Outbreak of Mass Sociogenic Illness in a School Feeding Program in Northwest Bangladesh, 2010

Abstract

BackgroundIn 2010, an acute illness outbreak was reported in school students eating high-energy biscuits supplied by the school feeding programme in northwest Bangladesh. We investigated this outbreak to describe the illness in terms of person, place and time, develop the timeline of events, and determine the cause and community perceptions regarding the outbreak.MethodsWe defined case-patients as students from affected schools reporting any two symptoms including abdominal pain, heartburn, bitter taste, and headache after eating biscuits on the day of illness. We conducted in-depth interviews and group discussions with students, teachers, parents and community members to explore symptoms, exposures, and community perceptions. We conducted a questionnaire survey among case-patients to determine the symptoms and ascertain food items eaten 12 hours before illness onset, and microbiological and environmental investigations.Results Among 142 students seeking hospital care, 44 students from four schools qualified as case-patients. Of these, we surveyed 30 who had a mean age of 9 years; 70% (21/30) were females. Predominant symptoms included abdominal pain (93%), heartburn (90%), and bitter taste (57%). All students recovered within a few hours. No pathogenic Vibrio cholerae, Shigella or Salmonella spp. were isolated from collected stool samples. We found no rancid biscuits in schools and storage sites. The female index case perceived the unusually darker packet label as a “devil’s deed” that made the biscuits poisonous. Many students, parents and community members reported concerns about rumors of students dying from biscuit poisoning.ConclusionsRapid onset, followed by rapid recovery of symptoms; female preponderance; inconsistent physical, microbiological and environmental findings suggested mass sociogenic illness rather than a foodborne or toxic cause. Rumours of student deaths heightening community anxiety apparently propagated this outbreak. Sharing investigation results and reassuring students and parents through health communication campaigns could limit similar future outbreaks and help retain beneficiaries’ trust on nutrition supplementation initiatives.

Mass Psychogenic Illness in Haraza Elementary School, Tigray, Northern Ethiopia: Investigation to the nature of an Episode.

“…Similar finding was reported from Kombolcha of Northern Ethiopia, Derashe of Southern Ethiopia, [17][18]. On the other hand toxic chemicals and environmental pollution have been notified in western setting; India due to toxic fumes [13], these attributions in Africa, lead many victims commonly seek treatment from different religious and traditional healing sites [13][14][15][16][17][18]. This is also practice in Ethiopia context in which more than half (63.9%) of study participants in Derashe district of Southern Ethiopia reported that they had been visiting traditional healing services, 8.2% had sought treatment from religious services, 75.3% modern health service, 5.1%, all the three treatment sites, namely traditional healers, religious healers and health institutions [18].…”

“…Among the total reported hospitalized ill students in Bangladesh, 88% complain about consumption of cake with abnormal smell or taste. Among these, 20% of them felt ill by only seeing other ill students in the school [16]. Satanism and evil devil force, punishment by God, due to the presence of toxic chemicals, polluted environment, cold air, and using family planning injection or pills had been discovered around the schools and community members in Ethiopia [16][17][18][19].…”

“…Common symptoms of mass psychogenic illness reported were nausea, dizziness, fainting, headache, abdominal pain, hyperventilation, cough, fatigue, drowsiness, weakness, watery eyes, chest pain, vomiting, communication difficulties, laughing, and fainting were common in African settings [8,10,[15][16][17].…”

“…Mass psychogenic out breaks were reported in different African settings including Ethiopia [14][15][16].…”

Chronic mass psychogenic illness among women in Derashe Woreda, Segen Area People Zone, southern Ethiopia: a community based cross-sectional study

“…Because of these attribution styles, in Africa, many victims of MPI commonly seek treatment from religious and traditional healing sites [5, 12, 13]. Though there is no conclusive evidence about the causes of MPI, the following are postulated causes: psychological factors, environmental factors, different stressors, conflicts, lower level of education, lower socioeconomic status, minority race, and history of abuse or trauma [17–19]. …”