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1948-49 Akureyri outbreak
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The '''Akureyri outbreak''' was an [[Epidemic myalgic encephalomyelitis|outbreak]] of [[myalgic encephalomyelitis]] in Northern [[Iceland]] during the winter of 1948-1949. It lasted for three months and a total of 488 cases were reported in Akureyri, and a total of 1,090 across Iceland.<ref name=":1" /> The outbreak may have been related to the earlier [[1946-47 Iceland outbreak]].<ref name="PoliomyelitisAkureyri1959">{{Cite journal | last = Sigurjonsson | first = J | author-link = | date = 1959-01-01 | title = Poliomyelitis & Akureyri disease|trans-title=Poliomyelitis & Akureyri disease; differentiation of poliomyelitis from poliomyelitis-like disease with characteristics of Akuteyri disease. | url = | journal = Nordisk Medicin|language=da | volume = 61 | issue = 5 | pages = 174-177|doi=|pmc=|pmid=13623058|access-date=|quote=|via=}}</ref> It was after this outbreak that the term ''Icelandic disease'', an early name for myalgic encephalomyelitis, was coined. == Onset == Initial symptoms involved pain in the neck and back accompanied by a rise in temperature. The estimated period of incubation was five to eight days.<ref name=":2">{{Cite journal | last = Sigurdsson | first = B | author-link = Björn Sigurdsson | date = May 1956 | title = The Lancet | url = https://www.ncbi.nlm.nih.gov/pubmed/13320872 | journal = Clinical findings six years after outbreak of Akureyri disease | volume = 270 | pages = 766-7|via=}}</ref> == Symptoms == The systemic form of the illness was present in 70% of patients with the characteristic [[Low-grade fever|low fever]], [[myalgia|muscle tenderness]] and marked lassitude. 30% had [[Paresis|muscle weakness]]. [[Infectious disease testing]] failed to find evidence of [[poliovirus]], [[Coxsackie]] or other known [[encephalitis]] viruses. == Findings == == Epidemiology == In town, the incidence was 6.7%.<ref name=":2" /> In rural areas, it was 0.8%.<ref name=":1" /> While the incidence among adults was significantly higher for females, there was no significant difference in incidence between sexes among those under twenty.<ref name=":1" /> Rates of infection were highest among those 15-19 years of age.<ref name=":1" /><ref name=":2" /> Multiple cases were often found in the same household and schools. Schools (with the exception of the elementary school) were heavily struck. No toxic, food, or waterborne agent was found. The dairy in Akureyri pasteurised the milk and did not appear to have spread the illness to other communities served by it.<ref name=":1">{{Cite journal | last = Sigurdsson | first = Björn | author-link = Björn Sigurdsson | last2 = Sigurjonsson | first2 = Júlíus | author-link2 = | last3 = Sigurdsson | first3 = Jón HG | author-link3 = | last4 = Thorkelsson | first4 = Jóhann | author-link4 = | last5 = Gudmundsson | first5 = Kjartan R | author-link5 = | date = 1950 | title = A Disease Epidemic in Iceland Simulating Poliomyelitis |url =http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.1012.5349 | journal = Am. J. Hyg. | volume = 52 | issue = | pages = 222-238|doi=|pmc=|pmid=14771044|access-date=|quote=|via=}}</ref> When infections spread beyond Akureyri, the first cases appeared along the main land transportation route from Akureyri to Reykjavik, suggesting person-to-person transmission.<ref name=":1" /> Ultimately, 1,090 cases were reported, with the majority (70%) coming from three districts: Akureyri, Saudarkrokur and Isafjordur. ==Course & prognosis == In 1955, neurologist Kjartan Gudmundsson reexamined 39 patients affected by the outbreak. He found that 31% were free from objective clinical signs and only 13% considered themselves completely recovered.<ref name=":2" /> Of the most severely affected, only 25% had completely recovered, 52% had residual muscle tenderness, and 65% had objective [[Nervous system|neurological]] signs. Many patients still complained of nervousness, abnormal [[Muscle fatigability|fatiguability of muscles]], [[Myalgia|muscle pain]], [[Insomnia|sleeplessness]] and [[Memory problems|loss of memory]]. Of those mildly affected in 1948 only 44% had fully recovered, 50% had muscular tenderness, and 19% had residual objective neurological signs.<ref name=":0">{{Cite journal | last = Parish | first = JG | author-link = Gordon Parish | date = 1978 | title = Early outbreaks of 'epidemic neuromyasthenia' | url = https://www.ncbi.nlm.nih.gov/pubmed/370810 | journal = Postgraduate Medical Journal | volume = 54 | pages = 711-7|via=}}</ref><ref name=":2" /> There were no deaths.<ref name=":2" /> In 1988, [[Byron Hyde]] published a long term follow-up in [[the Lancet]], 40 years after the initial outbreak. He managed to examine 10 patients, of which only 2 reported a full recovery.<ref>{{Cite journal | last = Hyde | first = B. | author-link = Byron Hyde | last2 = Bergmann | first2 = S. | date = 1988-11-19 | title = Akureyri disease (myalgic encephalomyelitis), forty years later |url =https://www.ncbi.nlm.nih.gov/pubmed/2903396 | journal = Lancet (London, England) | volume = 2 | issue = 8621 | pages = 1191–1192|issn=0140-6736|pmid=2903396|quote=|via=}}</ref> == Polio vaccine == In a study of children in Iceland vaccinated against polio in 1956, [[Björn Sigurdsson|Sigurdsson]], et. al found significant differences in antibody response to [[Vaccine|vaccination]] depending on where the children lived. Children in Egilsstadir had only a slight antibody rise to type 2 and type 3 [[poliovirus]], while children in Thorshofn, which had recently had an outbreak of [[epidemic myalgic encephalomyelitis]], had a much stronger antibody response to the polio vaccine. Sigurdsson postulated that this might be explained by "the existence of basic immunity acquired through a related infection."<ref>{{Cite journal | last = Sigurdsson | first = B | author-link = Björn Sigurdsson | date = February 15, 1958 | title = Response to poliomyelitis vaccination | url =https://www.ncbi.nlm.nih.gov/pubmed/13515219 | journal = The Lancet | volume = 1 | pages = 370-1|via=}}</ref> Indirect evidence of [[Poliovirus#Cross-immunity|cross-immunity]] was also seen in the outbreak in [[1949-53 Adelaide outbreak|Adelaide]], [[Australia]],<ref>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2542300/ "Poliomyelitis in 1953"] ''Bulletin of the World Health Organization.'' 1955;12(4):595-649.</ref> where there was a 43% reduction in polio cases following an [[Myalgic encephalomyelitis|ME]] outbreak. Conversely, in a study of children exposed to live and inactive poliovirus vaccines in [[Estonia]] and [[Finland]],<ref>{{Cite journal | last = Juhela | first = S | date = July 1999 | title = Comparison of enterovirus-specific cellular immunity in two populations of young children vaccinated with inactivated or live poliovirus vaccines |url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1905481/ | journal = Clinical & Experimental Immunology | volume = 117 | pages = 100–105|via=}}</ref> where those who has been exposed to the live polio vaccine had a stronger antibody response to [[Coxsackievirus B4]]. ==See also== * [[Björn Sigurdsson]] *[[1946-47 Iceland outbreak]] *[[Epidemic myalgic encephalomyelitis]] *[[List of myalgic encephalomyelitis and chronic fatigue syndrome outbreaks|List of outbreaks]] ==References== {{reflist}} [[Category:History]] [[Category:Outbreaks]] [[Category:Outbreaks in the 1940s]] [[Category:Outbreaks in Iceland]]
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