Palumbo John P, Meek James I, Fazio Darcy M, Turner Susan B, Hadler James L, Sofair André N
CT Emerging InfectionsProgram, Yale University School of Medicine, Department of Epidemiology and Public Health, One Church Street, 7th Floor, New Haven, CT 06510, USA.
Disaster Med Public Health Prep. 2008 Jun;2(2):87-94. doi: 10.1097/DMP.0b013e318161315b.
Recognition of bioterrorism-related infections by hospital and emergency department clinicians may be the first line of defense in a bioterrorist attack.
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.
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.
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.
医院和急诊科临床医生对生物恐怖主义相关感染的识别可能是生物恐怖袭击中的第一道防线。
我们利用康涅狄格州的死亡证明和医院病历信息，确定了与炭疽、兔热病、天花和肉毒中毒临床表现相符的不明原因感染死亡病例。制定了最低检查标准以评估诊断测试的完整性。
在4558例不明原因感染死亡病例中，133例与炭疽相符（2.9%），6例与兔热病相符（0.13%）。无一例与天花或肉毒中毒相符。鉴别诊断中未列出炭疽或兔热病，也未进行疾病特异性血清学检测。仅53%的病例符合最低检查标准。
除炭疽外，康涅狄格州很少有不明原因死亡可能是所研究的生物恐怖主义病原体导致的。在可能是炭疽的疾病导致的死亡病例中，有47%的病例可能会漏诊。截至2004年，康涅狄格州的医生在有意或无意诊断炭疽或兔热病的初始病例方面准备不足。需要更有效的临床医生教育和监测策略，以尽量减少在生物恐怖袭击中漏诊初始病例的可能性。
