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Epidemic myalgic encephalomyelitis
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==Relationship to polio== Prior to the poliovirus vaccine, several [[outbreaks]] of what later came to be called [[myalgic encephalomyelitis]] coincided with confirmed outbreaks of [[poliomyelitis]] including the [[1934 Los Angeles atypical polio outbreak|1934 Los Angeles outbreak]], the [[1948-49 Akureyri outbreak|1948 Akureyri, Iceland outbreak]], and 1949 outbreak in [[1949-53 Adelaide outbreak|Adelaide, Australia]].<ref name="Pellew1951" /> Many outbreaks were initially misinterpreted as clusters of [[poliomyelitis]] or [[abortive poliomyelitis]], hence one of [[myalgic encephalomyelitis|ME]]'s earliest names, [[atypical polio]]. It is not known whether there is a direct relationship between polio outbreaks and ME or if outbreaks of ME were more likely to be reported when public health authorities were already mobilized for an earlier crisis. No serological evidence of polio was ever found in these outbreaks and the ultimate pattern of the outbreaks differed in significant ways, chief among them the higher attack rate, the tendency to affect adults rather than children, and the higher [[morbidity]] than poliomyelitis but no [[mortality]].<ref name="Parish1978" /><ref name="Acheson, 1959" /> Findings in several outbreaks seemed to suggest that symptoms were caused by an [[enterovirus]] distinct from but related to polio: findings of mild, diffuse peripheral nervous system damage in monkeys infected with the virus; a stronger response to polio vaccination in children who had been in epidemic areas; and seasonal patterns of infection resembling polio, i.e., the rise in cases during summer months.<ref name="Parish1978" /><ref name="Acheson, 1959" /> There is indirect evidence of cross-immunity between [[poliovirus]] and the unidentified virus or viruses in epidemic myalgic encephalomyelitis outbreaks. After the Akureyri outbreak, children in areas that had been affected responded to poliomyelitis vaccination with higher antibody titres, as if these children had already been exposed to an agent immunologically similar to the poliovirus.<ref name="Parish1978" /><ref>{{Cite journal| url = https://www.ncbi.nlm.nih.gov/pubmed/13515219 | title = Response to poliomyelitis vaccination | last = Sigurdsson | first = B | author-link = Björn Sigurdsson | date = February 15, 1958|journal=The Lancet|volume=1 | pages = 370-1|via=}}</ref> During the [[1949-53 Adelaide outbreak|outbreak in Adelaide]], cases of classic poliomyelitis dropped by 43%.<ref name="PMC2542300">{{Cite journal | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2542300/| title = Poliomyelitis in 1953"|journal =Bulletin of the World Health Organization | date = 1955|volume =12|issue =4| pages =595-649|pmc=PMC2542300}}</ref>
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