Outbreak of illness in schools in Angola - WHO sends a team to assist Government in investigation

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Outbreak of illness in schools in Angola

15 August 2011 - An outbreak of an unknown illness has been reported among children and students in schools in Angola. In most cases, the illness has occurred suddenly, followed by the resolution of symptoms within a few hours. No deaths have been reported.

The typical symptoms reported include: vomiting, headache, sore throat, eye irritation, coughing, breathing difficulties and fainting in some cases. The outbreaks have been reported in schools of the capital, Luanda, and in a number of other provinces. Although the cause of these o

Although the cause of these outbreaks still remains unknown, this may be related to exposure to irritant chemicals. WHO has sent a team to Angola to assist the Government in investigating these outbreaks and to suggest measures for preventing further occurrences.

The WHO team includes an epidemiologist, laboratory specialists and a pharmacologist/toxicologist who are providing technical support to the national intersectoral committee created for this purpose.

This is complex work and WHO is consulting with experts and specialized institutions from other countries to explore ideas on appropriate lines of investigation.

http://www.who.int/csr/don/2011_08_15/en/index.html

[alert]

Re: Outbreak of illness in schools in Angola - WHO sends a team to assist Government in investigation

http://www.promedmail.org/pls/apex/f?p=2400:1001:848102162127128::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,89826

Archive Number 20110817.2490
Published Date 17-AUG-2011
Subject PRO> Undiagnosed outbreak, schools - Angola (02): hysteria susp

UNDIAGNOSED OUTBREAK, SCHOOLS - ANGOLA (02): MASS HYSTERIA SUSPECTED
************************************************** ******************
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[1]
Date: Wed 17 Aug 2011
From: Jahangir Hossain <jhossain@icddrb.org> [edited]


There is a possibility of mass psychogenic illness [MPI]. Only
vomiting is unusual in mass psychogenic illness and all other features
correspond to MPI. Always exclude other causes before diagnosis of
MPI.

--
Dr. Jahangir Hossain
Associate Scientist
Head, Outbreak investigation cluster
Dhaka
Bangladesh
<jhossain@icddrb.org>

******
[2]
Date: Wed 17 Aug 2011
From: Eran Kopel <eran.kopel@mail.huji.ac.il> [edited]


Following the latest ProMED-mail communication (20110816.2486) of the
WHO outbreak report in Angola, suspected currently for exposure to
irritant chemicals, I would like to comment that although it should be
primarily a diagnosis by exclusion only, an outbreak of "mass
hysteria", also known as "epidemic hysteria" or "mass sociogenic
illness", could eventually make another possible etiology for this
kind of outbreak and its unique characteristics, as preliminary
reported.

Sudden onset with rapid (and complete) resolution within a few hours
of several symptoms, all of which could have had a psychogenic origin
(such as, vomiting, breathing difficulties, fainting), and
particularly in school children (no other population, such as school
teachers, was mentioned in the initial WHO report), was also reported
before in numerous outbreaks of epidemic hysteria [1].

A literature review [1] has found that about 50 percent of the
reported past 20th century epidemic hysteria outbreaks were associated
with schools, mostly with schoolchildren and with higher female
prevalence. The trigger of such outbreaks was often reported to be
associated with an environmental event or even a rumor of such an
event (such as, water supply contamination, a gas odor or perception
of such odor).

Reference
---------
1. Boss LP: Epidemic hysteria: a review of the published literature.
Epidemiol Rev 1997; 19(2): 233-43 [available at
<http://epirev.oxfordjournals.org/content/19/2/233.full.pdf>].

--
Eran Kopel MD
Tel Aviv, Israel
<eran.kopel@mail.huji.ac.il>

[ProMED-mail thanks Drs Hossain and Kopel for their timely comments.
This moderator also considered MPI in the differential diagnosis in
this situation in Angola but was awaiting more information. A
commission in Angola has also suggested the diagnosis as well as seen
below. - Mod.LL]

******
[3]
Date: Thu 4 Aug 2011
Source: Daily Monitor (Uganda) [edited]
<http://www.monitor.co.ug/News/World/-/688340/1213862/-/11gql3e/-/index.html>


A commission set up by the Angolan government to probe mass fainting
in schools in the country has denied that toxic gas was responsible
and instead blamed "mass hysteria" for the phenomenon.

More than 500 pupils have allegedly fainted in 7 provinces including
the capital Luanda since April 2011, allegedly due to intoxication
with an unidentified gas. The fainting wave has affected mainly
females and speculation had earlier centered on criminals supposedly
sighted launching toxic gas in the institutions.

But on Wednesday, 3 Aug 2011, the deputy commander of the National
Police, Paulo de Almeida, dismissed the existence of such a gas.
"Tests do not confirm any toxic substance causing the fainting
registered in several schools in the country," he said at a news
conference. "The tests were done and the results are negative," he
said, adding that the samples had also been sent to foreign
laboratories. The officer however admitted that some gangs were
seeking to capitalize on the public's panic and confirmed the force
had made some arrests

Another member for the commission, Luanda psychiatric hospital
director Dr Rui Pires, said that no syndrome of any sort had been
confirmed and alluded to "psychological" problems instead.

Dr Adelaide de Carvalho the national director of public health, said
none of the teenagers had spent more than 5 days in hospitals, and
some of them were asthmatics.

[Byline: Arnaldo Vieira]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Additional references on mass hysteria cited in a previous
ProMED-mail posting:
1. Govender I: Mass hysteria with possible pseudoseizures at a primary
school. S Afr Med J. 2003; 93(1): 10 (available at
<http://www.samj.org.za/index.php/samj/article/viewFile/2025/1283>).
2. Small GW, Feinberg DT, Steinberg D, Collins MT: A sudden outbreak
of illness suggestive of mass hysteria in schoolchildren. Arch Fam
Med. 1994; 3(8): 711-6 (available at
<http://archfami.ama-assn.org/cgi/content/abstract/3/8/711>).
3. Mkize DL, Ndabeni RT: Mass hysteria with pseudoseizures at a South
African high school. S Afr Med J. 2002; 92(9): 697-9.
4. Roach ES, Langley RL: Episodic neurological dysfunction due to mass
hysteria. Arch Neurol. 2004; 61(8): 1269-72 (available at
<http://archneur.ama-assn.org/cgi/content/full/61/8/1269>).
5. Pastel RH: Collective behaviors: mass panic and outbreaks of
multiple unexplained symptoms. Mil Med. 2001; 166(12 Suppl): 44-6
(available at
<http://findarticles.com/p/articles/mi_qa3912/is_200112/ai_n9008773/>).
6. CDC: Rashes Among Schoolchildren: 14 States, October 4,
2001-February 27, 2002. MMWR 2002: 51(8); 161-4; available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5108a1.htm>.
7. Bartholomew RE: Re: "Epidemic hysteria: a review of the published
literature". Am J Epidemiol. 2000; 151(2): 206-7 (available at
<http://aje.oxfordjournals.org/content/151/2/206.full.pdf>).
8. Cole TB, Chorba TL, Horan JM: Patterns of transmission of epidemic
hysteria in a school. Epidemiology. 1990; 1(3): 212-8 (available at
<http://www.jstor.org/pss/25759800>).
9. Robinson P, Szewczyk M, Haddy L, Jones P, Harvey W: Outbreak of
itching and rash. Epidemic hysteria in an elementary school. Arch
Intern Med. 1984; 144(10): 1959-62 (abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/6486980>).
10. Dhadphale M, Shaikh SP: Epidemic hysteria in a Zambian school:
"the mysterious madness of Mwinilunga". Br J Psychiatry. 1983; 142:
85-8 (abstract available at
<http://bjp.rcpsych.org/content/142/1/85.abstract>).
11. Jones TF, Craig AS, Hoy D, et al: Mass psychogenic illness
attributed to toxic exposure at a high school. N Engl J Med. 2000;
342(2): 96-100 (available at
<http://www.nejm.org/doi/full/10.1056/NEJM200001133420206>. - Mod.LL]

[The curiosity here is the occurrence of these events in multiple
schools located in 7 different provinces. We have not seen
information on the time line (epidemic curves) of each of these
outbreaks, but one wonders if there has been media coverage of each
outbreak and that subsequent outbreaks occurred following the media
coverage. A review of the literature revealed reports of illnesses
labeled as "mass hysteria" were overwhelmingly from a single
geographic location (a school, a single town, a single village). Of
interest, there was an incident associated with vaccine administration
in Jordan where day one, there was a mass hysteria event leading to 80
students from one school being hospitalized that day, with the
following day up to 122 students country-wide were hospitalized. A
contributing factor seemed to be the media coverage of the initial
mass hysteria event. (see Kharabsheh S, Al-Otoum H, Clements J, Abbas
A, Khuri-Bulos N, Belbesi A, Gaafar T, Dellepiane N. Mass psychogenic
illness following tetanus-diphtheria toxoid vaccination in Jordan.
Bull World Health Organ. 2001;79(8):764-70. Epub 2001 Oct 24.
available at
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2566491/pdf/11545334.pdf>).
Given the unusual geographic distribution of these events, we await
further information on the results of the investigation underway as
mentioned in the WHO report in the earlier post on this outbreak
(Undiagnosed outbreak, schools - Angola: WHO, RFI 20110816.2486). -
Mod.MPP]


[The HealthMap/ProMED-mail interactive map of Angola can be seen at
<http://healthmap.org/r/18AP>. - Sr.Tech.Ed.MJ]