Medical Examiner/Coroner Based Surveillance For Fatal Infectious Diseases And Bioterrorism

Medical Examiner/Coroner Based Surveillance For Fatal Infectious Diseases and Bioterrorism

Purpose

The Medical Examiner/Coroner Based Surveillance for Fatal Infectious Diseases and Bioterrorism (Med-X) is a pathology-based syndromic surveillance system designed to recognize bioterrorism mortality and fatal infections of public health importance.

Goals & Objectives

Improve the identification of deaths potentially due to an infectious disease.
Increase the proportion of potential infectious disease deaths that are submitted to autopsy.
Obtain accurate and standardized data and reporting for suspect cases in a timely manner.
Collect specimens for routine and reference testing for both toxins and infectious pathogens.
Implement state-of-the-art methods for autopsy-based microbiologic evaluation to obtain an organism- specific diagnosis.

Activities

Med-X is an active prospective population-based surveillance project that is being conducted at the State of Connecticut’s Office of the Chief Medical Examiner (OCME) utilizing all deaths in Connecticut as the denominator. Cases are identified if they have either a defined ante mortem sign/symptom (i.e. fever, cough) or a defined pathologic syndrome (i.e. community-acquired pneumonia), which may be related to bioterrorism mortality or other fatal infections of public health importance. Pathologic syndromes are defined by the gross and histologic findings at autopsy. Symptoms and syndromes are used to define a differential diagnosis and direct microbiologic testing. Pathologists will attempt to achieve an o rganism-specific diagnosis in every infectious disease case. A specially designed specimen collection kit will be designed in collaboration with CDC and used during autopsy on patients who meet the study criteria in order to facilitate the appropriate collection of specimens for further analysis.

In addition, a retrospective review of the OCME database will take place quarterly to identify potential cases that may have been referred to the OCME but where no autopsy was performed and/or an autopsy was performed and where a pathologic syndrome was identified but an organism-specific diagnosis was not defined. During the fiscal year 2001-02 in Connecticut, 15,031 deaths were reported to Connecticut’s OCME. After initial investigation, the OCME took jurisdiction of 12,850 cases for further investigation. OCME investigators investigated each of these cases and in 1,619 (13% of cases) autopsies/examinations were conducted. These cases will then be grouped by pathologic syndrome. Clinical and epidemiologic data will be gathered using standardized case report forms to be developed in conjunction with CDC.

Purpose

Goals & Objectives

Activities

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