Mass Psychogenic Illness in a School during a Human Papillomavirus Vaccination Campaign, Bangladesh, 2024

Abstract

Mass psychogenic illness (MPI) poses a public health threat due to rapid spread, diagnostic difficulty, and potential to undermine public trust. Effective prevention and response require recognition of social and psychological risk factors with clear communication, education, and preparedness. On 30 Oct 2024, two students at a school in Gobindaganj, Bangladesh developed symptoms such as shortness of breath, abdominal cramps, and body aches shortly after receiving the human papillomavirus (HPV) vaccine. Within hours, 17 more reported similar symptoms. This investigation describes the outbreak by person, place, and time, documents the response by health authorities and hospital staff, and outlines measures taken to maintain confidence in HPV vaccine safety. Health officials reviewed hospital records, interviewed students, teachers, vaccinators, and health officials, and evaluated vaccine storage and cold chain integrity. Among 80 vaccinated students, 19 developed symptoms, resulting in an attack rate of 24%. Five students were hospitalized, three had hypokalemia linked to hyperventilation. All fully recovered within 24 hours. No evidence was found of vaccine quality issues, cold chain failures, immunization errors, infectious causes, or environmental exposures. The symptom pattern, rapid spread, absence of an organic cause, and presence of psychological stressors led to classification of the event as MPI. Management focused on symptomatic care, reassurance about vaccine safety, and real-time public and media communication. Authorities also addressed vaccine misinformation through press briefings, community outreach, and engagement with religious leaders. This incident highlights the need to integrate MPI preparedness into immunization campaign planning to ensure rapid containment and sustained public trust.