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Guidelines to Implement Medical Examiner/Coroner-Based Surveillance for Fatal Infectious Diseases and Bioterrorism ("Med-X")

Nolte, Kurt B. MD*; Fischer, Marc MD; Reagan, Sarah BA; Lynfield, Ruth MDand Members of the National Association of Medical Examiners (NAME) Ad Hoc Committee for Bioterrorism and Infectious Diseases

The American Journal of Forensic Medicine and Pathology: December 2010 - Volume 31 - Issue 4 - p 308-312
doi: 10.1097/PAF.0b013e3181c187b5
Original Articles

Medical examiners and coroners investigate deaths that are sudden, unexplained, and violent. Oftentimes these deaths are a consequence of infections, many of which have public health consequences. Additionally, because deaths from bioterrorism are homicides, they fall under the jurisdiction of medical examiners and coroners. Surveillance for infectious disease-related deaths can enhance the opportunities to recognize these deaths. Beginning in 2000, the New Mexico Office of the Medical Investigator developed and tested a medical examiner surveillance model for bioterrorism and infectious disease mortality ("Med-X") using a set of symptoms to determine which cases should receive an autopsy and a set of pathology-based syndromes for early reporting of cases to public health authorities. This model demonstrated that many of the symptoms had a high predictive value for infections and were useful criteria for autopsy performance. The causative organism was identified for 81% of infections of which 58% were notifiable conditions by public health standards. Uniform criteria for performing autopsies and reporting cases to public health authorities enhance surveillance for notifiable infectious diseases and increase the probability of recognizing fatalities related to bioterrorism. We have developed guidelines for medical examiners, coroners and their public health partners to use in implementing Med-X surveillance in their jurisdictions. These guidelines encompass definitions of symptoms and syndromes, specimen collection and storage procedures, laboratory diagnostic approaches, and processes for case flow, case reporting, and data collection. We also suggest resources for autopsy biosafety information and funding.

From the *Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque, NM; †Unexplained Deaths and Critical Illnesses Project Centers for Disease Control and Prevention, Atlanta, GA; and ‡Minnesota Department of Health, St. Paul, MN.

Manuscript received December 18, 2008; accepted January 18, 2009.

Members of the National Association of Medical Examiners (NAME) Ad Hoc Committee for Bioterrorism and Infectious Diseases are listed in theAppendix.

Reprints: Kurt B. Nolte, MD, Office of the Medical Investigator, MSC11 6030, 1 University of New Mexico, Albuquerque, NM 87131-0001. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.