1984 Incline Village chronic fatigue syndrome outbreak

In 1984, there was an outbreak of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) (then thought to be Chronic Epstein-Barr virus) at Incline Village, Nevada, United States. Incline Village is a small town on the north shore of Lake Tahoe.

Chronic fatigue syndrome (CFS) was the name coined by the Centers for Disease Control (CDC) in response to an outbreak of "chronic flu-like illness" at Incline Village.

Outbreak

An estimated 160 residents of Incline Village became ill with chronic fatigue syndrome (CFS) the winter of 1985 of which the majority were seen by local doctors, Paul Cheney and Daniel Peterson.

Dr. Anthony Komaroff studied 175 cases around Lake Tahoe and found "quite a number" have been fully or partially disabled while a third said their condition improved.

Truckee, California High School

During this same time, about 20 miles away, Truckee, California was involved in a similar outbreak. Nine of 10 teachers using a conference room at the same high school were found to be suffering from sick building syndrome (SBS) as well as symptoms typical of CFS.

Local response

Paul Cheney and Dan Peterson

Doctors who practiced at Incline Village and experienced the outbreak first hand include Daniel Peterson and Paul Cheney. They have continued to work in the ME/CFS field.

CDC investigation

'The CDC showed up eventually, but they refused to examine any of the patients. Stephen Straus called it a disease of “depressed menopausal women.” HHS made this characterization known to the press, which then dubbed the disease “Yuppie Flu.”'

See also

Stigma and discrimination and List of abnormal findings in chronic fatigue syndrome and myalgic encephalomyelitis.

The local doctors seemed to be defending their scorned and disabled patients from the CDC and medical establishment.

In an interview with Hillary Johnson, she spoke about Incline Village and the CDC response. "In 1984-85, a large number of people living in Incline Village, Nevada, were devastated by a mysterious, debilitating disease, now known to be Chronic Fatigue Syndrome. After a cursory investigation of the outbreak, the Centers for Disease Control (CDC) and the National Institutes of Health (NIH) have made little effort to aggressively research the disease. It was not until 1995--ten years later--that scientists at the CDC gave CFS a "Priority 1" listing among their "New and Reemerging Infectious Diseases" category, thus officially recognizing it as a bona fide disease. Despite including CFS in this category, these agencies continue to insist there is no evidence that CFS is infectious."

Although the CDC did not examine patients when they were sent to investigate the mysterious illness they were called in for, they somehow were able to, at a later date, produce a report based on whether or not the patients were experiencing Chronic Epstein-Barr virus. The non-conclusion was: "Currently available data neither prove nor disprove the hypothesis that EBV activity is responsible for chronic illness, but it is clear that the diagnosis of CEBV using current clinical and laboratory criteria in an individual patient is unreliable."

Media coverage

• 1996 PrimeTime TV segment Sick and Tired - Incline Village Outbreak
• I Remember Me
• Doctors say strange form of mono under control in Incline Village via Twitter Erik Johnson. Dated Oct, 16, 1985, Media outlet unknown.

Possible causes

Herpes viruses

Gary Holmes found that patients in Nevada near the outbreak with what his team hypothesized was chronic Epstein-Barr virus had elevated antibody titers to several herpesviruses including Epstein-Barr virus, cytomegalovirus, and herpes simplex, as well as measles viruses than age-matched controls. However, the study cohort was defined as patients who had experienced excessive fatigue between January 1 and September 15.

In 1992, Buchwald, Cheney, Peterson and others published a study of 259 patients who fell ill during the outbreak, with 29% of these severely ill. They concluded:

Patients had a higher mean (+/- SD) CD4/CD8-cell ratio than matched healthy controls (3.16 +/- 1.5 compared with 2.3 +/- 1.0, respectively; P < 0.003). Magnetic resonance scans of the brain showed punctate, subcortical areas of high signal intensity consistent with edema or demyelination in 78% of patients (95% Cl, 72% to 86%) and in 21% of controls (Cl, 11% to 36%) (P < 10-9). Primary cell culture of lymphocytes showed active replication of HHV-6 in 79 of 113 patients (70%; CI, 61% to 78%) and in 8 of 40 controls (20%; Cl, 9% to 36%) (P < 10-8), a finding confirmed by assays using monoclonal antibodies specific for HHV-6 proteins and by polymerase chain reaction assays specific for HHV-6 DNA.

Conclusions: Neurologic symptoms, MRI findings, and lymphocyte phenotyping studies suggest that the patients may have been experiencing a chronic, immunologically mediated inflammatory process of the central nervous system. The active replication of HHV-6 most likely represents reactivation of latent infection, perhaps due to immunologic dysfunction.

— Buchwald et al. (1992), Annals of Internal Medicine 116(2) pp. 103–113

Dr. Paul Cheney theorizes that a particularly virulent strain of Human herpesvirus 6 swept the population. He found that the sufferers were "mass-producing antibodies to Epstein-Barr virus, the herpes virus that causes infectious mononucleosis." Dr. Cheney contacted the CDC to report the outbreak.

Biotoxin exposure

Erik Johnson, a patient who pioneered mold avoidance for chronic fatigue syndrome, theorizes that an outbreak of toxic cyanobacteria (blue green algae) on Lake Tahoe located near Incline Village, combined with other biotoxins such as toxic mold, may have created susceptibility to a viral infection and caused the outbreak. It has been observed that the outbreak in Tahoe shared some but not all features with Sick Building Syndrome, and that the cluster of teachers who became sick at Truckee high school involved teachers who all used the same lounge, which may have had a chemical or biotoxin.

Learn more

• Nov 12, 1990, Chronic Fatigue Syndrome - Newsweek

• January 15, 1992, A Chronic Illness Characterised by Fatigue, Neurological and Immunological Disorders, and Active Human Herpesvirus Type 6 Infection

See also

• Daniel Peterson
• Paul Cheney
• List of outbreaks
• Osler's Web