In some cases, there may be remissions and exacerbations of decreasing intensity for years. Buccal and palatal enanthema may occur. The rash resolves within seven to 10 days, followed by a fine desquamation. Cervical lymphadenopathy occurs frequently, and parasthesiae and tenderness of palms and soles are present in a small percentage of cases.
Fever is commonly absent.
Public Health Significance and Occurrence Major outbreaks have occurred in Australia in the Murray Valley, Gippsland, coastal New South Wales, Northern Territory, Queensland and Western Australia, chiefly from January to May. Sporadic cases occur in other coastal regions of Australia and Papua New Guinea. In 1979, a major outbreak occurred in Fiji and spread to other Pacific islands, including Tonga and the Cook Islands. Infection is rare in prepubertal children and increases with age. In those affected, the disease can cause incapacity to work for two to three months and sometimes longer.