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Volume 8, Number 2—February 2002

Surveillance for Unexplained Deaths and Critical Illnesses

Rana A. Hajjeh*Comments to Author , 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*, and for the Unexplained Deaths Critical Illness Working Group1
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Stanford University, Stanford, California, USA; ‡the Emerging Infections Program, Portland, Oregon, USA; §the Emerging Infections Program, Hartford, Connecticut, USA; ¶the Emerging Infections Program, San Francisco, California, USA; #the Emerging Infections Program, Minneapolis, Minnesota, USA;

Main Article

Table 2

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

Syndrome No. (%) No. of deaths (%) No. of explained /cases with specimens (%)
Neurologic 39 (29) 7 (18) 15/37 (41)
Respiratory 36 (26) 11 (31) 13/33 (39)
Cardiac 28 (20) 13 (46) 3/22 (14)
Multisystem 18 (13) 4 (22) 3/15 (20)
Hepatic 9 (7) 4 (44) 0/8 (0)
Other 7 (5) 2 (29) 0/7 (0)
All cases 137 41 (30) 34/122 (28)

Main Article

1Divya Agrawal, William Bower, Richard Danila, Linda Duke, Mark Eberhard, Marc Fischer, Jeannette Guarner, Connie Heye, James Johnson, Rima Khabbaz, Fred Lopez, Ruth Lynfield, James Meek, Christopher Paddock, Arthur Reingold, Robert Ryder, Susan Smith, Deborah F. Talkington, Michael Virata, and Duc Vugia.

2Oregon used a different age cut-off because of limited resources.

3IHC was available at CDC for the following pathogens: Acanthamoeba culbertzoni; adenovirus; Bacillus anthracis; Balamuthia spp.; Bartonella henselae, Bartonella quintana; Brucella spp.; Chlamydia spp.; Coccidiodes spp; Coxiella burnetii; Crimean-Congo hemorrhagic fever virus; Cryptococcus spp.; Cytomegalovirus; Dengue virus; Eastern equine encephalitis virus; Ebola virus; Ehrlichia chaffeensis; Enterovirus (Pan-enterovirus); human enterovirus 71; Flavivirus; Japanese encephalitis serocomplex group (West Nile virus, St. Louis encephalitis virus [SLEV], Japanese encephalitis virus); Francisella tularensis; Group A streptococci; Guanarito virus (Venezuelan hemorrhagic fever virus); Hantavirus; Helicobacter pylori; Hendra virus; herpes simplex viruses 1 and 2; Histoplasma spp.; human granulocytic ehrlichiosis; Human herpesvirus 6; HIV-1; HIV-2; B19 virus (B19V); Influenza A virus (FLUA); Influenza B virus (FLUB); Junin virus (Argentine hemorrhagic fever); La Crosse virus; Lassa virus; Legionella pneumophila serogroups 1, 5, 6; Leptospira spp.; Listeria monocytogenes; Lymphocytic choriomeningitis virus (LCMV); Machupo virus (Bolivian hemorrhagic fever); Marburg virus; measles (Edmonston) virus (MeV); Mycobacterium spp.; Mycoplasma pneumoniae; Naegleria fowleri; Neisseria meningitidis C; Nipah virus; Human parainfluenza virus types 1 and 3 (HPIV 1,3); Rabies virus (RABV); Human respiratory syncytial virus (HRSV); Rickettsia spp. Orientia group; Rickettsia spp. spotted fever group; Rickettsia spp. Typhus group; Rift Valley fever virus; Rotavirus; Streptococcus pneumoniae; Toxoplasma gondii; Treponema pallidum; Trypanosoma cruzi; varicella-zoster virus (VZV); Venezuelan equine encephalitis virus; Western equine encephalomyelitis virus (WEEV); Yellow fever virus; and Yersinia pestis.

4The following viral tests were used at the CDHS Viral and Rickettsial Diseases Laboratory: IgG was detected by both EIA and IFA for adenovirus, HHV-6, HHV-8, herpes simplex virus, FLUAV, FLUBV, MeV, Mumps virus (MuV), HPIV-1-4, HRSV, Rubella virus (RUBV), VZV, SLEV, and WEEV. IgG was detected by EIA only for Hantavirus (Sin Nombre virus [SNV]) and B-19. IgG was detected by IFA only for Epstein-Barr virus (viral capsid antigen), LCV, and RABV. IgM was detected by both EIA and IFA for HHV-6, herpes simplex virus, MeV, MuV, HPIV-1-4, HRSV, RUBV, and VZV. IgM was detected by EIA only for enterovirus, hantavirus (SNV), and B19V. IgM was detected by IFA only for Epstein-Barr virus. PCR tests performed were Herpesvirus consensus PCR (6); enterovirus PCR, modified from (7) [Antisense primer (1R): 5’-ATT GTC ACC ATA AGC AGC CA, sense primer (1L): 5’-CCT CCG GCC CCT GAA TGC GGC TAA T]; and adenovirus PCR (8).

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