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American Journal of Epidemiology Vol. 155, No. 2 : 140-147
Copyright © 2002 by The Johns Hopkins University School of Hygiene and Public Health

ORIGINAL CONTRIBUTIONS

Belgian Coca-Cola-related Outbreak: Intoxication, Mass Sociogenic Illness, or Both?

A. Gallay1,2, F. Van Loock1, S. Demarest1, J. Van der Heyden1, B. Jans1 and H. Van Oyen1

1 Unit of Epidemiology, Scientific Institute of Public Health, Brussels, Belgium.
2 European Programme for Intervention Epidemiology Training (EPIET), Brussels, Belgium.

An epidemic of health complaints occurred in five Belgian schools in June 1999. A qualitative investigation described the scenario. The role of soft drinks was assessed by using a case-control study. Cases were students complaining of headache, dizziness, nausea, vomiting, abdominal pain, diarrhea, or trembling. Controls were students present at school on the day of the outbreak but not taken ill. An analysis was performed separately for school A, where the outbreak started, and was pooled for schools B–E. In school A, the attack rate (13.2%) was higher than in schools B–E (3.6%, relative risk = 3.6, 95% confidence interval (CI): 2.5, 5.3). Exclusive consumption of regular Coca-Cola (school A: odds ratio (OR) = 29.7, 95% CI: 1.32, 663.6; schools B–E: OR = 7.3, 95% CI: 2.9, 18.0) and low mental health score (school A: OR = 16.1, 95% CI: 1.3, 201.9; schools B–E: OR = 3.1, 95% CI: 1.5, 6.6) were independently associated with the illness. In schools B–E, consumption of Fanta, consumption of Coca-Cola light, and female gender were also associated with the illness. It seems reasonable to attribute the first cases of illness in school A to regular Coca-Cola consumption. However, mass sociogenic illness could explain the majority of the other cases.

carbonated beverages; disease outbreaks; hydrogen sulfide; poisoning

Abbreviations: CI, confidence interval; OR, odds ratio; RR, relative risk


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