Emerging Infectious Diseases (Feb 2002)

Surveillance for Unexplained Deaths and Critical Illnesses

  • Rana A. Hajjeh,
  • David Relman,
  • Paul R. Cieslak,
  • Andre N. Sofair,
  • Douglas Passaro,
  • Jennifer Flood,
  • James Johnson,
  • Jill K. Hacker,
  • Wun-Ju Shieh,
  • R. Michael Hendry,
  • Simo Nikkari,
  • Stephen Ladd-Wilson,
  • James L. Hadler,
  • Jean Rainbow,
  • Jordan W. Tappero,
  • Christopher W. Woods,
  • Laura Conn,
  • Sarah Reagan,
  • Sherif Zaki,
  • Bradley A. Perkins

DOI
https://doi.org/10.3201/eid0802.010165
Journal volume & issue
Vol. 8, no. 2
pp. 145 – 153

Abstract

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Population-based surveillance for unexplained death and critical illness possibly due to infectious causes (UNEX) was conducted in four U.S. Emerging Infections Program sites (population 7.7 million) from May 1, 1995, to December 31, 1998, to define the incidence, epidemiologic features, and etiology of this syndrome. A case was defined as death or critical illness in a hospitalized, previously healthy person, 1 to 49 years of age, with infection hallmarks but no cause identified after routine testing. A total of 137 cases were identified (incidence rate 0.5 per 100,000 per year). Patients’ median age was 20 years, 72 (53%) were female, 112 (82%) were white, and 41 (30%) died. The most common clinical presentations were neurologic (29%), respiratory (27%), and cardiac (21%). Infectious causes were identified for 34 cases (28% of the 122 cases with clinical specimens); 23 (68%) were diagnosed by reference serologic tests, and 11 (32%) by polymerase chain reaction-based methods. The UNEX network model would improve U.S. diagnostic capacities and preparedness for emerging infections.

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