Rumor of death of two to three students further worsened the situation. Reports of a mysterious illness were being broadcasted in all the major television channels. Political leaders, social workers, and many curious people also came. The situation was getting worse and local administration along with police department got involved to control the situation. Within a short period of time media men and more anxious relatives rushed to the hospital. Assurance and reassurance were also given to the parents and relatives. Counseling was done repeatedly to the sick students. Treatment was given after a triage done by the hospital consultants. Most of the students complained of bad odor or bad taste of the cake. Subsequently some of the students who carried the sick students to hospital also felt unwell. They were brought to the emergency department of nearby hospital. As the news spread among other students, some of the other students also started to feel sick. They were brought to the headmaster's room immediately. Few students of class five started feeling unwell within few minutes of taking the tiffin while playing in the playground. The incidence occurred in a girls' high school in the morning of 14 April 2013 after serving tiffin to the students like every other day. This study was aimed at reporting the demographic characteristics and symptom profile of an outbreak of mass psychogenic illness occurring in a girls' high school at Gopalganj in Bangladesh in April 2013.
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Brief duration of illness, sudden onset without specific time, place, or person, and lack of opportunity for controlled experiment have made it a difficult field for the researchers. Responders of emergency management and the initial media reports of unexplained illness are believed to amplify the phenomenon by spreading threatening information and lead more people to report symptoms. Investigators failed to conclude regarding any predisposing factor of an episode, but psychological factors, environmental factors, different stressors, conflicts, lower education, lower socioeconomic status, minority race, and history of abuse or trauma may be involved. Common symptoms are nausea, dizziness, fainting, headache, abdominal pain, hyperventilation, cough, fatigue, drowsiness, weakness, watery eyes, chest pain, vomiting, and so forth. It has unique characteristics-symptoms without any plausible organic cause, transient and benign, occurring in a segregated group, presence of extraordinary anxiety, spread via sight, sound, or oral communication the spread moves down the age scale, more affecting the females. An index case sometimes has organic problem. Outbreak of mass psychogenic illness often starts with an environmental trigger such as a bad smell, a sound, a suspicious looking substance, or something else that makes people in a group believe that they have been exposed to a danger and they start to experience symptoms of illness. It can be defined as “the rapid spread of illness signs and symptoms affecting members of a cohesive group, originating from a nervous system disturbance involving excitation, loss, or alteration of function, whereby physical complaints that are exhibited unconsciously have no corresponding organic etiology”. Affected schools or occupational sites are often closed for days or weeks. It is probably more common than the reported incidences and imposes a significant financial burden and unexpected management difficulties for the emergency department. Mass psychogenic illness (MPI) is a not a very rare phenomenon anymore. To avoid unnecessary panic in the community a prompt, coordinated response is important in resolving widespread community anxiety surrounding these episodes. Hospital stay following the incident was about 12 hours on average. Commonest symptoms were abdominal pain (83%), headache (73%), chest pain (69%), body ache (63%), nausea (69%), and generalized weakness and fatigue (61%). Average interval between exposure to the trigger and onset of symptoms was 151.5 minutes. Trigger factor was found in 98% of students. 93 female students were included who were hospitalized during the incident. No organic explanation for the reported illnesses was found.
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A descriptive, cross-sectional observational survey was done to define various characteristics of the outbreak. In 14 April 2013, a total of 93 students of a girls' high school suddenly developed various symptoms following intake of tiffin cake which resulted in panic and hospital admission. This study was aimed at investigating the demographic characteristics and symptom profile of an outbreak of mass psychogenic illness occurring in a girls' high school. Mass psychogenic illness has been a recurrent phenomenon in Bangladesh over recent times.