title: Belgian coca-cola-related outbreak: intoxication, mass sociogenic illness, or both?
abstract: An epidemic of health complaints occurred in five Belgian schools in June 1999. A qualitative investigation described the scenario. The role of soft drinks was assessed by using a case-control study. Cases were students complaining of headache, dizziness, nausea, vomiting, abdominal pain, diarrhea, or trembling. Controls were students present at school on the day of the outbreak but not taken ill. An analysis was performed separately for school A, where the outbreak started, and was pooled for schools B-E. In school A, the attack rate (13.2%) was higher than in schools B-E (3.6%, relative risk = 3.6, 95% confidence interval (CI): 2.5, 5.3). Exclusive consumption of regular Coca-Cola (school A: odds ratio (OR) = 29.7, 95% CI: 1.32, 663.6; schools B-E: OR = 7.3, 95% CI: 2.9, 18.0) and low mental health score (school A: OR = 16.1, 95% CI: 1.3, 201.9; schools B-E: OR = 3.1, 95% CI: 1.5, 6.6) were independently associated with the illness. In schools B-E, consumption of Fanta, consumption of Coca-Cola light, and female gender were also associated with the illness. It seems reasonable to attribute the first cases of illness in school A to regular Coca-Cola consumption. However, mass sociogenic illness could explain the majority of the other cases.
authors.affiliation: Unit of Epidemiology, Scientific Institute of Public Health, Brussels, Belgium. European Programme for Intervention Epidemiology Training (EPIET), Brussels, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Gallay
authors.forename: F
authors.initials: F
authors.lastname: Van Loock
authors.forename: S
authors.initials: S
authors.lastname: Demarest
authors.forename: J
authors.initials: J
authors.lastname: Van der Heyden
authors.forename: B
authors.initials: B
authors.lastname: Jans
authors.forename: H
authors.initials: H
authors.lastname: Van Oyen
mesh_terms: D000293:Adolescent; D001530:Belgium / Q000453:epidemiology; D002253:Carbonated Beverages / Q000506:poisoning*; D016022:Case-Control Studies; D002648:Child; D004196:Disease Outbreaks; D005506:Food Contamination; D006801:Humans; D006862:Hydrogen Sulfide / Q000506:poisoning; D016015:Logistic Models; D013001:Somatoform Disorders / Q000453:epidemiology*; D018709:Statistics, Nonparametric; D013461:Sulfur Oxides / Q000506:poisoning; D011795:Surveys and Questionnaires
chemical_list: D013461:Sulfur Oxides; C010063:carbonyl sulfide; D006862:Hydrogen Sulfide