See this thread for a similar outbreak in Leroy and Corinth NY in 2011-2012.
Another outbreak:
Published Date: 2013-07-03 12:28:53
Subject: PRO/EDR> Tic disorder - USA: (MA) outbreak, high school students
Archive Number: 20130703.1805240
TIC DISORDER - USA: (MASSACHUSETTS) OUTBREAK, HIGH SCHOOL STUDENTS
******************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Sun 30 Jun 2013
Source: Top News Examiner [edited]
http://www.examiner.com/article/hic...s-school-kids-mass-hysteria-witch-trials-site
State health officials are quietly investigating the cases of the unexplained hiccups that originally hit just students, but one adult is suffering the same symptoms today [30 Jun 2013]. This past school year up to 2 dozen students are exhibiting unexplained vocal tics or repetitive hiccups at 2 schools in Danvers, [Massachusetts]. The Essex Agricultural and Technical School and to a lesser degree, the North Shore Technical High in Middleton are the 2 schools seeing these mysterious cases, according to Yahoo News.
Air tests and visual observations at the schools have turned up nothing. The air contains nothing that would lead to "significant neurological effects." The Department of Public Health and the Board of Registration of Medicine sent letters to more than 2600 attending physicians, who encompass more than a dozen medical specialties looking to see if any of the doctors had treated patients with chronic hiccups or vocal tics from the 2 schools. The doctors were asked to discuss the state investigation with parents, hopefully to see if they would consent to allow the state to obtain the patients' medical records.
Both schools each have a little less than 500 students enrolled and the students come from a wide area, which includes several towns in that region. So far, no environmental factors seem to play into these cases.
Some health experts, who had not seen any of the local students, theorized that this mystery appeared to be a case of conversion disorder and mass psychogenic illness, also known as mass hysteria. That explanation was given for another widely publicized case involving high school girls suffering tics in Le Roy, NY [see ProMED-mail post Tourette disorder - USA: (NY) outbreak 20111202.3505.]
One of the leading theories for a biological cause is PANDAS, [an acronym standing for] pediatric autoimmune [neuropsychiatric disorder associated with streptococcal infections]. This causes autoimmune reactions in the brain.
Whatever the reason behind these tics and chronic hiccups, it has to be weighing heavily on the parents of the kids right now as it has been going on for almost a year. Will there be long-term problems of whatever this is for going untreated for such a long time?
[Byline: Roz Zurko]
--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka
[The news report above says that there has been an outbreak of a tic disorder (vocal tics or repetitive hiccups) involving 24 students and one adult at 2 high schools with a total of about 1000 students (an attack rate of 2.4 percent) during the past year in Danvers, Massachusetts (USA). We are not told of the gender, specific ages, temporal distribution, race, socioeconomic status, preceding streptococcal infection, presence of carditis, or epidemiologic linkage of the sick students. Apparently, no environmental factor, such as a toxin, is said to have been discovered so far.
A similar outbreak occurred among high school girls in LeRoy, a small town with a population of 7790, in western New York State in 2011 among high school girls that was posted by ProMED-mail at the time (Tourette disorder - USA: (NY) outbreak 20111202.3505). 2 leading theories that have been mentioned to explain both outbreaks are conversion reaction (that is, mass hysteria) and PANDAS.
PANDAS or pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections is said to be an autoimmune process that follows group A beta-hemolytic streptococcal infections (Kurlan R, Johnson D, Kaplan EL: Tourette Syndrome Study Group: Streptococcal infection and exacerbations of childhood tics and obsessive-compulsive symptoms: a prospective blinded cohort study. Pediatrics. 2008; 121(6): 1188-97. Available at http://pediatrics.aappublications.org/content/121/6/1188.long; and Swedo SE, Leonard HL, Garvey M, et al: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases [published correction appears in Am J Psychiatry. 1998; 155(4): 578]. Am J Psychiatry 1998; 155(2): 264-71; available at http://ajp.psychiatryonline.org/article.aspx?articleid=172706).
The autoimmune process is thought to be analogous to that of Sydenham chorea, a major neurologic manifestation of acute rheumatic fever (ARF) (http://www.pandasnetwork.org/Cunningham.NMpaper[1].pdf). As with Sydenham's chorea, PANDAS is said to require both 1) a preceding infection with a particularly virulent strain of group A streptococcus that elicits an immune reaction that cross-reacts with the patient's own brain tissues, and 2) a genetic susceptibility to post-streptococcal autoimmunity (http://thebatavian.com/howard-owens/q-dr-susan-swedo-regarding-pandas/30364). Specifically in the case of Sydenham's chorea, the basal ganglia that serve to regulate a person's movements are involved.
Some characteristics of Sydenham's chorea include: only 1-3 percent of people with streptococcal throat infections develop ARF and about 26 percent of ARF patients develop chorea; people living in poverty, in crowded, unsanitary conditions are at greater risk of developing Sydenham's chorea; about 20 percent of patients diagnosed with Sydenham's chorea experience a recurrence; Sydenham's chorea occurs most commonly in children between the ages of 5 and 15, like the age distribution of PANDAS; the interval between group A streptococcal infection until the development of chorea may be long (that is, 9 weeks); Sydenham's chorea mainly affects female patients, unlike the gender distribution in PANDAS.
Commenting on the LeRoy, New York outbreak, Dr Swedo, a PANDAS expert, said that because there have been epidemics of rheumatic fever and Sydenham chorea, a PANDAS outbreak, although unlikely, could theoretically occur, but boys should outnumber girls by 3-4 cases to 1 (http://thebatavian.com/howard-owens/q-dr-susan-swedo-regarding-pandas/30364).
Danvers is a town in Essex County, Massachusetts, located near the northeastern coast of Massachusetts (http://en.wikipedia.org/wiki/Danvers,_Massachusetts). Originally known as Salem Village, the town is most widely known for its association with the 1692 Salem witch trials. For a map showing the location of Danvers, see http://goo.gl/maps/cpI1n. - Mod.ML
Another outbreak:
Published Date: 2013-07-03 12:28:53
Subject: PRO/EDR> Tic disorder - USA: (MA) outbreak, high school students
Archive Number: 20130703.1805240
TIC DISORDER - USA: (MASSACHUSETTS) OUTBREAK, HIGH SCHOOL STUDENTS
******************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Sun 30 Jun 2013
Source: Top News Examiner [edited]
http://www.examiner.com/article/hic...s-school-kids-mass-hysteria-witch-trials-site
State health officials are quietly investigating the cases of the unexplained hiccups that originally hit just students, but one adult is suffering the same symptoms today [30 Jun 2013]. This past school year up to 2 dozen students are exhibiting unexplained vocal tics or repetitive hiccups at 2 schools in Danvers, [Massachusetts]. The Essex Agricultural and Technical School and to a lesser degree, the North Shore Technical High in Middleton are the 2 schools seeing these mysterious cases, according to Yahoo News.
Air tests and visual observations at the schools have turned up nothing. The air contains nothing that would lead to "significant neurological effects." The Department of Public Health and the Board of Registration of Medicine sent letters to more than 2600 attending physicians, who encompass more than a dozen medical specialties looking to see if any of the doctors had treated patients with chronic hiccups or vocal tics from the 2 schools. The doctors were asked to discuss the state investigation with parents, hopefully to see if they would consent to allow the state to obtain the patients' medical records.
Both schools each have a little less than 500 students enrolled and the students come from a wide area, which includes several towns in that region. So far, no environmental factors seem to play into these cases.
Some health experts, who had not seen any of the local students, theorized that this mystery appeared to be a case of conversion disorder and mass psychogenic illness, also known as mass hysteria. That explanation was given for another widely publicized case involving high school girls suffering tics in Le Roy, NY [see ProMED-mail post Tourette disorder - USA: (NY) outbreak 20111202.3505.]
One of the leading theories for a biological cause is PANDAS, [an acronym standing for] pediatric autoimmune [neuropsychiatric disorder associated with streptococcal infections]. This causes autoimmune reactions in the brain.
Whatever the reason behind these tics and chronic hiccups, it has to be weighing heavily on the parents of the kids right now as it has been going on for almost a year. Will there be long-term problems of whatever this is for going untreated for such a long time?
[Byline: Roz Zurko]
--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka
[The news report above says that there has been an outbreak of a tic disorder (vocal tics or repetitive hiccups) involving 24 students and one adult at 2 high schools with a total of about 1000 students (an attack rate of 2.4 percent) during the past year in Danvers, Massachusetts (USA). We are not told of the gender, specific ages, temporal distribution, race, socioeconomic status, preceding streptococcal infection, presence of carditis, or epidemiologic linkage of the sick students. Apparently, no environmental factor, such as a toxin, is said to have been discovered so far.
A similar outbreak occurred among high school girls in LeRoy, a small town with a population of 7790, in western New York State in 2011 among high school girls that was posted by ProMED-mail at the time (Tourette disorder - USA: (NY) outbreak 20111202.3505). 2 leading theories that have been mentioned to explain both outbreaks are conversion reaction (that is, mass hysteria) and PANDAS.
PANDAS or pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections is said to be an autoimmune process that follows group A beta-hemolytic streptococcal infections (Kurlan R, Johnson D, Kaplan EL: Tourette Syndrome Study Group: Streptococcal infection and exacerbations of childhood tics and obsessive-compulsive symptoms: a prospective blinded cohort study. Pediatrics. 2008; 121(6): 1188-97. Available at http://pediatrics.aappublications.org/content/121/6/1188.long; and Swedo SE, Leonard HL, Garvey M, et al: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases [published correction appears in Am J Psychiatry. 1998; 155(4): 578]. Am J Psychiatry 1998; 155(2): 264-71; available at http://ajp.psychiatryonline.org/article.aspx?articleid=172706).
The autoimmune process is thought to be analogous to that of Sydenham chorea, a major neurologic manifestation of acute rheumatic fever (ARF) (http://www.pandasnetwork.org/Cunningham.NMpaper[1].pdf). As with Sydenham's chorea, PANDAS is said to require both 1) a preceding infection with a particularly virulent strain of group A streptococcus that elicits an immune reaction that cross-reacts with the patient's own brain tissues, and 2) a genetic susceptibility to post-streptococcal autoimmunity (http://thebatavian.com/howard-owens/q-dr-susan-swedo-regarding-pandas/30364). Specifically in the case of Sydenham's chorea, the basal ganglia that serve to regulate a person's movements are involved.
Some characteristics of Sydenham's chorea include: only 1-3 percent of people with streptococcal throat infections develop ARF and about 26 percent of ARF patients develop chorea; people living in poverty, in crowded, unsanitary conditions are at greater risk of developing Sydenham's chorea; about 20 percent of patients diagnosed with Sydenham's chorea experience a recurrence; Sydenham's chorea occurs most commonly in children between the ages of 5 and 15, like the age distribution of PANDAS; the interval between group A streptococcal infection until the development of chorea may be long (that is, 9 weeks); Sydenham's chorea mainly affects female patients, unlike the gender distribution in PANDAS.
Commenting on the LeRoy, New York outbreak, Dr Swedo, a PANDAS expert, said that because there have been epidemics of rheumatic fever and Sydenham chorea, a PANDAS outbreak, although unlikely, could theoretically occur, but boys should outnumber girls by 3-4 cases to 1 (http://thebatavian.com/howard-owens/q-dr-susan-swedo-regarding-pandas/30364).
Danvers is a town in Essex County, Massachusetts, located near the northeastern coast of Massachusetts (http://en.wikipedia.org/wiki/Danvers,_Massachusetts). Originally known as Salem Village, the town is most widely known for its association with the 1692 Salem witch trials. For a map showing the location of Danvers, see http://goo.gl/maps/cpI1n. - Mod.ML
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