Epidemic neuromyasthenia & Chronic Fatigue Syndrome (CFS): epidemiological importance of a cluster definition

Outbreaks of illness variously identified by a number of

terms, including epidemic neuromyasthenia, myalgic

encephalomyelitis, Iceland disease, and atypical

poliomyelitis, have been reported from many countries during

the past 45 years. Since the first well-described outbreak

occurring in 1934, > 60 outbreaks have been reported, but few

of these have been described in considerable detail. These

outbreaks are usually cited in historical reports of chronic

fatigue syndrome (CFS) since each of these outbreaks appears

to contain a number of cases meeting the current case

definition of CFS. There has been inadequate attention given

to the fact that epidemic neuromyasthenia and related clusters

characterized by various complaints, including fatigue, do not

have an accepted epidemiological or clinical definition, and

only rarely have descriptions of these clusters included a

specific case definition. When such case definitions have been

applied, the occurrence of cases meeting the current case

definition for CFS appears to be both variable and infrequent.

This report utilizes examples of several well-documented

outbreaks to emphasize specific aspects that should be

considered in the investigation of future clusters.

Levine PH

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