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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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Can Surveillance for Unexplained Deaths Be Used as a Public Health Approach for Early Recognition of New Pathogens?, Page 1 of 2

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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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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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References

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1. Anderson, B.,, K. Sims,, R. Regnery,, L. Robinson,, M. J. Schmidt,, S. Goral,, C. Hager,, and K. Edward. 1994. Detection of Rochalimaea henselae DNA in specimens from cat scratch disease patients by PCR. J. Clin. Microbiol. 32:942948.
2. Bakken, J. S.,, J. S. Dumler,, S.-M. Chen,, M. R. Eckman,, L. L. Van Etta,, and D. H. Walker. 1994. Human granulocytic ehrlichiosis in the upper midwest United States. JAMA 272:212218.
3. Barre-Sinoussi, F.,, J. C. Chermann,, and F. Rey. 1983. Isolation of a T-lymphotrophic retrovirus from a patient at risk for acquired immunodeficiency syndrome (AIDS). Science 220:868871.
4. Briese, T.,, X. Y. Jia,, C. Huang,, L. J. Grady,, and W. I. Lipkin. 1999. Identification of a Kunjin/West Nile-like flavivirus in brains of patients with New York encephalitis. Lancet 354:12611262.
5. Brynes, R. K.,, W. C. Chan,, T. J. Spira,, E. P. Ewing,, and F. W. Chandler. 1983 Value of lymph node biopsy in unexplained lymphadenopathy in homosexual men. JAMA 250:13131317.
6. Centers for Disease Control. 1981. Pneumocystis pneumonia— Los Angeles. Morb. Mortal. Wkly. Rep. 30:250252.
7. Centers for Disease Control and Prevention. 1994. Addressing emerging infectious disease threats: a prevention strategy for the United States. Public Health Service, U.S. Department of Health and Human Services, Atlanta, Ga.
8. Centers for Disease Control and Prevention. 1996. Outbreak of acute febrile illness and pulmonary hemorrhage—Nicaragua, 1995. Morb. Mortal. Wkly. Rep. 44:841843.
9. Centers for Disease Control and Prevention. 1998. Outbreak of acute febrile illness among athletes participating in triathlons—Wisconsin and Illinois, 1998. Morb. Mortal. Wkly. Rep. 47:585588.
10. Centers for Disease Control and Prevention. 1999. Outbreak of West Nile-like viral encephalitis— New York. Morb. Mortal. Wkly. Rep. 48:845849.
11. Centers for Disease Control and Prevention. 1999. Outbreak of hendra-like virus— Malaysia and Singapore, 19981999. Morb. Mortal. Wkly. Rep. 48:265269.
12. Centers for Disease Control and Prevention. 1999. Update: outbreak of Nipah virus— Malaysia and Singapore, 1999. Morb. Mortal. Wkly. Rep. 48:335337.
13. Centers for Disease Control and Prevention. 2000. Unexplained illness and death among injecting-drug users— Glasgow, Scotland; Dublin, Ireland; and England, April– June 2000. Morb. Mortal. Wkly. Rep. 49: 489492.
14. Centers for Disease Control and Prevention. 2001. Public health dispatch: update: unexplained deaths following knee surgery— Minnesota, 2001. Morb. Mortal. Wkly. Rep. 50:1080.
15. Chadburn, A.,, C. Metrka,, and J. Mouradian. 1989. Progressive lymph node histology and its prognostic value in patients with acquired immunodeficiency syndrome and AIDS-related complex. Hum. Pathol. 20:579587.
16. Chang, Y.,, E. Cesarman,, M. S. Pessin,, F. Lee,, J. Culpepper,, D. M. Knowles,, and P. S. Moore. 1994. Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi's sarcoma. Science 266:18651869.
17. Choo, Q. L.,, G. Kuo,, A. J. Weiner,, L. R. Overby,, D. W. Bradley,, and M. Houghton. 1989. Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome. Science 244:359362.
18. Chua, K. B.,, W. J. Bellini,, P. A. Rota,, B. H. Harcourt,, A. Tamin,, S. K. Lam,, T. G. Ksiazek,, P. E. Rollin,, S. R. Zaki,, W.-J. Shieh,, C. S. Goldsmith,, D. J. Gubler,, J. T. Roehrig,, B. Eaton,, A. R. Gould,, J. Olson,, H. Field,, P. Daniels,, A. E. Ling,, C. J. Peters,, L. J. Anderson,, and B. W. J. Mahy. 2000. Nipah virus: a recently emergent deadly paramyxovirus. Science 288:14321435.
19. Duchin, J. S.,, F. T. Koster,, C. J. Peters,, G. L. Simpson,, B. Tempest,, S. R. Zaki,, T. G. Ksiazek,, P. E. Rollin,, S. Nichol,, E. T. Umland, and The Hantavirus Study Group. 1994. Hantavirus pulmonary syndrome: a clinical description of 17 patients with a newly recognized disease. N. Engl. J. Med. 330: 949955.
20. Dumler, J. S.,, P. Brouqui,, J. Aronson,, J. T. Taylor,, and D. H. Walker. 1991. Identification of ehrlichia in human tissue. N. Engl. J. Med. 325:11091110.
21. Dumler, J. S.,, J. E. Dawson,, and D. H. Walker. 1993. Human ehrlichiosis: hematopathology and immunohistologic detection of Ehrlichia chaffeensis. Hum. Pathol. 24:391396.
22. Garry, R. F.,, W. H. Witte,, and A. Gottlieb. 1988. Documentation of an AIDS virus infection in the United States in 1968. JAMA 260:20852087.
23. Georges-Courbot, M. C.,, A. Sanchez,, C. Y. Lu,, S. Baize,, E. Leroy,, J. Lansout-Soukate,, C. Tevi-Benissan,, A. J. Georges,, S. G. Trappier,, S. R. Zaki,, R. Swanepoel,, P. A. Leman,, P. E. Rollin,, C. J. Peters,, S. T. Nichol,, and T. G. Ksiazek. 1997. Isolation and phylogenetic characterization of Ebola viruses causing different outbreaks in Gabon. Emerg. Infect. Dis. 3:5962.
23a. Glaser, C. A.,, S. Gilliam,, D. Schnurr,, B. Forghani,, S. Honarmand,, N. Khetsuriani,, M. Fischer,, C. K. Cossen,, and L. J. Anderson. 2003. In search of encephalitis etiologies: diagnostic challenges in the California Encephalitis Project, 19982000. Clin. Infect. Dis. 36:731742.
24. Goldsmith, C. S.,, L. H. Elliott,, C. J. Peters,, and S. R. Zaki. 1995. Ultrastructural characteristics of Sin Nombre virus, causative agent of hantavirus pulmonary syndrome. Arch. Virol. 140:21072122.
25. Gottlieb, M. S.,, R. Schroff,, H. M. Schanker,, J. D. Weisman,, P. T. Fan,, R. A. Wolf,, and A. Saxon. 1981. Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men. Evidence of a newly acquired cellular immunodeficiency. N. Engl. J. Med. 305:14251431.
26. Hajjeh, R. A.,, D. Relman,, P. R. Cieslak,, A. N. Sofair,, D. Passaro,, J. Flood,, J. Johnson,, J. K. Hacker,, W.-J. Shieh,, R. M. Hendry,, S. Nikkari,, S. Ladd-Wilson,, J. Hadler,, J. Rainbow,, J. W. Tappero,, C. W. Woods,, L. Conn,, S. Reagan,, S. Zaki, and B. A. Perkins for the Unexplained Deaths and Critical Illnesses Working Group. 2002. Surveillance for unexplained deaths and critical illnesses due to possibly infectious causes, United States, 19951998. Emerg. Infect. Dis. 8:145152.
27. Hanzlick, R.,, and R. G. Parrish. 1996. The role of medical examiners and coroners in public health surveillance and epidemiologic research. Annu. Rev. Public Health 17:383409.
28. Houpikian, P.,, and D. Raoult. 2002. Traditional and molecular techniques for the study of emerging bacterial diseases: one laboratory's perspective. Emerg. Infect. Dis. 8:122131.
29. Institute of Medicine. 1992. Emerging infections: microbial threats to health in the United States. National Academy Press, Washington, D.C.
30. Khan, A. S.,, R. F. Khabbaz,, L. R. Armstrong,, R. C. Holman,, S. P. Bauer,, J. Graber,, T. Strine,, G. Miller,, S. Reef,, J. Tappero,, P. E. Rollin,, S. T. Nichol,, S. R. Zaki,, R. T. Bryan,, L. E. Chapman,, C. J. Peters,, and T. G. Ksiazek. 1996. Hantavirus pulmonary syndrome: the first 100 U.S. cases. J. Infect. Dis. 173:12971303.
31. Khan, A. S.,, T. F. Kweteminga,, D. H. Heymann,, B. LeGuenno,, P. Nabeth,, B. Kersteins,, Y. Fleerackers,, P. H. Kilmarx,, G. R. Rodier,, O. Nkuku,, P. E. Rollin,, A. Sanchez,, S. R. Zaki,, R. Swanepoel,, O. Tomori,, S. T. Nichol,, C. J. Peters,, T. Muyembe, and T. G. Ksiazek for the Commission de Lutte contre les Epidemies a Kik. 1999. The reemergence of Ebola hemorrhagic fever, Zaire, 1995. J. Infect. Dis. 179: S76S86.
32. Lanciotti, R. S.,, J. T. Roehrig,, V. Deubel,, J. Smith,, M. Parker,, K. Steele,, B. Crise,, K. E. Volpe,, M. B. Crabtree,, J. H. Scherret,, R. A. Hall,, J. S. MacKenzie,, C. B. Cropp,, B. Panigrahy,, E. Ostlund,, B. Schmitt,, M. Malkinson,, C. Banet,, J. Weissman,, N. Komar,, H. M. Savage,, W. Stone,, T. McNamara,, and D. J. Gubler. 1999. Origin of the West Nile virus responsible for an outbreak of encephalitis in the northeastern United States. Science 286:23332337.
33. Lloyd, E. S.,, S. R. Zaki,, P. E. Rollin,, T. G. Ksiazek,, P. Calain,, M. K. Konde,, K. Tchioko,, M. A. Bwaka,, E. Verchueren,, J. Kabwau,, R. Ndambe,, and C. J. Peters. 1999. Long-term disease surveillance in Bandundu Region, Democratic Republic of the Congo: a model for early detection and prevention of Ebola hemorrhagic fever. J. Infect. Dis. 179:S274S280.
34. McDade, J. E.,, D. J. Brenner,, and F. M. Bozeman. 1979. Legionnaires' disease bacterium isolated in 1947. Ann. Intern. Med. 90:659661.
35. Nichol, S. T.,, C. F. Spiropoulou,, S. Morzunov,, P. E. Rollin,, T. G. Ksiazek,, H. Feldmann, et al. 1993. Genetic identification of a hantavirus associated with an outbreak of acute respiratory illness. Science 262:914917.
36. Nikkari, S.,, F. A. Lopez,, P. W. Lepp,, P. R. Cieslak,, S. Ladd-Wilson,, D. Passaro,, R. Danila,, and D. A. Relman. 2002. Broad-range bacterial detection and the analysis of unexplained death and critical illness. Emerg. Infect. Dis. 8:188194.
37. Nolte, K. B.,, G. L. Simpson,, and R. G. Parrish. 1996. Emerging infectious agents and the forensic pathologist: the New Mexico model. Arch. Pathol. Lab. Med. 120:125128.
38. Nolte, K. B.,, and M. I. Wolfe,. 1999. Medical examiner and coroner surveillance for emerging infections, p. 201217. In W. M. Scheld,, W. A. Craig,, and J. M. Hughes (ed.), Emerging Infections 3. ASM Press, Washington, D.C.
39. Osterholm, M. T.,, and J. C. Forfang. 1982. Toxic-shock syndrome in Minnesota: results of an active-passive surveillance system. J. Infect. Dis. 145:458 464.
40. Osterholm, M. T.,, T. D. Y. Chin,, and D. O. Osborne. 1983. A 1957 outbreak of Legionnaires' disease associated with a meat packing plant. Am. J. Epidemiol. 117:6067.
41. O'Sullivan, J. D.,, A. M. Allworth,, D. L. Paterson,, T. M. Snow,, R. Boots,, L. J. Gleeson,, A. R. Gould,, A. D. Hyatt,, and J. Bradfield. 1997. Fatal encephalitis due to novel paramyxovirus transmitted from horses. Lancet 349:9395.
42. Perkins, B. A.,, J. M. Flood,, R. Danila,, R. C. Holman,, A. L. Reingold,, L. A. Klug,, M. Virata,, P. R. Cieslak,, S. R. Zaki,, R. W. Pinner,, R. F. Khabbaz, and the Unexplained Deaths Working Group. 1996. Unexplained deaths due to possibly infectious causes in the United States: defining the problem and designing surveillance and laboratory approaches. Emerg. Infect. Dis. 2:4753.
43. Rantakokko-Jalava, K.,, S. Nikkari,, J. Jalava,, E. Eerola,, M. Skurnik,, O. Meurman,, O. Ruuskanen,, A. Alanen,, E. Kotilainen,, P. Toivanen,, and P. Kotilainen. 2000. Direct amplification of rRNA genes in diagnosis of bacterial infections. J. Clin. Microbiol. 38:3239.
44. Relman, D. A.,, J. S. Loutit,, T. M. Schmidt,, S. Falkow,, and L. S. Tompkins. 1990. The agent of bacillary angiomatosis. An approach to the identification of uncultured pathogens. N. Engl. J. Med. 323:15731580.
45. Relman, D. A.,, T. M. Schmidt,, R. P. MacDermott,, and S. Falkow. 1992. Identification of the uncultured bacillus of Whipple's disease. N. Engl. J. Med. 327:293301.
46. Relman, D. A., 1993. Universal bacterial 16S rDNA amplification and sequencing, p. 489495. In D. H. Persing,, T. F. Smith,, F. C. Tenover,, and T. T. White (ed.), Diagnostic Molecular Microbiology: Principles and Applications. American Society for Microbiology, Washington, D.C.
47. Rosenblum, M. K. 1990. Infection of the central nervous system by the human immunodeficiency virus type 1; morphology and relation to syndromes of progressive encephalopathy and myelopathy in patients with AIDS. Pathol. Annu. 1:117169.
48. Scott, M. A.,, T. L. McCurley,, C. L. Vnencak-Jones,, C. Hager,, J. A. McCoy,, B. Anderson,, R. D. Collins,, and K. M. Edwards. 1996. Cat scratch disease: detection of Bartonella henselae DNA in archival biopsies from patients with clinically, serologically, and histologically defined disease. Am. J. Pathol. 149:2161 2167.
49. Selvey, L. A.,, R. M. Wells,, J. G. McCormack,, A. J. Ansford,, K. Murray,, R. J. Rogers,, P. S. Lavercombe,, P. Selleck,, and J. W. Sheridan. 1995. Infection of humans and horses by a newly described morbillivirus. Med. J. Aust. 162:642645.
50. Sexton, D. J.,, P. E. Rollin,, E. B. Breitschwerdt,, G. R. Corey,, S. A. Myers,, M. R. Dumais,, M. D. Bowen,, C. S. Goldsmith,, S. R. Zaki,, S. T. Nichol,, C. J. Peters,, and T. G. Ksiazek. 1997. Life-threatening Cache Valley virus infection. N. Engl. J. Med. 336:547 549.
51. Shieh, W. J.,, J. Guarner,, M. Layton,, A. Fine,, J. Miller,, D. Nash,, G. L. Campbell,, J. T. Roehrig,, D. J. Gubler,, and S. R. Zaki. 2000. The role of pathology in an investigation of an outbreak of West Nile encephalitis in New York, 1999. Emerg. Infect. Dis. 6:370372.
52. Shieh, W. J.,, S. M. Jung,, C. Hsueh,, T. T. Kuo,, A. Mounts,, U. Parashar,, C. F. Yang,, J. Guarner,, T. G. Ksiazek,, J. Dawson,, C. Goldsmith,, G. J. Chang,, L. J. Anderson,, S. M. Oberste,, M. A. Pallansch,, L. J. Anderson,, S. R. Zaki, and the Epidemic Working Group. 2001. Pathologic studies on fatal cases during outbreak of hand, foot, and mouth disease, Taiwan. Emerg. Infect. Dis. 7:146 148.
53. Travejo, R. T.,, J. G. Rigau-Perez,, D. A. Ashford,, E. M. McClure,, C. Jarquin-Gonzalez,, J. J. Amadore,, J. O. De Los Reyes,, A. Gonzales,, S. R. Zaki,, W.-J. Shieh,, R. G. McLean,, R. S. Nasci,, R. S. Weyant,, C. A. Bolin,, S. L. Bragg,, B. A. Perkin,, and R. A. Spiegel. 1998. Epidemic leptospirosis associated with pulmonary hemorrhage— Nicaragua, 1995. J. Infect. Dis. 178:14571463.
54. Visvesvara, G. S.,, F. L. Schuster,, and A. J. Martinez. 1993. Balamuthia mandrillaris, N. G., N. Sp., agent of amebic meningoencephalitis in humans and other animals. J. Eukaryot. Microbiol. 40:504514.
55. Walker, D. H.,, and J. S. Dumler. 1997. Human monocytic and granulocytic ehrlichioses. Discovery and diagnosis of emerging tick-borne infections and the critical role of the pathologist. Arch. Pathol. Lab. Med. 121:785 791.
56. Wang, L. F.,, W. P. Michalski,, M. Yu,, L. I. Pritchard,, G. Crameri,, B. Shiell,, and B. T. Eaton. 1998. A novel P/V/C gene in a new member of the Paramyxoviridae family, which causes lethal infection in humans, horses, and other animals. J. Virol. 72:14821490.
57. Wear, D. J.,, A. M. Margileth,, T. L. Hadfield,, G. W. Fischer,, C. J. Schlagel,, and F. M. King. 1983. Cat scratch disease: a bacterial infection. Science 221:14031405.
58. Wilbrink, B.,, I. M. van der Heijden,, L. M. Schouls,, J. D. van Embden,, J. M. Hazes,, F. C. Breedveld,, P. P. Tak. 1998.Detection of bacterial DNA in joint samples from patients with undifferentiated arthritis and reactive arthritis, using polymerase chain reaction with universal 16S ribosomal RNA primers. Arthritis Rheum. 41:535 543.
59. Williams, R. J.,, R. T. Bryan,, J. N. Mills,, R. E. Palma,, I. Vera,, F. De Velasquez,, E. Baez,, W. E. Schmidt,, R. E. Figueroa,, C. J. Peters,, S. R. Zaki,, A. S. Khan,, and T. G. Ksiazek. 1997. An outbreak of hantavirus pulmonary syndrome in western Paraguay. Am. J. Trop. Med. Hyg. 57:274282.
60. Winn, W. C.,, and R. L. Myerowitz. 1981. The pathology of the Legionella pneumonias. Hum. Pathol. 12:401.
61. Wong, K. T.,, W. J. Shieh,, S. R. Zaki,, and C. T. Tan. 2002. Nipah virus infection, an emerging paramyxoviral zoonosis. Springer Semin. Immunopathol. 24:215228.
62. Zaki, S. R.,, W.-J. Shieh, and The Epidemic Working Group at Ministry of Health in Nicaragua. 1996. Leptospirosis associated with outbreak of acute febrile illness and pulmonary haemorrhage, Nicaragua, 1995. Lancet 347:535536.
63. Zaki, S. R.,, P. W. Greer,, L. M. Coffield,, C. S. Goldsmith,, K. B. Nolte,, K. Foucar,, R. M. Feddersen,, R. E. Zumwalt,, G. L. Miller,, A. S. Khan, et al. 1995. Hantavirus pulmonary syndrome. Pathogenesis of an emerging infectious disease. Am. J. Pathol. 146:552 579.
64. Zaki, S. R.,, A. S. Khan,, R. A. Goodman,, L. R. Armstrong,, P. W. Greer,, L. M. Coffield,, T. G. Ksiazek,, P. E. Rollin,, C. J. Peters,, and R. Khabbaz. 1996. Retrospective diagnosis of hantavirus pulmonary syndrome, 1978– 1993: implications for emerging infectious diseases. Arch. Pathol. Lab. Med. 120:134139.
65. Zaki, S. R.,, and C. J. Peters,. 1997. Viral hemorrhagic fevers, p. 347364. In D. H. Connor,, F. W. Chandler,, D. A. Schwartz,, H. J. Manz,, and E. E. Lack (ed.), Diagnostic Pathology of Infectious Diseases. Appleton and Lange, Stamford, Conn.
66. Zaki, S. R.,, W. J. Shieh,, P. W. Greer,, C. S. Goldsmith,, T. Ferebee,, J. Katshitski,, K. Tchioko,, M. A. Bwaka,, R. Swanepoel,, P. Calain,, A. S. Khan,, E. Lloyd,, P. E. Rollin,, T. G. Ksiazek,, C. J. Peters, and the EHF Study Group. 1999. A novel immunohistochemical assay for detection of Ebola virus in skin: implications for diagnosis, spread and surveillance of Ebola hemorrhagic fever. J. Infect. Dis. 179:S36 S47.
67. Zaki, S. R.,, and C. Paddock,. 1999. The emerging role of pathology in infectious diseases, p. 181 200. In W. M. Scheld,, W. A. Craig,, and J. M. Hughes (ed.), Emerging Infections 3. ASM Press, Washington, D.C.

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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