{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T12:45:33Z","timestamp":1777898733914,"version":"3.51.4"},"reference-count":17,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T00:00:00Z","timestamp":1704931200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>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,\u2014a 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\u2013related deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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\u2013related deaths, representing 2.0% of total COVID-19\u2013related deaths in Minnesota. Eighty-nine decedents (42.0%) were from racial and ethnic minority populations, representing 6.1% more COVID-19\u2013related deaths among people from racial and ethnic minority populations than would have been detected without this surveillance system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Practice Implications:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00333549231218283","type":"journal-article","created":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T06:03:42Z","timestamp":1704953022000},"page":"325-332","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Surveillance for Unexplained Deaths of Possible Infectious Etiologies During the COVID-19 Pandemic\u2014Minnesota, 2020-2021"],"prefix":"10.1177","volume":"139","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2244-3729","authenticated-orcid":false,"given":"Melanie J.","family":"Firestone","sequence":"first","affiliation":[{"name":"Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, USA"},{"name":"Minnesota Department of Health, St Paul, MN, USA"},{"name":"Now with School of Public Health, University of Minnesota, Minneapolis, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linnea","family":"Thorell","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leslie","family":"Kollmann","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lydia","family":"Fess","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Greta","family":"Ciessau","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna K.","family":"Strain","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Danila","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth","family":"Lynfield","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St Paul, MN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stacy","family":"Holzbauer","sequence":"additional","affiliation":[{"name":"Minnesota Department of Health, St Paul, MN, USA"},{"name":"Career Epidemiology Field Officer Program, Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the UNEX Surveillance Team","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,1,11]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Centers for Disease Control and Prevention. Public health surveillance: preparing for the future. September 2018. Accessed June 6 2023. https:\/\/www.cdc.gov\/surveillance\/pdfs\/Surveillance-Series-Bookleth.pdf"},{"issue":"11","key":"e_1_3_3_3_2","first-page":"34","article-title":"Explaining the unexplained: identifying infectious causes of critical illness and death in Minnesota","volume":"91","author":"DeVries A","year":"2008","unstructured":"DeVries A, Lees C, Rainbow J, Lynfield R. Explaining the unexplained: identifying infectious causes of critical illness and death in Minnesota. Minn Med. 2008;91(11):34-36.","journal-title":"Minn Med"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid0201.960106"},{"issue":"2","key":"e_1_3_3_5_2","first-page":"125","article-title":"Emerging infectious agents and the forensic pathologist: the New Mexico model","volume":"120","author":"Nolte KB","year":"1996","unstructured":"Nolte KB, Simpson GL, Parrish RG. Emerging infectious agents and the forensic pathologist: the New Mexico model. Arch Pathol Lab Med. 1996;120(2):125-128.","journal-title":"Arch Pathol Lab Med"},{"key":"e_1_3_3_6_2","unstructured":"Minnesota Department of Health. MED-X case definition. November 9 2022. Accessed June 6 2023. https:\/\/www.health.state.mn.us\/diseases\/unex\/me\/casedef.html"},{"key":"e_1_3_3_7_2","unstructured":"Office of the Revisor of Statutes. Minnesota statutes: 390.11 investigations. 2022. Accessed June 6 2023. https:\/\/www.revisor.mn.gov\/statutes\/cite\/390.11"},{"key":"e_1_3_3_8_2","unstructured":"Minnesota Department of Health. Reporting unexplained deaths and unexplained critical illnesses. October 20 2022. Accessed June 6 2023. https:\/\/www.health.state.mn.us\/diseases\/unex\/report.html"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid1708.101914"},{"key":"e_1_3_3_10_2","unstructured":"Office of the Revisor of Statutes. Minnesota statutes: 149a.02 definitions. 2022. Accessed April 6 2023. https:\/\/www.revisor.mn.gov\/statutes\/cite\/149A.02"},{"key":"e_1_3_3_11_2","unstructured":"Minnesota Department of Health. MDH issues updated guidance on COVID-19 testing criteria. March 17 2020. Accessed June 5 2023. https:\/\/www.health.state.mn.us\/news\/pressrel\/2020\/covid031720.html"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6937a3"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid2708.204838"},{"key":"e_1_3_3_14_2","unstructured":"MPR News Staff. Timeline: COVID-19 in Minnesota. March 6 2021. Accessed May 25 2022. https:\/\/www.mprnews.org\/story\/2021\/03\/06\/timeline-covid-19-minnesota"},{"key":"e_1_3_3_15_2","unstructured":"Minnesota Department of Health. Testing decedents for COVID-19. October 1 2022. Accessed October 4 2023. https:\/\/www.health.state.mn.us\/facilities\/providers\/mortsci\/docs\/coviddecedenttest.pdf"},{"key":"e_1_3_3_16_2","unstructured":"Minnesota Department of Health. Clinical specimen collection and handling: unexplained critical illnesses and deaths. October 20 2022. Accessed May 24 2022. https:\/\/www.health.state.mn.us\/diseases\/unex\/collection.html"},{"key":"e_1_3_3_17_2","unstructured":"Minnesota Department of Health. Mortality (death) data: COVID-19 situation update. March 2023. Accessed April 6 2023. https:\/\/www.health.state.mn.us\/diseases\/coronavirus\/stats\/death.html"},{"key":"e_1_3_3_18_2","unstructured":"US Census Bureau. QuickFacts Minnesota. July 1 2022. 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