“Med-X”: a medical examiner surveillance model for bioterrorism and infectious disease mortality

A new surveillance system for undiagnosed serious infectious illness for the London 2012 Olympic and Paralympic Games

“…Additional objectives were to estimate the annual rate of cases of USII and to develop a system that was both feasible and acceptable to participating clinicians. This surveillance is based on similar systems for detecting cases of new and emerging infections established previously in the United States [4,7] and Taiwan [8]. The HPA-based USII surveillance is part of a range of enhanced existing and new surveillance systems, including syndromic surveillance in primary care, Olympic venues and emergency departments, put in place for the 2012 London Games [9,10].…”

Diagnosis of Influenza from Respiratory Autopsy Tissues

“…43,49,50 Several excellent programs have created surveillance systems to examine fatal cases with possible infectious etiologies. 51,52 This study also demonstrates that, although testing of FFPE tissues is useful, testing of frozen autopsy tissues provides the best chance for establishing a diagnosis. In this study, of the 24 rRT-PCR-positive cases in which both frozen and FFPE tissues were tested, 6 cases would have been deemed negative if only FFPE tissues had been available for analysis.…”

Role of the Medical Examiner in Zika Virus and Other Emerging Infections

“…However, many types of nonviolent deaths, including unexplained deaths and sudden natural deaths, not only are of public health significance but also are required by statute in most jurisdictions to be investigated by ME/Cs. [3][4][5] Many of these deaths are due to infectious processes, often making the ME/C the first physician to identify fatal disease in a particular patient. The key role of ME/Cs in identifying emerging infectious diseases is particularly well illustrated in the recognition of hantavirus pulmonary syndrome in the southwestern United States.…”

“…12 Other developments recognizing the ME/C role in infectious disease surveillance, both naturally occurring and potentially bioterrorism related, include the implementation of medical examiner/ coroner-based surveillance systems for fatal infectious diseases (''Med-X''), the formation of infectious death disease review teams (IDDRTs) at ME/C offices, and federal funding to support this infrastructure. 2,4,5 The Med-X surveillance system allows ME/Cs to electronically flag deaths that may be due to unusual infections, based on surveillance systems and autopsy-based pathologic syndromes, with automatic electronic notification of the local health department and enhanced laboratory testing for organism-specific diagnoses. 5 IDDRTs, comprised of forensic pathologists, infectious disease specialists, public health practitioners, laboratorians, and other stakeholders, can then be convened to review deaths designated as Med-X cases, improving the detection and investigation of infectious disease deaths and cultivating better communication between ME/Cs and public health agencies.…”

“…2,4,5 The Med-X surveillance system allows ME/Cs to electronically flag deaths that may be due to unusual infections, based on surveillance systems and autopsy-based pathologic syndromes, with automatic electronic notification of the local health department and enhanced laboratory testing for organism-specific diagnoses. 5 IDDRTs, comprised of forensic pathologists, infectious disease specialists, public health practitioners, laboratorians, and other stakeholders, can then be convened to review deaths designated as Med-X cases, improving the detection and investigation of infectious disease deaths and cultivating better communication between ME/Cs and public health agencies. 2 The approaches, experience, and infrastructure developed by medical examiners during previous infectious disease outbreaks and routine surveillance can now be applied to better understand the emergence and consequences of Zika virus infection.…”