title: Mass psychogenic illness attributed to toxic exposure at a high school.
abstract: METHODS
  Mass psychogenic illness may be difficult to differentiate from illness caused by bioterrorism, rapidly spreading infection, or toxic substances. We investigated symptoms attributed to exposure to toxic gas at a high school in Tennessee. In November 1998, a teacher noticed a 'gasoline-like' smell in her classroom, and soon thereafter she had a headache, nausea, shortness of breath, and dizziness. The school was evacuated, and 80 students and 19 staff members went to the emergency room at the local hospital; 38 persons were hospitalized overnight. Five days later, after the school had reopened, another 71 persons went to the emergency room. An extensive investigation was performed by several government agencies.
  
  
  RESULTS
  We were unable to find a medical or environmental explanation for the reported illnesses. The persons who reported symptoms on the first day came from 36 classrooms scattered throughout the school. The most frequent symptoms (in this group and the group of people who reported symptoms five days later) were headache, dizziness, nausea, and drowsiness. Blood and urine specimens showed no evidence of carbon monoxide, volatile organic compounds, pesticides, polychlorinated biphenyls, paraquat, or mercury. There was no evidence of toxic compounds in the environment. A questionnaire administered a month later showed that the reported symptoms were significantly associated with female sex, seeing another ill person, knowing that a classmate was ill, and reporting an unusual odor at the school.
  
  
  CONCLUSIONS
  The illness attributed to toxic exposure had features of mass psychogenic illness - notably, widespread subjective symptoms thought to be associated with environmental exposure to a toxic substance in the absence of objective evidence of an environmental cause. Alleviation of the anxiety surrounding an episode of mass psychogenic illness requires prompt recognition and a detailed investigation.
authors.affiliation: Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, USA.
authors.forename: T F
authors.initials: TF
authors.lastname: Jones
authors.forename: A S
authors.initials: AS
authors.lastname: Craig
authors.forename: D
authors.initials: D
authors.lastname: Hoy
authors.forename: E W
authors.initials: EW
authors.lastname: Gunter
authors.forename: D L
authors.initials: DL
authors.lastname: Ashley
authors.forename: D B
authors.initials: DB
authors.lastname: Barr
authors.forename: J W
authors.initials: JW
authors.lastname: Brock
authors.forename: W
authors.initials: W
authors.lastname: Schaffner
mesh_terms: D004196:Disease Outbreaks / Q000191:economics; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D005260:Female; D005742:Gasoline; D015386:Hazardous Substances / Q000009:adverse effects / Q000032:analysis*; D006801:Humans; D008297:Male; D008399:Mass Behavior; D009812:Odorants; D011602:Psychophysiologic Disorders / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D012574:Schools; D012737:Sex Factors; D013714:Tennessee / Q000453:epidemiology
chemical_list: D005742:Gasoline; D015386:Hazardous Substances