The case-control study report “Belgian Coca-Cola-related outbreak: intoxication, Mass Sociogenic illness or both?” was presented by Gallay et al and was published in the American Journal of Epidemiology in 2001…
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This epidemic of health complaints was first reported in school A on June 8 and two to six days later similar complaints were reported by four other schools (School B-E). Belgian Poisoning Cell received calls regarding the complaints against the Coca-Cola Company products and the questionable quality of their soft-drinks. The Coca-Cola Company explained these events to be caused by the low concentrations of hydrogen sulfide in their soft drink bottles and the presence of a chemical, 4-chloro-3-methylphenol, on the surface of cans consumed by the students of the schools. These sequences of events lead to the initiation of investigations held by the Unit of Epidemiology of the Scientific Institute of Public Health on June 23. The school A and schools B-E were taken as separate groups because of the difference in time of occurrence of symptoms and different suppliers of the Coca-Cola soft drinks. Questionnaires were handed out to the physicians of the respective schools and data was obtained from the school and hospital medical records as well. The urine and blood test records were also collected. The structured questionnaires consisted of inquiries about age, gender, soft drink consumption, signs and symptoms, illness among friends and any suspicious observation about the soft drinks. The results showed that the attack rate in school A was 13.2 percent and the attack rate in schools B-E was 3.5 percent. A dominant number of girls were included in the attack in both the school groups. Medical records of 32 cases from the total 37 cases were observed for school A and the predominant symptoms observed were headache, nausea, dizziness, respiratory troubles and abdominal pain. The 62 medical records from the total of 75 cases of schools B-E presented with clinical features of headaches, abdominal pain, nausea and dizziness. Furthermore, the age group in which the attack rate was highest consisted of adolescents and pre-adolescents. The case-control study of the six schools brought forward that the short time duration between the consumption of the soft drinks and the appearance of symptoms in the students suggested that the Coca-Cola drinks had a toxic effect leading to the occurrence of illness in the recorded cases. The study did not result with any other soft drink consumption that caused the illness and Coca-Cola beverages were the only items that were reported to have rotten smell. This was detected as a sulfur containing compound that contaminated the beverages and was tested thorough gas chromatography. The symptoms were also considered as strong evidence pointing towards contamination with hydrogen sulfide and carbonyl sulfide. School A epidemiological study proved Coca-Cola as a stronger determinant for illness as compared to the schools B-E. The investigative report also highlighted the mental health status of the students after the incident of outbreaks. Many students reported that they have been feeling bad since the incident; however certain factors like anxiety and stress related to the circumstances might also alter the mental status and feelings of the students. This might affect the accurate recording of the mental health score. The epidemiological report has explained systematically the gender, age, time duration of occurrence of symptoms, the type of beverage consumed and the suspected compounds leading to the appearance of compatible clinical features. These factors are helpful in
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