Eosinophilia-myalgia syndrome: lessons for public health researchers

To review epidemiological investigations into the epidemic of eosinophilia-myalgia syndrome which occurred predominantly in the United States of America in mid to late 1989, and examine the implications for similar urgent public health research in Australia.

Published data from epidemiological research, and relevant regulatory statements.

Intensive epidemiological investigations established that eosinophilia-myalgia syndrome was strongly associated with ingestion of L-tryptophan produced by a single manufacturer. It is likely that an identified contaminant has a role in pathogenesis, although the mechanism of action remains unclear.

Rapid epidemiological investigation led to early containment measures and prevention of further public exposure to the causative agent. The episode highlighted the importance of preparedness amongst public health organisations to promptly initiate investigations of disease outbreaks, and demonstrated the benefits of a nation-wide ability to coordinate these studies. There may be encumbrances to urgent public health research in the form of inadequate mechanisms of data linkage. It is recommended that attention be given to such barriers now rather than in a time of crisis.