title: Surveillance for unexplained deaths and critical illnesses due to possibly infectious causes, United States, 1995-1998.
abstract: 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.
authors.affiliation: Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. rfh5@cdc.gov
authors.forename: Rana A
authors.initials: RA
authors.lastname: Hajjeh
authors.forename: David
authors.initials: D
authors.lastname: Relman
authors.forename: Paul R
authors.initials: PR
authors.lastname: Cieslak
authors.forename: Andre N
authors.initials: AN
authors.lastname: Sofair
authors.forename: Douglas
authors.initials: D
authors.lastname: Passaro
authors.forename: Jennifer
authors.initials: J
authors.lastname: Flood
authors.forename: James
authors.initials: J
authors.lastname: Johnson
authors.forename: Jill K
authors.initials: JK
authors.lastname: Hacker
authors.forename: Wun-Ju
authors.initials: WJ
authors.lastname: Shieh
authors.forename: R Michael
authors.initials: RM
authors.lastname: Hendry
authors.forename: Simo
authors.initials: S
authors.lastname: Nikkari
authors.forename: Stephen
authors.initials: S
authors.lastname: Ladd-Wilson
authors.forename: James
authors.initials: J
authors.lastname: Hadler
authors.forename: Jean
authors.initials: J
authors.lastname: Rainbow
authors.forename: Jordan W
authors.initials: JW
authors.lastname: Tappero
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Woods
authors.forename: Laura
authors.initials: L
authors.lastname: Conn
authors.forename: Sarah
authors.initials: S
authors.lastname: Reagan
authors.forename: Sherif
authors.initials: S
authors.lastname: Zaki
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Perkins
mesh_terms: D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011159:Population Surveillance / Q000379:methods*; D014481:United States / Q000453:epidemiology; D014777:Virus Diseases / Q000150:complications* / Q000175:diagnosis / Q000401:mortality*