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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 - WHO sends a team to assist Government in investigation

    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.
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

  • #2
    Re: Outbreak of illness in schools in Angola - WHO sends a team to assist Government in investigation,89826

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

    ************************************************** ******************
    A ProMED-mail post
    ProMED-mail is a program of the
    International Society for Infectious Diseases

    Date: Wed 17 Aug 2011
    From: Jahangir Hossain <> [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

    Dr. Jahangir Hossain
    Associate Scientist
    Head, Outbreak investigation cluster

    Date: Wed 17 Aug 2011
    From: Eran Kopel <> [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

    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).

    1. Boss LP: Epidemic hysteria: a review of the published literature.
    Epidemiol Rev 1997; 19(2): 233-43 [available at

    Eran Kopel MD
    Tel Aviv, Israel

    [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]

    Date: Thu 4 Aug 2011
    Source: Daily Monitor (Uganda) [edited]

    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:

    [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
    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
    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
    5. Pastel RH: Collective behaviors: mass panic and outbreaks of
    multiple unexplained symptoms. Mil Med. 2001; 166(12 Suppl): 44-6
    (available at
    6. CDC: Rashes Among Schoolchildren: 14 States, October 4,
    2001-February 27, 2002. MMWR 2002: 51(8); 161-4; available at
    7. Bartholomew RE: Re: "Epidemic hysteria: a review of the published
    literature". Am J Epidemiol. 2000; 151(2): 206-7 (available at
    8. Cole TB, Chorba TL, Horan JM: Patterns of transmission of epidemic
    hysteria in a school. Epidemiology. 1990; 1(3): 212-8 (available at
    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
    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
    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
    <>. - 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
    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). -

    [The HealthMap/ProMED-mail interactive map of Angola can be seen at
    <>. - Sr.Tech.Ed.MJ]