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1984 Tapanui & West Otago Outbreak
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[[File: Tapanui, New Zealand.png |right|Source:en.wikipedia.org]] In 1984, an epidemic outbreak of [[chronic fatigue syndrome]] occurred in the small, rural town of '''Tapanui, in West Otago''' in New Zealand's South Island, close to the boundary with Southland region.<ref name="Snow2002" /> Dr. [[Peter Grahame Snow]] was a General Practitioner in Tapanui, [[New Zealand]] when the [[List of myalgic encephalomyelitis and chronic fatigue syndrome outbreaks|chronic fatigue syndrome outbreak]], then called [[Tapanui Flu]], occurred.<ref name="Maclean2010">{{Cite web | url = https://www.odt.co.nz/regions/southland/murdoch-be-towns-next-gp | title = Murdoch to be town's next GP | last = McLean | first = Elspeth | date = 2010-07-17 | website = Otago Daily Times Online News|language=en | access-date = 2022-07-30}}</ref> Dr Snow was considered the first doctor in New Zealand to diagnosis and treat [[chronic fatigue syndrome|CFS]] patients. His obituary states: "It was that farmer's wisdom, that ability to see phenomena clearly, and to perceive the connections among them, that led Peter to describe an epidemic of [[chronic fatigue syndrome]] (CFS) in West Otago, a syndrome that was then recognized elsewhere in New Zealand, and that the media soon dubbed [[Tapanui Flu]]."<ref name="obituary">{{Cite web | date = 2006 | title = Annual Report 2006| publisher = Royal New Zealand College of General Practitioners| pages=38-42 | url = http://www.rnzcgp.org.nz/documents/ANNUAL_REPORT_2006.pdf | archive-url=https://web.archive.org/web/20061007204023/http://www.rnzcgp.org.nz/documents/ANNUAL_REPORT_2006.pdf | archive-date=July 17, 2016}}</ref> The outbreak was characterized by [[Flu-like illness|flu-like]] [[malaise]] and prolonged unexplained [[fatigue]]. Levine, P.H. et al. 1997, stated: "This outbreak resembled other reported outbreaks of [[Epidemic neuromyasthenia|epidemic neuromyasthenia]] in that affected individuals presented with a spectrum of complaints ranging from transient diarrhea and upper respiratory disorders to chronic fatigue syndrome."<ref name="Levine1997">{{Cite journal | title = Epidemic neuromyasthenia and chronic fatigue syndrome in west Otago, New Zealand. A 10-year follow-up | date = 1997-04-14 | url = https://pubmed.ncbi.nlm.nih.gov/9125006/ | journal = Archives of Internal Medicine | volume = 157 | issue = 7 | pages = 750β754 | last = Levine | first = P.H. | author-link = | last2 = Snow | first2 = P.G. | author-link2 = Peter Grahame Snow | last3 = Ranum | first3 = B.A. | author-link3 = | last4 = Paul | first4 = C. | author-link4 = | last5 = Holmes | first5 = M.J. | author-link5 = |doi=|pmc=|pmid=9125006|access-date=|issn=0003-9926|quote=|via=}}</ref> Two other physicians studied the illness outbreak with Dr. Snow: Dr. [[Marion Poore]] and Dr. [[Charlotte Paul]]. Together they wrote a piece in 1984 for ''The New Zealand Medical Journal'': "An apparent epidemic of undiagnosed illness in a rural general practice was investigated. The aims were to describe the illness, the characteristics of the people affected, and to look for possible causes. The patients were questioned about their symptoms, and both patients and controls matched for age and sex, were questioned about possible aetiological factors. Twenty-eight cases were identified; all but three were less than 45 years of age; there were equal numbers of females and males. The most commonly experienced symptoms were [[Fatigue|tiredness]], [[Mood swings|mood]] and [[Sleep dysfunction|sleep disturbances]], [[headache]], and [[Arthralgia|joint]] or [[Myalgia|muscle pains]]. Results of the case-control study suggested that pollution of the water supply, [[zoonotic]] infections, contact with agricultural chemicals, and self-dosing with selenium were unlikely to be causes of this illness. An unidentified [[virus]] was regarded as the most likely cause."<ref name="Poore1984">{{Cite journal | title = An unexplained illness in West Otago | date = 1984-06-13 | url = https://pubmed.ncbi.nlm.nih.gov/6589518/ | journal = The New Zealand Medical Journal | volume = 97 | issue = 757 | pages = 351β354 | last = Poore | first = M. | author-link = | last2 = Snow | first2 = P. | author-link2 = Peter Grahame Snow | last3 = Paul | first3 = C. | author-link3 = |doi=|pmc=|pmid=6589518|access-date=|issn=0028-8446|quote=|via=}}</ref> A ten-year follow-up concluded that: "A return to premorbid activity was seen in most (n=16) patients, although some reported the need to modify their lifestyle to prevent [[Relapse|relapses]]. A [[Sex differences in myalgic encephalomyelitis and chronic fatigue syndrome|female predominance]] was noted in those meeting the [[Centers for Disease Control and Prevention]] (CDC) case definition for [[Chronic fatigue syndrome|CFS]], whereas males predominated in patients diagnosed as having prolonged or [[Idiopathic chronic fatigue|idiopathic fatigue]]."<ref name="Levine1997" /> It is unknown if the difference in diagnoses between males and females was because the presentation of the disease differed in the sexes or whether physician bias lead one sex to be diagnosed differently that the other. Eighteen years later, in 2002, Dr. Peter Snow wrote a reminiscing piece for ''New Zealand Family Physician'' journal, in which he discussed the dismissive nature in which patients of the outbreak were treated. "I can recall poems, cartoons (''NZ Herald'') and songs β ''I have got those old Tapanui flu blues''... [where] the press made light, dumbing down if you wish, of the subject, which I considered an important cause of distress in our community." Later, after the medical and research fields began to view the illness seriously, the pendulum began to swing the other way. "What I find disturbing now is the exact opposite to the problem we started in 1985. Then it was getting physicians to accept that there was a chronic fatiguing condition, whereas today I fear that the diagnosis is being applied [[misdiagnosis of myalgic encephalomyelitis and chronic fatigue syndrome|before adequate investigation has taken place]] often leaving the patient's real disorder undiagnosed and untreated. Unfortunately chronic fatigue syndrome has become a convenient dumping ground for the difficult to diagnose."<ref name="Snow2002">{{Cite journal | last = Snow | first = P.G. | author-link = Peter Grahame Snow | title = Reminiscences of the chronic fatigue syndrome | journal = New Zealand Family Physician|volume = 29 | issue = 6 | pages = 385-386 | url = https://www.rnzcgp.org.nz/assets/documents/Publications/Archive-NZFP/Dec-2002-NZFP-Vol-29-No-6/Snow-December-02.pdf | archive-url=http://web.archive.org/web/20160206073445/https://www.rnzcgp.org.nz/assets/documents/Publications/Archive-NZFP/Dec-2002-NZFP-Vol-29-No-6/Snow-December-02.pdf |archive-date=2016-02-06 | date = 2002}}</ref> To illustrate this phenomenon, Dr. Snow and Dr. [[Mike Holmes]], of the Microbiology Department of the University of Otago, further studied the present local population with diagnoses of CFS and found that 65% were actually suffering from a bowel disorder caused by [[giardia lamblia]] which responded to the [[antibiotic]], [[nitroimidazole]]. Initially left untreated, the giardia had moved into a chronic phrase, presenting as "[[diarrhea|diarrhoea]], [[constipation]], frequent [[Loose bowels|mushy bowel]] motions, rotten egg [[Gas|flatus]], post prandial [[bloating]], [[abdominal distention]], [[Hypersensitivity|food intolerances]] particularly to milk products, alcohol, fatty foods, spicy foods, along with the multiplicity of signs such as [[headache]], [[lymphadenopathy]] and others." This symptom cluster is atypical for CFS. He cautioned other physicians that only 5% of patients with a fatiguing illness "probably is [of] the group that would fulfill the criteria of the Centre of Disease Control USA [sic] for the chronic fatigue syndrome."<ref name="Snow2002" /> ==Learn more== *[https://www.southerncross.co.nz/group/medical-library/chronic-fatigue-syndrome-tapanui-flu Medical description of Tapanui Flu] *[https://en.wikipedia.org/wiki/Peter_Snow_(doctor) Dr. Peter Snow] - Wikipedia *[https://www.rnzcgp.org.nz/assets/documents/Publications/Archive-NZFP/Dec-2002-NZFP-Vol-29-No-6/Snow-December-02.pdf "Reminiscences of the chronic fatigue syndrome" by Dr. Peter Snow] *[http://anzmes.org.nz/ ANZMES - The Associated New Zealand ME Society] ==See also== *[[Tapanui Flu]] *[[Peter Grahame Snow]] *[[List of myalgic encephalomyelitis and chronic fatigue syndrome outbreaks]] *[[New Zealand]] ==References== {{Reflist}} [[Category:History]] [[Category:Outbreaks]] [[Category:Outbreaks in the 1980s]] [[Category:Outbreaks in New Zealand]]
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