01x11 - Outbreak

[bunniefuu]

in 1985 121 people in South Dakota and

Minnesota were struck with a mysterious

illness there had been only one outbreak

like it and the last time it happened

medical detectives couldn't figure out

the cause

Valley Springs South Dakota a tiny

farming community of about 800 people

not far from the Minnesota border it's a

community of farms and suburban

professionals many of whom work in the

nearby city of Sioux Falls

people here are accustomed to hard work

and the hard weather and art the type to

complain so when some residents began

suffering from irregular heart rhythms

fevers weight loss diarrhea edginess and

mysterious aches and pains they wondered

if it was more than a coincidence I was

this fidgety and nervous and not all the

time I guess that's a three off it been

that steady you couldn't put up with him

heart would be then you only feel your

pulse is just pounding you could feel

your heart pounding and you hate your

legs and arms hurt real bad

I started getting chills then I'd get

hot flashes then I couldn't eat and I'd

be nauseated everything was just

happening really really fast at first

doctors were confused about the symptoms

Jain netis dad's doctor thought she was

having a nervous breakdown and put her

in the hospital I'd never you know had

any of this problem before with a mental

problem so he put me on a mood elevator

and about eight hours later my heart was

a hundred and sixty beats per minute and

I just knew I was going to have a heart

att*ck it felt like it was just flying

out of my chest

ten miles down the road in Luverne

Minnesota the stories were the same Toni

dis Pinet suffered heart symptoms too

and immediately went to the emergency

room certain he was having a heart

att*ck well about 3 o'clock in the

morning proximately 3 I woke up with a

tightness in my chest like something it

did it felt like somebody was sitting on

it tests revealed it wasn't a heart

att*ck but he spent three days in the

hospital as doctors tried to find out

the cause

some of the local physicians thought it

was the flu or a virus but after weeks

of suffering the residents started to

compare notes there were folks that were

sick and had been sick for a long time

and a couple were I had got close to

death and they couldn't figure out what

was wrong with them and they didn't know

if it was contagious if it was something

in the water and they were all feeling

these same symptoms and then they were

hearing of other people that were

feeling these same symptoms when Richard

Jacobson went to his doctor he was told

that his thyroid was malfunctioning and

was sent to the area's leading tyroid

specialist when Jacobson called the

specialist he had just one question doc

can you tell me why there's five people

in my small town with the same condition

dr. Michael Macmillan has been a thyroid

specialist in South Dakota for the past

30 years at first he thought Jacobson

was exaggerating but just to make sure

he decided to do a little of his own

investigating he went to the local

hospital and looked through the x-rays

and medical records of some recent

patients he discovered something

alarming there had been an increase in

the number of patients with thyroid type

complaints but there was a problem

because in every x-ray the thyroids were

perfectly normal the thyroid is a small

butterfly-shaped gland at the base of

the neck which produces hormones that

control both metabolism and growth

an overactive thyroid floods the body

with hormones disrupting the entire

nervous system causing symptoms such as

heart fluctuations weight loss diarrhea

nervousness muscle aches and pains dr.

McMillan searched the medical journals

for clues trying to find out what could

be causing an outbreak of thyroid

problems in the area and I came across a

title that said first ever epidemic of

silent thyroiditis York Nebraska well

York Nebraska is about 120 miles south

of here

the outbreak in York Nebraska happened

just one year earlier residents

complained of the same symptoms heart

problems

fevers fatigue loss of appetite and

weight loss so many people were ill it

threatened the economy of the small

farming community doctors from the

Centers for Disease Control in Atlanta

were called in to investigate but just

as they arrived the outbreak of silent

thyroiditis ended as mysteriously as it

had begun the residents recovered and

the cause of the York outbreak was never

discovered dr. McMillan immediately

called the CDC to let them know it was

happening again I'm trying to get ahold

of dr. Dan Fishbein I was knew that it

was going to happen again because I knew

the one thing we all admitted is even

the people who thought it was a virus we

didn't know what virus we didn't know

what it was caused by so I knew that was

going to happen again and so I was not

quite expecting but certainly was not

surprised as the CDC prepared to

investigate this outbreak the number of

cases was rising even if it just spread

the Sioux Falls with all the people here

let alone Minneapolis or Detroit or

something we would have a major medical

catastrophe on our hands

investigators needed to find the cause

of the outbreak before thousands were

affected in June of 1985 there were 50

cases of the mysterious thyroid outbreak

concentrated in two nearby towns

Luverne Minnesota and Valley Springs

South Dakota the Centers for Disease

Control in Atlanta was called in to

investigate certainly one of the most

puzzling things about the outbreak is we

didn't know what it was due to and this

made it incredibly difficult was it in

the air was it in the water was it in

the food there was just no way to know

investigators needed to know as much

about the outbreak as possible it was

striking both men and women equally all

age groups were affected there appeared

to be no occupational Association and no

worksite or school clusters entire

families were affected

was it possible that the outbreak was

being spread person-to-person everyone

suspected of having the disease was

given a blood test and interviewed about

where or how they might have contracted

it you talk to patients and you hope

that by doing unstructured interviews

you'll get some ideas one of the

questions that I thought was kind of

cute that the epidemiologist asked

everybody was what do you think causes

this and the most frequent response

there had been a lot of tornadoes in

this area of the year before the more

frequent response was I guess those

tornadoes stirred up some chemicals and

that got got into our water supply but

in order to determine what was causing

the outbreak investigators first had to

figure out what the problem was blood

tests revealed that all of the victims

had an excess of thyroid hormone in

their system in some cases the levels

were eight and ten times above normal

tests of the drinking water did not

reveal anything which could have caused

the outbreak

dr. Lewis Braverman is the country's

leading expert in thyroid diseases he

was asked to examine some of the sick

patients in South Dakota we then went

out to a small community called Beaver

Creek if I recall and went into one

household where there were four

generations in the house who had all of

the signs and symptoms of thyrotoxicosis

and none of them from a four-year-old

child to an 85 or 90 year old

great-grandfather had an enlarged

thyroid since the thyroid glands of

these victims weren't enlarged they had

no idea what was causing these symptoms

in the past and large thyroid glands

were so common in this part of the

country it was known as the goiter belt

a goiter is the term for an enlarged

thyroid this part of the country is

called a goiter belt because there was

iodine deficiency

here there's no iodine in the soil

there's nobody eating seafood and so

people used to get large iodine

deficient goiters the condition was so

common that in 1922 the Mayo brothers

opened the Mayo Clinic in nearby

Rochester Minnesota offering safe

affordable surgery to alleviate the huge

number of thyroid problems in the region

over the years as diets improved the

thyroid problems went away but this

outbreak was different all of the

patients had normal thyroid and for some

patients the condition was serious one

of the cases was a patient I had seen in

the intensive care unit here in the

hospital and it was an older lady who

whose heart had suddenly started b*ating

irregularly and she'd gone into heart

failure to find out if this was indeed a

virus health officials decided to take

throat and fecal specimens for analysis

but all of the tests were negative then

dr. McMillan noticed something

interesting the geographic location of

many of the victims here was a community

of Valley Springs and then three miles

across the highway was a community of

Garretson which was almost the same size

there were nine people in Valley Springs

with the disease and nobody in Garretson

with the disease how could those two

communities what was what was the

difference in fact the epicenter of the

outbreak was Luverne Minnesota and there

were no cases west of Valley Springs but

that changed when a resident of Sioux

Falls called dr. McMillan to say that

she was suffering from the thyroid

disease

her name Rhonda pesky her parents owned

a grocery store in Valley Springs where

she occasionally purchased her groceries

dr. McMillin drove out to visit her

parents Larry and Margaret long and to

take a look around their store the

Long's did not have thyrotoxicosis but

their daughter did dr. McMillan wanted

to know why

when dr. McMillan learned that the

daughter of a grocery store owner

developed thyroid toxicosis yet her

parents did not he decided to

investigate the grocery store owned by

Larry and Margaret long had a specialty

item extra lean ground beef dr. McMillan

asked the Long's how often they ate the

ground beef themselves they laughed and

said never it was such a popular item

they were always sold out it was a great

meat

it was his run about 90% lean but the

long said their daughter might have

taken some with her on her last visit on

a hunch McMillan took a sample for

analysis by now there were more than 100

cases of the mysterious thyroid outbreak

and for some the symptoms were troubling

when I had that thyroid scan couple gals

of work in the hospital they thought I

had cancers what they told me they told

me this personally then we thought you

were dying of cancer because I looked so

bad when I went in for this thyroid scan

then of course the world's greatest

enter chronologist were called in and

and we had I remember the meeting with

them and we laid out all the data told

everything and they sat there and

shrugged their shoulders and said we

don't know what this is the only thing

they knew was that patients had eight or

ten times the normal amount of thyroid

hormone in their bloodstream causing

heart problems fatigue muscle aches and

pain investigators finally got a break

when they heard of an entire family

tyro toxicosis it was a large extended

family all of whom had confirmed cases

of the thyroid condition all except one

there must have been eight or 10 people

we've let everybody in the family did

their blood testing everybody had

elevated thyroid function tests except

one person and that was a teenager but

how was the teenager different from the

other family members who got sick the

father told investigators he worked at

the local meatpacking plant and

regularly brought ground beef home for

his family

it was the same plant which supplied the

Long's grocery store with their

specialty hamburger the extra lean

ground beef samples of the hamburger

were collected for analysis and taken to

a local pathologist using a cryostat a

portion of the hamburger was frozen in a

matter of seconds we convert the tissue

really into a block of ice

that makes a tissue firm enough that we

could cut thin sections stained and look

at them on the microscope and make a

diagnosis

under a microscope the pathologist

noticed something unusual something not

normally seen in ground beef bits of

animal thyroid mixed into the ground

meat animal thyroid contains extremely

high levels of thyroid hormones was it

possible that this was causing the

outbreak of thyrotoxicosis in the two

small communities to find out

doctors conducted an experiment one can

say well just because you find it in the

hamburger how do you know that when the

people eat the hamburger that they're

really absorbing the thyroid hormones so

our next step was to feed the ground

beef from Minnesota to rats one group of

rats were fed the raw hamburger

collected in Minnesota and for

comparison another group was fed raw

burger purchased near the laboratory in

Worcester Massachusetts the rats which

ate the Minnesota burger exhibited all

the signs of thyroid problems these rats

were wild rats I mean they were very

jittery nervous and this is compared to

the rather tranquil normal behavior of

the rats fed the Worcester hamburger so

that there's no question that these rats

were one could use the expression

clinically thyrotoxic but residents of

Valley Springs and Luverne weren't

eating raw hamburger and cooking the

meat usually kills all bacteria and

microorganisms most of us eat cooked

hamburger and as a matter of fact people

in the Midwest tend to cook their

hamburgers much more so than we do in

the Northeast investigators next step to

do some tests on humans they also wanted

to know how an entire family developed

thyrotoxic

while they're young son did not when

investigators from the CDC found a large

extended family who all suffered from

thyroid problems except their young son

they wanted to know why interviews with

the family revealed that the boy didn't

eat meat except for an occasional

pepperoni pizza I hate me I like this

and he's my son this was an important

discovery the next step

to confirm that the tainted hamburger

created elevated thyroid hormone levels

in humans as it did with the rats even

after it was cooked so that we did

obtain for young physicians to

participate in the study and what we did

was essentially bring them in in the

morning fasting drew their blood and fed

them an extremely well-cooked half pound

hamburger which they enjoyed immensely

since the was smothered in onions and on

toast so it was a very tasty breakfast

the meat used in the experiment was the

same that was sold in the local stores

it came from this local slaughtering

house in Luverne Minnesota but how was

the local meat being contaminated

public health officials inspected the

local meatpacking plant and learned

something interesting the plant had been

a kosher k*lling plant up until a few

years earlier when animals are k*lled

kosher they're actually bled to death

and the thyroid gland it has a real

intense blood supply and it's really red

except that if you bled the animal to

death then it would look white and it

would look completely different and when

the thyroid gland changed color

it was easier for the butcher to see and

remove the animal thyroid was then sold

to drug companies all the Meatpacking

companies would carefully dissect the

thyroids out and sell them to the drug

company so they could make thyroid

extract to treat other people but two

things happened first this meat plant

discontinued its kosher k*lling

production and with the development of

synthetic hormones drug companies no

longer purchased the animal thyroids

from slaughterhouses the result since

the animal thyroid wasn't sold to the

drug companies it was included along

with the rest of the neck trim from the

animal's gullet and inadvertently passed

along for human consumption

the gullet basically is this part of the

cow's neck and the muscles that are

trimmed that are low fat are these

muscles here the sternocleidomastoid

muscles on humans the thyroid gland sits

right under those muscles and if someone

is not paying attention as they're

trimming it's very easy to clip off a

bit of thyroid gland as they take off

the muscle when the animal's thyroid

gland was mixed in with other ground

meat for hamburger it caused the highly

elevated levels of thyroid hormones in

those who ate it the meat plant was

producing the equivalent of 3600

hamburger patties each day but as soon

as the problem was discovered they

immediately recalled the beef and

instituted safeguards to prevent the

problem from recurring well it was

almost like the eureka type thing we

were we were really quite thrilled we

thought that we had at that point in

time discovered the cause of this

epidemic and was something relatively

simple a simple solution to a

complicated problem after seven months

of investigation the cause of the

outbreak was finally discovered and

investigators believe

that the tainted meat also was the cause

of the outbreak in York Nebraska the

year before

shortly after this outbreak the US

Department of Agriculture instituted

strict guidelines for the trimming of

meat from neck muscles and declared the

thyroid gland was to be considered unfit

for human consumption but the residents

of Valley Springs and Luverne don't care

much about their place in medical

history and they aren't the type to hold

a grudge



and all recovered fortunately there were

no fatalities it's become one of CDC's

major teaching cases because it

illustrates all sorts of things that are

really not usually encountered but are

very important lessons for young

epidemiologists the outbreak was halted

promptly thanks to skill intuition and a

little bit of luck all our important

ingredients in a successful medical

investigation

you