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1955 Durban outbreak
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In February, 1955, near the end of summer, a disease resembling [[poliomyelitis]] struck the nursing staff of Addington Hospital in Durban, [[South Africa]]. A total of 98 nurses became ill.<ref name=":0">{{Cite journal | last = Hill | first = RC | date = April 4, 1959 | title = Epidemic myalgic encephalomyelopathy: the Durban outbreak | url =https://www.ncbi.nlm.nih.gov/pubmed/13642847 | journal = The Lancet | volume = 1 | pages = 689-693|via=}}</ref> Addington Hospital at the time served the European and "Coloured" populations of Durban, but not Asians or Africans. == Onset == Patients typically presented with severe headache 14 days after onset. == Symptoms == * [[Respiratory tract infection|respiratory-tract infection]] or [[flu-like illness]] * severe [[headache]] * extreme lassitude * stiffness of the [[Neck stiffness|neck]], [[backache]] * [[Myalgia|muscle pain]] and cramps * [[muscle weakness]] * [[paresthesia]] * temporary [[paralysis]] worsened by [[exertion]] * [[sweating]] of the extremities "In certain cases symptoms and signs were very slight, and recovery was rapid; in others the illness proved extremely debilitating and protracted, with residual signs or relapses three years after the onset."<ref name=":0" /> == Signs & findings == * low-grade [[fever]] or absence of fever * [[tachycardia]] * [[stiff neck|neck stiffness]] * [[sleep reversal|reversal of normal sleeping pattern]] * slight facial [[Paresis|muscle weakness]], diminution of facial sensation * difficulty initiating movement * reflexes variable (some abnormal) * patchy areas of diminished sensation "Since [[exercise]] definitely aggravated [[weakness]] and [[pain]], physiotherapy in the initial stages was contraindicated."<ref name=":0" /> == Epidemiology == The absence of spread to other hospital personnel or patients initially led physicians to suspect a toxic substance common to the nurses' quarters might be the cause. However, the disease eventually spread to nurses who were not living in the hospital, and sporadic cases were later admitted from the city, all supporting a theory of infection. After a field investigation, it was suspected that the hospital outbreak was an episode in an infection which has been occurring in the general population for some weeks and months, but went unrecognized until it "broke out with explosive force among the nurses."<ref name=":0" /> Among the 98 cases within the hospital, the ages of those affected ranged from 17 to 49, although the majority of cases were 25 years of age or younger. While several nurses became ill while working in the children's ward, none of the children themselves became ill, suggesting that while children could be carriers, they were themselves immune: "...unlike [[poliomyelitis]], the changes at puberty render the individual susceptible, since cases occurred in adolescents and the incidence among teenagers was high."<ref name=":0" /> In the 30 cases outside the hospital, the age range was 15 to 54. == Prognosis == More than 11% of the patients were still severely disabled after three years<ref name=":0" /><ref>Bannister, B. A. (1988). Post-infectious disease syndrome. Postgraduate Medical Journal, 64(753), 559β567.</ref> (a greater proportion may have had more mild impairments, but this was not reported). The study authors noted, "In the acute phase complete bed rest is essential, since any form of activity tends to evoke painful cramps in the affected [[muscle]]-groups. Moreover, in our most serious relapse cases, most of the nurses admit to having been active during the acute phase."<ref name=":0" /> == See also == *[[Epidemic myalgic encephalomyelitis]] *[[List of myalgic encephalomyelitis and chronic fatigue syndrome outbreaks]] ==Learn more== == References == {{Reflist}} [[Category:Outbreaks]] [[Category:History]] [[Category:Outbreaks in the 1950s]] [[Category:Outbreaks in the Republic of South Africa]]
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