Details:

Alternative Title:
PLoS One
Personal Author:
Haque, Farhana ; Kundu, Subodh Kumar ; Islam, Md Saiful ; Hasan, S. M. Murshid ; Khatun, Asma ; ... More +
Haque, Farhana ; Kundu, Subodh Kumar ; Islam, Md Saiful ; Hasan, S. M. Murshid ; Khatun, Asma ; Gope, Partha Sarathi ; Mahmud, Zahid Hayat ; Alamgir, A. S. M. ; Islam, M. Sirajul ; Rahman, Mahmudur ; Luby, Stephen P. Less -
Description:
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 Salmonellaspp. 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.


Subjects:
[+]
Child Disease Outbreaks Female Humans Hysteria Male Mass Behavior Research Article Schools Students
Source:
PLoS One. 2013; 8(11).
Document Type:
Journal Article
Place as Subject:
Bangladesh
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:7abcb92c4e13e3321952e93390068c97c50b51bb02823ed36afff3d2c5eda323
Download URL:
https://stacks.cdc.gov/view/cdc/21350/cdc_21350_DS1.pdf
File Type:

Supporting Files

• 	license.txt	txt
  	pone.0080420.g001.gif	gif
  	pone.0080420.g001.jpg	jpeg
  	pone.0080420.nxml	txt

More +