Myalgic Encephalomyelitis (M.E.)/Chronic Fatigue Syndrome (C.F.S) in Europe.
C.F.I.D.S/ME in North America.
Chronic Fatigue Syndrome in the Rest of the World.
Although the two incidents at in Los Angeles and the Royal Free Hospital are the most well known and publicised, there have also been over 70 smaller outbreaks around the world (Shepherd, 1999).
U.K.
In the UK a number of outbreaks, albeit of a smaller nature, occurred around the country such as at Middlesex Hospital in 1952, Newcastle in 1959, and at London's Great Ormond Street Hospital in 1970-1 (where almost 150 cases occurred).
The UK has also been the source of much good work, much of which has stemmed from work undertaken by Professor Behan in the last two decades as well as Dr. Ramsay (who was the first doctor to acknowledge ME/CFS in the country). As a result of this, the UK along with the USA is at the forefront of research into the condition. For a good account of research being undertaken consult Wessely et al. "Chronic Fatigue and its Syndromes" (1999) as well as Dr. Shepherd's (1999) aforementioned book.
ICELAND
Iceland experienced an outbreak in 1948-9 of ME/CFS in a small town in the north of the island called Akureyri. The incident affected in excess of 1000 people. What proved to be particularly interesting about the condition was that in a subsequent polio epidemic on the island in 1955, the same town was apparently unaffected. As a result, it has been argued that the virus that 'triggered' the ME/CFS outbreak resulted in a level of immunity to polio (Macintyre, 1998). The origins of the outbreak led it to be called 'Icelandic or Akureyri Disease' (Wessely et al., 1999). Information suggests that the condition is generally well-accepted and supported in the country (Shepherd, 1999).
NETHERLANDS
The Netherlands appears to have done much in advancing the cause of ME/CFS, with apparently 70% of the medical profession acknowledging ME/CFS as a valid condition, and a substantial amount of research work being carried out (Shepherd, 1999).
ITALY
In Italy, there is also much good research work being done into the condition.
NORWAY & SWEDEN
There appears to be a growing acceptance of the condition in Norway, although many still find it hard to obtain a diagnosis and get good information on how to manage the condition. In Sweden there is a small amount of research taking place.
DENMARK
Despite much hostility, there appears to be evidence that the condition is slowly being acknowledged. However, despite these improvements, the quality of support and research provision still lags behind the UK and USA (Shepherd, 1999).
REMAINDER OF EUROPE
Unfortunately, aside from some minor research being carried out in Belgium, there appears to little research being done in the rest of Europe. Some countries such as France, Spain and Portugal seem to be particularly lacking in terms of medical and self-help support groups (Shepherd, 1999).
U.S.A
In the USA, despite the occurrence of additional smaller outbreaks, it was not until a further incident unfolded at Lake Tahoe in Nevada during 1985 that the US public and media really took notice. Events took place towards the end of 1984 when a number of previously healthy adults came down with an unusual 'flu-like' illness followed by symptoms linked with ME/CFS such as muscular fatigue and cognitive problems. Blood tests taken from those affected failed to reveal anything unusual, and this led a number of doctors to become sceptical as to whether the patients were actually physically ill.
Around the same time and stimulated further by the Lake Tahoe event, researchers began to look into the possible relationship between the virus linked with glandular fever, the Epstein-Barr virus (EBV). Medical researchers such as Drs. Cheney and Peterson began to speculate as to whether the symptoms of sore throats, raised glands and headaches that those at the Lake experienced could be caused by glandular fever (infectious mononucleosis). Papers around the same time, from Israeli and American researchers, appeared in high-profile medical journals such as the 'Lancet' (Tobi et al., 1982) and 'Annals of Internal Medicine' (Jones et al., 1985; Straus et al., 1985) pursuing this line of enquiry. Many researchers wondered whether, as the Epstein-Barr virus belongs to the herpes family of viruses which can stay dormant in the body, the symptoms could be due to a reactivation of the virus (Wessely et al., 1999).
However, the findings showed that although around three-quarters of the patients had raised antibodies to EBV, the remainder had normal or even no EBV antibodies. Their theory also became problematic due to the fact that EBV antibody tests are particularly difficult to interpret and that the spectrum of test results from the patients were similar to what would be anticipated from normal healthy adults from a common background. Furthermore, most people by the age of 30 have been exposed to the virus, with only a few going on to develop glandular fever (Wessely et al. 1999; Shepherd, 1999).
'Chronic Epstein-Barr Disease'
Despite these questions, the US media quickly picked up on it, with publications such as Newsweek calling it 'the malaise of the 80's', while others referred to it as 'yuppie flu' as a great number of those taken ill were young, active professionals. Although there was still uncertainty over the implication of the glandular fever virus, the term 'Chronic Epstein-Barr Disease' or 'Chronic Mononucleosis' caught the public's imagination, and became the commonly used term for the condition. Subsequently, further attention became focused on a recently discovered virus in the same family, Human Herpes Virus Type 6 (HHV-6) (Wessely et al. 1999; Shepherd, 1999).
CANADA
In Canada, there does not appear to have been any major clusters of the illness and as a consequence the condition has received less attention and awareness. Nevertheless, efforts from the support group, ME Canada, has helped increase recognition of the illness in the country.
AUSTRALIA
One of the earliest incidences of ME/CFS in Australia occurred in Adelaide in 1949, when 700 people were admitted to hospital with a ME/CFS like illness. Australia has also been a great source of research into the condition, especially into aspects of immunology, infection and management. This led, for instance, to the creation of a Working Group by the Royal Australian College of Physicians in 1998, which gave instructions on how to best diagnose and manage people with ME/CFS (Shepherd, 1999).
NEW ZEALAND
In New Zealand, an outbreak of ME/CFS in the South Island region of Otago in 1984, led to the illness being dubbed 'Tapanui Flu'. Those affected by the condition initially developed a 'flu-like malaise' and suffered from debilitating fatigue for several weeks afterwards. A subsequent 10-year study on 21 of those affected, in the journal, Archives of Internal Medicine, showed that 16 of the 21 had been able to achieve an almost full-degree of functioning by the end of the ten year period (Levine, 1997).
Past research in New Zealand has tended to focus on retroviruses, immunological aspects, and on haematology (looking into potential abnormalities in red blood cells). There also seems to be an increasing acceptance of ME/CFS in the country and support group provision is good (Shepherd, 1999).
SOUTH AFRICA
Curiously, in South Africa, a similar incident to the Royal Free Hospital outbreak in the UK, occurred in Durban many thousands of miles away a few months earlier. In common with most outbreaks, there were possible connections with polio.
Unfortunately, the condition is still only very gradually starting to be accepted by doctors and there appears to be a lack of good quality information on the subject (Shepherd, 1999).
JAPAN
Research in Japan has tended to focus on immunological abnormalities linked with the condition; on muscle abnormalities, especially carnitine deficiency; and the influence of certain potential viruses. So far Japanese research into the possibility of carnitine deficiency and its impact upon muscle fatigue (Kuratsune, 1994) has been supported by subsequent work in the UK (Majeed, 1995).
