Unexplained deaths in Connecticut, 2002-2003: failure to consider category a bioterrorism agents in differential diagnoses.
BACKGROUND
Recognition of bioterrorism-related infections by hospital and emergency department clinicians may be the first line of defense in a bioterrorist attack.


METHODS
We identified unexplained infectious deaths consistent with the clinical presentation of anthrax, tularemia, smallpox, and botulism using Connecticut death certificates and hospital chart information. Minimum work-up criteria were established to assess the completeness of diagnostic testing.


RESULTS
Of 4558 unexplained infectious deaths, 133 were consistent with anthrax (2.9%) and 6 (0.13%) with tularemia. None were consistent with smallpox or botulism. No deaths had anthrax or tularemia listed in the differential diagnosis or had disease-specific serology performed. Minimum work-up criteria were met for only 53% of cases.


CONCLUSIONS
Except for anthrax, few unexplained deaths in Connecticut could possibly be the result of the bioterrorism agents studied. In 47% of deaths from illnesses that could be anthrax, the diagnosis would likely have been missed. As of 2004, Connecticut physicians were not well prepared to intentionally or incidentally diagnose initial cases of anthrax or tularemia. More effective clinician education and surveillance strategies are needed to minimize the potential to miss initial cases in a bioterrorism attack.
CT Emerging InfectionsProgram, Yale University School of Medicine, Department of Epidemiology and Public Health, One Church Street, 7th Floor, New Haven, CT 06510, USA. john.palumbo@yale.edu
John P
JP
Palumbo
James I
JI
Meek
Darcy M
DM
Fazio
Susan B
SB
Turner
James L
JL
Hadler
André N
AN
Sofair
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023482:Bioterrorism; D003141:Communicable Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D003237:Connecticut / Q000453:epidemiology; D003937:Diagnosis, Differential; D054597:Disaster Medicine / Q000379:methods; D004189:Disaster Planning; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007239:Infections / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged