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

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    Author
    Haque, F; Kundu, SK; Islam, MS; Hasan, SMM; Khatun, A; Gope, PS; Mahmud, ZH; Alamgir, ASM; Islam, MS; Rahman, M; ...
    Date
    2013-11-14
    Source Title
    PLoS One
    Publisher
    PUBLIC LIBRARY SCIENCE
    University of Melbourne Author/s
    Gope, Partha Sarathi
    Affiliation
    Microbiology and Immunology
    Metadata
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    Document Type
    Journal Article
    Citations
    Haque, F., Kundu, S. K., Islam, M. S., Hasan, S. M. M., Khatun, A., Gope, P. S., Mahmud, Z. H., Alamgir, A. S. M., Islam, M. S., Rahman, M. & Luby, S. P. (2013). Outbreak of Mass Sociogenic Illness in a School Feeding Program in Northwest Bangladesh, 2010. PLOS ONE, 8 (11), https://doi.org/10.1371/journal.pone.0080420.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/256712
    DOI
    10.1371/journal.pone.0080420
    Abstract
    BACKGROUND: In 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. METHODS: We 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. CONCLUSIONS: Rapid 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.

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