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Chapter 13 : Medical Examiner and Coroner Surveillance for Emerging Infections

Authors: Kurt B. Nolte1, Mitchell I. Wolfe4
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Affiliations: 1: Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque, NM 87131-5091; 2: Medical Examiner/Coroner Information Sharing Program, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341; 3: Infectious Disease Pathology Activity, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333; 4: Surveillance and Programs Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341
Content Type: Monograph
Publication Year: 1999

Category: Clinical Microbiology

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Abstract:

This chapter describes the use of medical examiner or coroner (ME/C) data for public health surveillance, provides an overview of surveillance for fatal infectious conditions, and describes ongoing efforts aimed at identifying the most complete and accurate methods for incorporating ME/C-based autopsy data into state-based and national surveillance systems. In contrast to retrospective surveillance methods, the Centers for Disease Control and Prevention (CDC) in 1994 began active surveillance for infectious disease with the establishment of the Emerging Infections Program (EIP) at four sites in the United States. Sections in the chapter discuss issues related to the incorporation of ME/Cs into the overall surveillance for infectious diseases, including those from bioterrorist attacks, and describe the potential advantages and limitations of this data source. In New Mexico, approximately 25% of autopsied natural deaths are infectious disease related. Because some of these deaths are caused by emerging infections, it is likely that ME/Cs could play an important role in surveillance for these conditions nationally. In recognition of this fact, CDC’s 1994 emerging infections plan identifies medical examiners as an important sentinel surveillance network. Any system that is implemented to conduct surveillance for acts of bioterrorism should involve medicolegal death investigators for several reasons. First, medical examiners and coroners may see cases of fatal unattended infections from acts of bioterrorism that other physicians, hospitals, or emergency rooms have not seen. Directing autopsy pathologists to search for emerging infections is not without some element of danger.

Citation: Nolte K, Wolfe M. 1999. Medical Examiner and Coroner Surveillance for Emerging Infections, p 201-217. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch13
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Medical Examiner and Coroner Surveillance for Emerging Infections
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Citation: Nolte K, Wolfe M. 1999. Medical Examiner and Coroner Surveillance for Emerging Infections, p 201-217. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch13
/content/10.1128/9781555818418.chap13.fig13-1
Figure 1

Overlap of forensic pathology and emerging infectious diseases.

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10.1128/9781555818418/fig13-1.gif
Image of Figure 1
Figure 1

Overlap of forensic pathology and emerging infectious diseases.

Citation: Nolte K, Wolfe M. 1999. Medical Examiner and Coroner Surveillance for Emerging Infections, p 201-217. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch13
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Figure 2

Death investigation system by state, United States, 1996.

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10.1128/9781555818418/fig13-2.gif
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Figure 2

Death investigation system by state, United States, 1996.

Citation: Nolte K, Wolfe M. 1999. Medical Examiner and Coroner Surveillance for Emerging Infections, p 201-217. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch13
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Figure 3

Hospital autopsy rates by year, United States, 1950 to 1995 ( ).

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10.1128/9781555818418/fig13-3.gif
Image of Figure 3
Figure 3

Hospital autopsy rates by year, United States, 1950 to 1995 ( ).

Citation: Nolte K, Wolfe M. 1999. Medical Examiner and Coroner Surveillance for Emerging Infections, p 201-217. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 3. ASM Press, Washington, DC. doi: 10.1128/9781555818418.ch13
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References

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