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Unexplained Deaths in Connecticut, 2002–2003:Failure to Consider Category A Bioterrorism Agents in Differential Diagnoses

  • John P. Palumbo, James I. Meek, Darcy M. Fazio, Susan B. Turner, James L. Hadler and André N. Sofair...

Abstract

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. (Disaster Med Public Health Preparedness. 2008;2:87–94)

Copyright

Corresponding author

Correspondence and reprint requests to John Palumbo, MS, CT Emerging Infections Program, One Church Street, 7th Floor, New Haven, CT 06510(e-mail: john.palumbo@yale.edu).

References

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1. Public Health Security and Bioterrorism Preparedness and Response Act. P Law No. 107-188. 116 Stat. 594 (2002).
2. Pandemic and All-Hazards Preparedness Act. P Law No. 109–417 (2006).
3.Cosgrove, S, Perl, T, Song, X, Sisson, S. Ability of physicians to diagnose and manage illness due to Category A bioterrorism agents. Arch Intern Med. 2005; 165: 20022006.
4.Nolte, KB, Lathrop, SL, Nashelsky, MB, et al“Med-X”: a medical examiner surveillance model for bioterrorism and infectious disease mortality. Hum Pathol. 2007; 38: 718.
5.Alexander, C, Larkin, L, Wynia, M. Physicians' preparedness for bioterrorism and other public health priorities. Acad Emerg Med. 2006; 13: 12381241.
6.Griffith, K, Mead, P, Armstrong, G, et alBioterrorism-related inhalational anthrax in an elderly woman, Connecticut, 2001. Emerging Infect Dis. 2003; 9: 681688.
7. Centers for Disease Control and Prevention. Guidance for Fiscal Year 2002 Supplemental Funds for Public Health Preparedness and Response for Bioterrorism, Announcement No. 99051-Emergency Supplemental. February 15, 2002.
8.Hajjeh, RA, Relman, D, Cieslak, PR, et alSurveillance for unexplained deaths and critical illnesses due to possibly infectious causes, United States, 1995-1998. Emerging Infect Dis. 2002; 8: 145.
9.Arnon, S, Schechter, R, Inglesby, T, et alBotulinum toxin as a biological weapon. Medical and public health management. JAMA. 2001; 285: 10592081.
10.Dennis, D, Inglesby, T, Henderson, D, et alTularemia as a biological weapon. Medical and public health management. JAMA. 2001; 285: 27632773.
11.Henderson, D, Inglesby, T, Bartlett, J, et alSmallpox as a biological weapon. Medical and public health management. JAMA. 1999; 281: 21272137.
12.Inglesby, T, O'Toole, T, Henderson, D, et alAnthrax as a biological weapon, 2002. Updated recommendations for management. JAMA. 2002; 287: 22362252.
13.Ketai, L, Alrahji, A, Hart, B, Enria, D, Mettler, F. Radiologic manifestations of potential bioterrorist agents of infection. Am J Roentgenol. 2003; 180: 565575.
14.Penn, R. Francisella tularensis (tularemia). In: Mandell G, Bennett J, Dolin R, eds. Principles and Practice of Infectious Disease, Vol 2, 4th ed. New York: Churchill Livingstone; 1995 20602068.
15. US Bureau of Census. Annual Estimates of the Population for Counties in Connecticut: April 1, 2000, to July 1, 2004. Table CO-EST2004-01-09. Release Date April 14, 2005. http://www.census.gov/popest/counties/CO-EST2004-01.html.
16.Jernigan, J, Stephens, D, Ashford, D, et alBioterrorism-related inhalational anthrax: the first 10 cases reported in the United States. Emerging Infect Dis. 2001; 7: 933944.
17.Campbell, S, Marrie, T, Anstey, R, Ackroyd-Stolarz, S, Dickinsin, G. Utility of blood cultures in the management of adults with community acquired pneumonia discharged from the emergency department. Emerg Med J. 2003; 20: 521523.
18.Begier, E, Barrett, N, Mshar, P, Johnson, D, Hadler, J. Gram-positive rod surveillance for early anthrax detection. Team CBFER. Emerging Infect Dis. 2005; 11: 14831486.
19.Hadler, J, Siniscalchi, A, Dembek, Z. Hospital admission syndromic surveillance–Connecticut, October 2001–June 2004. MMWR. 2005; 54 Suppl169173.
20.Nolte, K. Infectious disease pathology and the autopsy. Clin Infect Dis. 2002; 34: 130131.

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