Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Minnesota Department of Health, St Paul, MN, USA.
Public Health Rep. 2024 May-Jun;139(3):325-332. doi: 10.1177/00333549231218283. Epub 2024 Jan 11.
Surveillance systems for unexplained deaths that might have an infectious etiology are rare. We examined the Minnesota Department of Health Unexplained Deaths and Critical Illnesses of Possible Infectious Etiology and Medical Examiner Infectious Deaths (UNEX/MED-X) surveillance system,-a system that expanded postmortem surveillance for infectious diseases during the COVID-19 pandemic by leveraging standard (medical examiner [ME]) and expanded (mortuary) surveillance to identify COVID-19-related deaths.
MEs, coroners, or morticians collected postmortem swabs from decedents with an infectious prodrome or with SARS-CoV-2 exposure before death but with no known recent infectious disease testing. The Minnesota Department of Health Public Health Laboratory used nucleic acid amplification, viral culture, and standard algorithms to test specimens collected postmortem for SARS-CoV-2, influenza virus, and other infectious pathogens. We reviewed UNEX/MED-X data from March 2, 2020, through December 31, 2021, and characterized decedents by location of swab collection (ie, ME or mortuary).
From March 2, 2020, through December 31, 2021, the UNEX/MED-X surveillance system received samples from 182 decedents from mortuaries and 955 decedents from MEs. Mortuary decedents were older than ME decedents (median age, 78 vs 46 y). Seventy-three mortuary decedents (40.1%) and 197 ME decedents (20.6%) had SARS-CoV-2 detections. The UNEX/MED-X system identified 212 COVID-19-related deaths, representing 2.0% of total COVID-19-related deaths in Minnesota. Eighty-nine decedents (42.0%) were from racial and ethnic minority populations, representing 6.1% more COVID-19-related deaths among people from racial and ethnic minority populations than would have been detected without this surveillance system.
Expanded and standard UNEX/MED-X surveillance builds capacity and flexibility for responding to emerging public health threats. Similar programs should be considered elsewhere as resources allow.
用于监测可能具有传染性病因的不明原因死亡的监测系统很少见。我们检查了明尼苏达州卫生部不明原因死亡和可能传染性病因及法医传染性死亡（UNEX/MED-X）监测系统，这是一个在 COVID-19 大流行期间通过利用标准（法医[ME]）和扩展（太平间）监测来扩大传染病死后监测以确定与 COVID-19 相关的死亡的系统。
法医、验尸官或太平间人员从有传染性前驱症状或在死亡前有 SARS-CoV-2 暴露但无近期已知传染病检测的死者身上采集死后拭子。明尼苏达州卫生部公共卫生实验室使用核酸扩增、病毒培养和标准算法来测试死后采集的标本中的 SARS-CoV-2、流感病毒和其他传染性病原体。我们审查了 2020 年 3 月 2 日至 2021 年 12 月 31 日的 UNEX/MED-X 数据，并根据拭子采集地点（即法医或太平间）对死者进行了特征描述。
从 2020 年 3 月 2 日至 2021 年 12 月 31 日，UNEX/MED-X 监测系统收到了 182 名太平间死者和 955 名法医死者的样本。太平间死者比法医死者年龄大（中位数年龄，78 岁比 46 岁）。73 名太平间死者（40.1%）和 197 名法医死者（20.6%）检测到 SARS-CoV-2。UNEX/MED-X 系统共发现 212 例 COVID-19 相关死亡，占明尼苏达州 COVID-19 相关死亡总数的 2.0%。89 名死者（42.0%）来自种族和少数民族群体，这意味着在没有这种监测系统的情况下，该群体的 COVID-19 相关死亡人数比预计的要多 6.1%。
扩大和标准的 UNEX/MED-X 监测为应对新出现的公共卫生威胁提供了能力和灵活性。在资源允许的情况下，其他地方也应考虑类似的项目。
