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13 : Can Surveillance for Unexplained Deaths Be Used as a Public Health Approach for Early Recognition of New Pathogens?

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Abstract:

Molecular diagnostic methods had recently made it possible to identify and characterize new infectious agents in the absence of in vitro cultivation. The next step was to develop a systematic public health approach to identify illnesses that may be due to new pathogens and subject them to these novel diagnostic techniques. Persons with exposures to toxic agents, ingestions of such agents, trauma, or recent hospitalization were also excluded. Hallmarks of an infectious disease included fever, leukocytosis, cerebrospinal fluid pleocytosis, and histopathologic evidence of an infection. The infectious disease death review team (IDDRT) uses antemortem symptoms (e.g., fever and cough) to identify cases with potential pathologic syndromes (e.g., community acquired pneumonia) that warrant an autopsy for infectious agent- or toxin-related etiologies. In turn, the pathologic syndrome helps to define a differential diagnosis, including potential bioterrorism agents (e.g., plague bacillus) and organisms of public health importance (e.g., influenza virus). In 1998, syndrome-specific surveillance for encephalitis was initiated in California. Unexplained death surveillance may serve as a sentinel surveillance system to identify new infectious agents, recognize unique presentations of known pathogens, or detect bioterrorism. The surveillance and diagnostic infrastructures assembled under the UNEX have been used both domestically and internationally for the investigation of unexplained illness and death. Although currently available serologic and molecular techniques may be used to explain a proportion of cases, this approach is limited by the quality and timing of available specimens as well as by the sensitivity and specificity of these tests.

Citation: Fischer M, Hajjeh R, Sofair A. 2004. Can Surveillance for Unexplained Deaths Be Used as a Public Health Approach for Early Recognition of New Pathogens?, p 177-190. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch13
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Figure 1

Incidence of cases by age group, 1995 to 1998, from UNEX. Adapted from reference 26.

Citation: Fischer M, Hajjeh R, Sofair A. 2004. Can Surveillance for Unexplained Deaths Be Used as a Public Health Approach for Early Recognition of New Pathogens?, p 177-190. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch13
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Tables

Generic image for table
Table 1

Distribution of unexplained deaths and critical illness cases by syndrome, with proportion explained

Citation: Fischer M, Hajjeh R, Sofair A. 2004. Can Surveillance for Unexplained Deaths Be Used as a Public Health Approach for Early Recognition of New Pathogens?, p 177-190. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch13
Generic image for table
Table 2

Infectious disease causes for explained cases, UNEX, 1995–1998, California, Oregon, Connecticut, and Minnesota (= 34)

Citation: Fischer M, Hajjeh R, Sofair A. 2004. Can Surveillance for Unexplained Deaths Be Used as a Public Health Approach for Early Recognition of New Pathogens?, p 177-190. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch13
Generic image for table
Table 3

Selected examples of emerging infectious diseases that can cause severe illness and for which pathologic evaluation has made significant contributions

Citation: Fischer M, Hajjeh R, Sofair A. 2004. Can Surveillance for Unexplained Deaths Be Used as a Public Health Approach for Early Recognition of New Pathogens?, p 177-190. In Scheld W, Murray B, Hughes J (ed), Emerging Infections 6. ASM Press, Washington, DC. doi: 10.1128/9781555816995.ch13

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