Unexplained Deaths May Herald a New Disease

The newly established Mortality Surveillance Division in the Office of the Armed Forces Medical Examiner is a

joint effort of the DoD GEIS and the Armed Forces Institute of Pathology.  It was created to obtain baseline

mortality data on military personnel and monitor in near real time cause specific mortality among service

personnel, an objective that is facilitated by the Division's location at the AFIP.  A specific goal is to immediately

investigate deaths without a clear explanation so they can be evaluated for a possible infectious cause.  The

division begins to collect data within hours of an active duty member's death being reported to casualty offices.

Supplementary  sources of mortality information include death certificates, medical records, autopsy reports,

AFIP consultations, toxicology studies, and investigative reports from legal agencies.  Many emerging infectious

diseases, such as Legionnaire's disease, hantavirus pulmonary syndrome, and H5N1 influenza, were first recognized

when they caused unexpected deaths.

In a recent example, a Special Forces soldier died of malaria after returning from duty in Nigeria.  The Division

was notified and began an investigation to determine if the death was caused by a new drug resistant strain

of malaria, which would be important news for those preparing military personnel for travel to Africa.  After

a thorough investigation, the Division found that the problem was not drug resistance but the inadequate use of

personal protective measures.  With this information, medical personnel could advise commanders on the proper

actions to prevent this situation from recurring.

The infrastructure supported by DoD GEIS provides capabilities that go beyond detection of emerging infections,

however.  The Mortality Surveillance Division was called into action after the September 11th attacks.  The effort

to identify the remains of the victims was staffed by many specialists from the AFIP.  One of those, MAJ Lisa

Pearse, is the chief of the Mortality Surveillance Division.  She created an electronic database to track victim

identification information for those who died in the attack on the Pentagon.  This is the first time that the Office

of the Armed Forces Medical Examiner has used an electronic tracking database to supplement paper records.

This made the reports coming from the field team more accurate and timely.  Dr. Pearse described the tracking

system is this way:   The database tracked demographic information on the missing [and] .as identifications

were made, we utilized the database to keep track of who had been identified and by what method (dental,

fingerprint, or DNA).   The Division is analyzing the data to evaluate casualty identification methods and injury

patterns and is assisting Pentagon engineers in identifying structural issues in the building that might have

influenced survival patterns.

Integrating the insights of epidemiologists, pathologists, clinicians, and legal investigators gives the Division a

unique perspective from which to identify emerging

infectious diseases of public health significance.

A dead service member is more than just an individual

tragedy; the death may be a harbinger of disease and

death to come.  Investigations into unexplained deaths,

which are relatively rare events in the military, may reveal

critical, population based insights that can be used to focus

prevention efforts.  This coffin at the Dover AFB Port

Mortuary holds recently identified remains of a victim of

the September 11th attack on the Pentagon.

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