title: Postmortem Diagnosis of Dengue as an Epidemiological Surveillance Tool.
abstract: Dengue remains a problem in Brazil, and a substantial number of cases that progress to death are not diagnosed by health services. We evaluated the impact of a protocol adopted by the Coroner's Office Rocha Furtado (CO-RF) for the detection of unreported deaths from dengue in Brazil. We evaluated prospectively cases of deaths referred to the CO-RF with suspicion of dengue and those referred with other diagnosis in which the pathologists suspected dengue as the cause of death. Biological material was collected from all bodies autopsied, for which the suspected cause of death was dengue, between January 2011 and December 2012. Of the 214 bodies autopsied, 134 (62.6%) tested positive for dengue; of these cases, 121 were classified as dengue according to the World Health Organization's case definition (1997 or 2009, as appropriate). Thus, CO-RF detected 90 deaths from dengue, which were not suspected during disease progression. This CO-RF protocol, through a combined effort of the surveillance and laboratory teams, increased the detection of fatal dengue cases by 5-fold. This is the largest series of autopsies performed in cases of death related to dengue in the world to date.
authors.affiliation: Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil pamplona.luciano@gmail.com.
authors.forename: Luciano Pamplona de Góes
authors.initials: LP
authors.lastname: Cavalcanti
authors.affiliation: Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil.
authors.forename: Deborah Nunes de Melo
authors.initials: DN
authors.lastname: Braga
authors.affiliation: Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil.
authors.forename: Lívia Maria Alexandre
authors.initials: LM
authors.lastname: da Silva
authors.affiliation: Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil.
authors.forename: Marina Gondim
authors.initials: MG
authors.lastname: Aguiar
authors.affiliation: Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil.
authors.forename: Mariana
authors.initials: M
authors.lastname: Castiglioni
authors.affiliation: Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil.
authors.forename: José Udevanier
authors.initials: JU
authors.lastname: Silva-Junior
authors.affiliation: Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil.
authors.forename: Fernanda Montenegro de Carvalho
authors.initials: FM
authors.lastname: Araújo
authors.affiliation: Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil.
authors.forename: Renata Allana da Costa
authors.initials: RA
authors.lastname: Pereira
authors.affiliation: Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil.
authors.forename: Danielle Lima
authors.initials: DL
authors.lastname: Malta
authors.affiliation: Department of Community Health, Federal University of Ceara, Fortaleza, Brazil; Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil; Faculdade de Medicina, Centro Universitário Christus, Fortaleza, Brazil; Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brazil; Central Public Health Laboratory, Department of Health of Ceará State, Fortaleza, Brazil; Curso de Medicina, Universidade de Fortaleza, Fortaleza, Brazil; Programa de Pós-graduação em Patologia da Universidade Federal do Ceará, Departmento de Patologia, Universidade Federal do Ceará, Fortaleza, Brazil.
authors.forename: Margarida Maria de Lima
authors.initials: MM
authors.lastname: Pompeu
mesh_terms: D000914:Antibodies, Viral; D001938:Brazil / Q000453:epidemiology; D002423:Cause of Death; D003715:Dengue / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D005554:Forensic Medicine; D006801:Humans; D010338:Pathology, Clinical; D011159:Population Surveillance / Q000379:methods*; D013048:Specimen Handling
chemical_list: D000914:Antibodies, Viral