Outbreak Investigation of a “Mystery Illness” Among Students in a Coastal School in North Kerala, India

Abstract

An outbreak of acute headache, weakness, breathing difficulty and gastrointestinal symptoms occurred among schoolchildren who went near the seashore of a coastal school in North Kerala, India. This article describes a field investigation conducted in response to this outbreak. The overall attack rate was 47% among schoolchildren on the seashore, with a higher rate of 76% among girls. The symptoms subsided uneventfully within 1 day. The investigation team suspected heat stress, mass hysteria or harmful algal blooms. Our team could not identify the cause of the outbreak even after extensive environmental investigations. We recommend training and capacity building for public health specialists in the district’s rapid response team on environmental epidemiological methods to promptly respond to future events.