Unexplained deaths due to possibly infectious causes in the United States: defining the problem and designing surveillance and laboratory approaches. The Unexplained Deaths Working Group.

نویسندگان

  • B. A. Perkins
  • J. M. Flood
  • R. Danila
  • R. C. Holman
  • A. L. Reingold
  • L. A. Klug
  • M. Virata
  • P. R. Cieslak
  • S. R. Zaki
  • R. W. Pinner
  • R. F. Khabbaz
چکیده

Many new infectious diseases have been identified in the United States during the last several decades (1). Among these are AIDS, Legionnaires’ disease, toxic-shock syndrome, hepatitis C, and most recently, hantavirus pulmonary syndrome; all caused serious illness and death. In each instance, the disease was recognized through investigation of illness for which no cause had been identified. Retrospective studies of these and other newly recognized infectious diseases often identified cases that occurred before the recognition of the new agent; therefore, a more sensitive detection system may make the earlier recognition of new infectious agents possible. Delays in recognizing new infectious agents have often been substantial. For instance, Legionella pneumophila was established as the cause of Legionnaires’ disease in 1976 after an epidemic in Philadelphia, but sporadic cases in 1947 and an outbreak in 1957 were retrospectively identified (2, 3). Similarly, toxic shock syndrome was recognized in late 1979 and early 1980, but retrospective reporting and chart reviews documented cases as early as 1960 (4). HIV was identified in 1983 (5) yet retrospective investigations documented AIDS cases in the late 1970s and possibly as early as 1968 in the United States (6, 7). The difficulty of identifying unknown etiologic agents is part of the reason for delays between the occurrence and recognition of new infectious diseases. Until recently, to identify new infectious agents we relied primarily on culture techniques. For fastidious bacteria such as Legionella sp., and new viruses, such as HIV, which have very specific growth requirements, successful isolation usually required numerous attempts with various culture systems, often extending over years. Advances in molecular techniques, including polymerase chain reaction (PCR) amplification and other DNA(and RNA-) based techniques (e.g., representational difference analysis), allow identification and classification of unknown etiologic agents without having to culture them (8-10) and provide clues concerning appropriate conditions for subsequent isolation of the agent in culture (11,12). A more systematic public health approach for the early detection of unknown infectious agents is needed. This need was acknowledged in Addressing Emerging Infectious Diseases Threats: A Prevention Strategy for the United States, a CDC publication about emerging infections (13). CDC has established an emerging infections program (EIP) network to conduct special population-based surveillance projects, develop surveillance methods, pilot and evaluate prevention strategies, and conduct other epidemiologic and laboratory studies. In late 1994, CDC funded four programs based at state health departments and academic institutions in California (Alameda, Contra Costa, Kern, and San Francisco counties), Connecticut, Minnesota, and Oregon. Some projects are conducted at all program sites and others, depending on local interest and expertise, at only one or two sites.

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عنوان ژورنال:
  • Emerging Infectious Diseases

دوره 2  شماره 

صفحات  -

تاریخ انتشار 1996