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There have been dozens of documented outbreaks of ME and CFS since the 1930s. Many of these outbreaks occurred at institutions for example, hospitals, schools, army bases or convents. The true number of clusters and outbreaks is likely vastly higher.

History of the name

Before the polio vaccine, outbreaks were often observed in towns experiencing polio epidemics, hence one of ME's earliest names, atypical polio. It is not known whether there is a 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.

After the outbreak in Akureyri, Iceland in 1946, the disease came to be called "Akureyri Disease" or Icelandic disease through much of the 1940s and 1950s. It was named Myalgic Encephalomyelitis after London's Royal Free Hospital outbreak in 1955.

After the Incline village outbreak in Nevada in 1984, the disease came to be called and redefined as Chronic Fatigue Syndrome.

Outbreaks

Name	Date	Region	Location	Notes
Los Angeles atypical polio outbreak	1934	North America	Los Angeles, USA	Epidemic among personnel at L.A. County Hospital, Ruth Protection Home and throughout California, paralleling poliomyelitis, often diagnosed as atypical poliomyelitis, sometimes including arthropathy.
Fond-du-Lac outbreak	1936	North America	Fond-du-Lac, Wisconsin, USA	An outbreak of "encephalitis" in St. Agnes Convent.
Erstfeld outbreak	1937	Europe	Erstfeld, Switzerland	Outbreak described as "Abortive Poliomyelitis"
St. Gallen outbreak	1937	Europe	St. Gallen, Switzerland	Outbreak in Frohburg Hospital described as "Abortive Poliomyelitis"
Middlesex outbreak	1939	Europe	Middlesex, England	Outbreak at Harefield Sanatorium - "Persistent myalgia following sore throat"
Degersheim outbreak	1939	Europe	Degersheim, St. Gallen, Switzerland	Outbreak described as "Abortive Poliomyelitis"
Pennsylvania outbreak	1945	Europe	University Hospital of Pennsylvania, USA	Epidemic described as "pleurodynia with prominent neurological symptoms and no demonstrable cause."
Iceland outbreak	1946-47	Europe	Iceland	"Mixed epidemics of poliomyelitis and a disease resembling poliomyelitis with the character of the Akureyri Disease."
Akureyri outbreak	1948-49	Europe	North Coast Towns, Iceland	"A disease epidemic in Iceland simulating Poliomyelitis" in three separate towns during this time.
Adelaide outbreak	1949-1953	Oceania	Adelaide, Australia	Outbreak of a disease resembling poliomyelitis, during/after a poliomyelitis epidemic.
Louisville outbreak	1950	North America	Louisville, Kentucky, USA	Outbreak in the Nurse's Training School of St. Joseph Infirmary, later described as "epidemic neuromyasthenia."
Upper New York State outbreak	1950	North America	Upper New York State, USA	Outbreak described as resembling the "Iceland Disease...simulating Acute Anterior Poliomyelitis."
London outbreak	1952	Europe	London, England	Outbreak at Middlesex Hospital Nurses' Home described as "Encephalomyelitis associated with Poliomyelitis Virus."
Copenhagen outbreak	1952	Europe	Copenhagen, Denmark	Outbreak described as "epidemic myositis."
Florida outbreak	1952	North America	Lakeland, Florida, USA	Outbreak described as epidemic neuromyasthenia.
Coventry outbreak	1953	Europe	Coventry and Coventry District, England	"An illness resembling Poliomyelitis observed in nurses."
Maryland outbreak	1953	North America	Rockville, Maryland, USA	Chestnut Lodge Hospital student nurses described with poliomyelitis-like epidemic neuromyasthenia.
Jutland outbreak	1953	Europe	Jutland, Denmark	Outbreak of "Epidemic encephalitis with vertigo."
Florida outbreak	1954	North America	Tallahassee, Florida, USA	Bond JO. A new clinical entity? Lancet 1956; 2:256.<!!! fix this --->
Seward outbreak	1954	North America	Seward, Alaska	Outbreak described as "Benign Myalgic Encephalomyelitis (Iceland Disease)."
Berlin outbreak	1954	Europe	Berlin, Germany	Among the British Army, a "further outbreak of a disease resembling poliomyelitis."
Liverpool outbreak	1954	Europe	Liverpool, England	Outbreak among medical and nursing staff in a Liverpool Hospital.
Dalston outbreak	1954	Europe	Dalston, Cumbria, England	"...an unusual disease seen in epidemic and sporadic form in general practice in 1955 and subsequent years."
Royal Free Hospital outbreak	1955	Europe	London, England	Famous outbreak of benign myalgic encephalomyelitis among Royal Free Hospital staff.
Perth AUS outbreak	1955	Oceania	Perth, Australia	"Virus epidemic in recurrent waves."
Wales outbreak	1955	Europe	Gilfach Goch, Wales	Outbreak of Benign encephalomyelitis.
Durban outbreak	1955	Africa	Durban and Durban City, South Africa	Outbreak among nurses at Addington Hospital called "The Durban Mystery Disease" describing neuromuscular dysfunction, and epidemic myalgic encephalomyelopathy, including sporadic cases in Johannesburg of a outbreak resembling poliomyelitis.
Segbwema outbreak	1955-56	Africa	Segbwema, Sierra Leone	An outbreak of encephalomyelitis.
Iceland outbreak	1955-56	Europe	Patreksfordur and Thorshofn, Iceland	Unusual response to poliomyelitis vaccination.
London outbreak	1955-56	Europe	North West London, England	Outbreak of acute infective encephalomyelitis simulating poliomyelitis among a residential home for nurses.
Ridgefield outbreak	1956	North America	Ridgefield, Connecticut, USA	An epidemic of neuromyasthenia.
Punta Gorda outbreak	1956	North America	Punta Gorda, Florida, USA	An outbreak of epidemic neuromyasthenia.
Lancashire outbreak	1956	Europe	Newton-le-Willows, Lancashire, England	Outbreak described as "lymphocytic meningo-encephalitis with myalgia and rash," "An outbreak of a disease believed to have been cause by Echo 9 virus," with other varying descriptions.
Massachusetts outbreak	1956	North America	Pittsfield, Williamstown, Massachusetts, USA	Outbreak of "epidemic neuromyasthenia" later described as benign myalgic encephalomyelitis. (Included in this summary are sporadic cases in Hygiea, Sweden, with descriptions of encephalitis, meningitis or poliomyelitis; Coxsackie B and Echo Virus infections; benign myalgic encephalomyelitis.)
Coventry outbreak	1956-57	Europe	Coventry, England	Outbreak described as epidemic malaise and benign myalgic encephalomyelitis.
South Australia outbreak	1957	Oceania	Brighton, South Australia	Outbreak described as "Coxsackie, Echo Virus meningitis and myalgic encephalomyelitis", "Epidemic myalgic encephalomyelitis," and "Benign myalgic encephalomyelitis."
Athens outbreak	1958	Europe	Athens, Greece	An outbreak of benign myalgic encephalomyelitis in a nurse's school, "periostitis and arthropathy noted." (Included in this summary is an outbreak of benign myalgic encephalomyelitis in Switzerland.)
London SW outbreak	1958-59	Europe	South-West London, England	Reports of sporadic cases of myalgic encephalomyelitis.
Newcastle outbreak	1959	Europe	Newcastle upon Tyne, England	Outbreak of benign myalgic encephalomylitis.
London NW outbreak	1959	Europe	North-West London, England	Reports of sporadic cases of influenza-like illness.
England outbreak	1959	Europe	England	Article describing sporadic cases and "The psychiatric sequelae of Benign Myalgic Encephalomyelitis."
Basel outbreak	1961	Europe	Basel, Switzerland	Sporadic case of benign myalgic encephalomyelitis described.
New York State outbreak	1961-62	North America	New York State, USA	Outbreak described as epidemic neuromyasthenia in a convent in New York State.
London NW outbreak	1964-66	Europe	North-West London, England	Outbreak described as epidemic malaise and epidemic neuromyasthenia.
Franklin outbreak	1964-66	North America	Franklin, Kentucky, USA	Outbreak of "neuromyasthenia" in a Kentucky factory, possibly due to mercury exposure.
Galveston outbreak	1965-66	North America	Galveston County, Texas, USA	Outbreak described as "Epidemic Neuromyasthenia Variant?" and "Epidemic Diencephalomyelitis," the latter describing neuropsychiatric, cardiovascular and endocrine disorders.
Edinburgh outbreak	1967-70	Europe	Edinburgh, Scotland	Sporadic cases resembling benign myalgic encephalomyelitis.
Fraidek outbreak	1968	Europe	Fraidek, Lebanon	Report on an epidemic of benign myalgic encephalomyelitis.
New York outbreak	1969	North America	State University of New York, USA	Medical Centre - report of epidemic Neuromyasthenia and "unidentified symptom complex."
Lackland outbreak	1970	North America	Lackland Air Force Base, Texas, USA	Epidemic Neuromyasthenia reported. "A syndrome or disease?"
London outbreak	1970-71	Europe	London, England	An outbreak of "epidemic neuromyasthenia" among nurses a the Hospital for Sick Children, Great Oromond Street.
Sacramento outbreak	1975	North America	Sacramento, California, USA	"200 hospital staff in the [Mercy San Juan Hospital] fell ill in August September 1975. The epidemic appears to have spread to the children of the hospital staff and from there to the children's teachers. 43 have been seriously disabled with chronic illness from 1975-1992" [at publication of this text].
Ireland SW outbreak	1976	Europe	Southwest Ireland	Reports on Mylagic Encephalomyelits and epidemic neuromyasthenia in this region.
Dallas outbreak	1977	North America	Dallas-Fort Worth, Texas, USA	"Epidemic Neuromyasthenia" reported.
Southampton outbreak	1979	Europe	Southampton, England	Outbreak of M.E. in a girls' school.

Outbreaks by Decade

1978 - Symposium

[Ed. note: Dr. Hyde's text notes that the first major M.E./CFS Symposium was held at the Royal Society of Medicine in London in this year. M.E. aka epidemic neuromyasthenia, viral relationships to this disease, biochemical abnormalities in patients and other subjects were discussed by experts such as Shelokov, Ramsay, Richardson, Behan, Parish and others.]

1980s

1980-81 - West Kilbridge, Ayrshire, Scotland

M.E. epidemic reported in a rural medical practice.

1980-83 - Helensburgh, Scotland

Coxsackie B outbreak reported in a general practice.

1981-82 - Stirlingshire, Scotland

Sporadic cases of M.E. reported.

1981 - Gunnedah, NSW, Australia

The Gunnedah outbreak was linked with pesticides, which were conjectured to be interacting with viruses and other environmental chemicals in a post-viral syndrome. Those affected included one local GP, with that GP forming the view this was clearly a physical illness. The outbreak was featured in a film More than Just Poison made in 1986 by the Toxic and Hazardous Chemicals Committee.

1982-84 - Tapanui & West Otago, New Zealand

Outbreak first described and an "unexplained illness," later as M.E. Included here are outbreaks in Dunedin and Hamilton New Zealand.

1984 - North America (Endemic)

"From 1984 until 1992 [at publication of this text] an endemic period occurred in which an usually large number of cluster and epidemics of M.E./CFS have been recognized in North America. After an apparent initial increase in the morbidity in 1983 there seemed to have appeared in late summer of 1984 an unprecedented increase of sporadic and epidemic cases across North America. Although certain geographical hot spots seen to have taken up much of the medical interest, this endemic situation probably represents an unusual and unremitting morbidity in all areas of the United States and Canada." -Dr. Byron Hyde-

1984 - Incline village, Lake Tahoe, Nevada, USA

A chronic illness characterized by fatigue, neurologic and immunologic disorders and active human herpesvirus type 6 infection. This community epidemic, apparently started in a girls' basketball team, then involved primarily teacher in at least three high schools, and then large numbers of the community.

1984 - Chapel Hill, North Carolina, USA

"Epidemic amongst members of The North Carolina Symphony Orchestra. Low NKC [Natural Killer Cells] associated with high yield of lymphoma, astrocytoma, glioma."

1984 - Montreal, Quebec-Ontario, Canada

Over 500 cases of M.E./CFS documented during August-November 1984 period. This endemic was active in all parts of Canada during this period and appears [to] have maintained its activity until the time of writing in 1991.

1984-85 - Truckee, California, USA

M.E. epidemic involving teachers and students.

1985 - Lyndonville, New York, USA

M.E. epidemic in a rural community involving children and adults.

1985 Yerington, Nevada, USA

In the same area [not far from Truckee, California] an M.E./CFS-like epidemic reputedly occurred in a reservation of American Native people.

1986 - Placerville, California, USA

Outbreak of chronic fatigue syndrome 'coincident with a heavy contamination of the local unfiltered water supply'.

1988 - Sonora, California, USA

"More than 35 children and adults were diagnosed with M.E. in the mountain country 100 miles from Lake Tahoe. Many of these patients were associated in some way with Columbia Community College."

1989 - Roseville, California, USA

Rosedale Hospital reported 11 cases of M.E./CFS among staff.

1990s

1990 - Elk Grove, California, USA

M.E. epidemic among teachers and students.

temp

(to be moved to subpage for Adelaide 1949-1953 epidemic]

• 1951-06-30: "The author describes a disease which has been epidemic in Adelaide since August 1949, and which closely resembles poliomyelitis. Its most characteristic feature is the absence of abnormal findings in the cerebrospinal fluid. Thus, out of 1,350 consecutive cases of " poliomyelitis ", 800 had less than 10 cells per cubic millimetre in the cerebrospinal fluid (the majority had less than 5 cells); and the protein values were normal in all but 2 of these cases.
• The onset of this illness was either gradual or sudden and, if sudden, headache was a constant feature and often of marked intensity. Muscle weakness - generally slight and diffuse in distribution - occurred more commonly in the legs than in the arms. Where paralysis was severe, rapid recovery generally ensued. Two noteworthy features of the muscle involvement in this disease were as follows: the pain frequently persisted in various muscles for periods up to six months after the acute illness; in some cases the onset of muscle weakness was delayed for several months. The ultimate prognosis was always good, but frequent recurrences were not uncommon. The greatest disabling feature of the disease lay in the psychological sequelae which were fairly constant and comprised one or more of the following - lack of concentration, depression, irritability, emotional instability and hyperacuity of hearing. These manifestations, however, eventually resolved completely".

1952-02-01: "Dr. R.A. Pellew, of Adelaide, who will also address the conference, believes that most of SA's 3,130 polio cases during the past two years and nine months have suffered a mild form of the disease."

• 1955: The Adelaide outbreak of atypical polio was associated with a reduction in typical polio cases. "There was ... a marked regression of [typical] poliomyelitis in South Australia (413 notifications as compared with 721)." (from page 645 of 1955 WHO report )

Outbreaks by region

Australia and New Zealand

• 1949-54 - Adelaide, South Australia
• 1955 - Perth, Western Australia
• 1957 - Brighton, South Australia
• 1982-84 - West Otago, New Zealand
• 1988 - Narrabeen, NSW, Australia

Related Lists

• Myalgic Encephalomyelitis and Post Viral Fatigue States: the Saga of the Royal Free Disease by Dr Melvin Ramsay, 1955.
• Reference index of papers published on epidemics of ME 1934-80 (collected by Dr J. Gordon Parish), ME Research UK, 1980.
• The Clinical and Scientific Basis of Myalgic Encephalomyelitis and Chronic Fatigue Syndrome (edited by Dr. Byron Hyde), Nightingale Foundation, 1992.

References

<references>

See myalgic encephalomyelitis.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

World Health Organization (WHO) - "A specialized agency of the United Nations that is concerned with public health. It was established on 7 April 1948, and is headquartered in Geneva, Switzerland. The WHO is a member of the United Nations Development Group. Its predecessor, the Health Organization, was an agency of the League of Nations." The International Statistical Classification of Diseases and Related Health Problems (ICD) is maintained by WHO.

See World Health Organization.