Respiratory virus infections in decedents in a large, urban medical examiner's office

A F Brouwer; A M Wilson; E T Martin; J Zelner; P R Lephart; A Jaworski; C J Schmidt

doi:10.1016/j.puhe.2023.08.029

Respiratory virus infections in decedents in a large, urban medical examiner's office

Public Health. 2023 Sep 25:224:118-122. doi: 10.1016/j.puhe.2023.08.029. Online ahead of print.

Authors

A F Brouwer¹, A M Wilson², E T Martin³, J Zelner⁴, P R Lephart², A Jaworski⁵, C J Schmidt⁵

Affiliations

¹ Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States. Electronic address: brouweaf@umich.edu.
² Department of Pathology, University of Michigan, Ann Arbor, MI, United States.
³ Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States.
⁴ Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States; Center for Social Epidemiology and Population Health, University of Michigan, Ann Arbor, MI, United States.
⁵ Department of Pathology, University of Michigan, Ann Arbor, MI, United States; Wayne County Medical Examiner's Office, Detroit, MI, United States.

PMID: 37757630
DOI: 10.1016/j.puhe.2023.08.029

Abstract

Objective: Most respiratory virus surveillance relies on medically attended respiratory illness, but an understanding of the true patterns of infection independent of care-seeking behaviour would enhance clinical and public health responses to respiratory virus outbreaks. We evaluated the potential of decedent surveillance by estimating the burden of respiratory virus infection in decedents in a large, urban medical examiner's office.

Study design: Observational.

Methods: In 2020-2022, we tested nasopharyngeal swabs from 4121 decedents in Detroit, Michigan for 15 respiratory viruses, including SARS-CoV-2, respiratory syncytial virus, and influenza virus A and B. We analysed infection prevalence over time and by age, sex, race/ethnicity, and manner of death.

Results: Of 4113 valid tests, 30.2% were positive for at least one virus, and 6.1% were positive for multiple viruses. All viruses were detected except for influenza A/H1N1 and influenza B. The most prevalent viruses were SARS-CoV-2 (15.7%), rhinovirus (11.2%), and adenovirus (4.9%), which were detected in all months. Most viruses exhibited decreasing prevalence with age, higher prevalence among Black and Hispanic than among White decedents and lower prevalence among deaths from natural causes; SARS-CoV-2 was a notable exception to the patterns by age and manner of death, instead reflecting community trends in catchment counties.

Conclusions: There was high prevalence and diversity of respiratory viruses in decedents entering a large, urban medical examiner's office. Decedent surveillance could offer a clearer picture of the true underlying burden of infection, motivating public health priorities for intervention and vaccine development, and augmenting data for real-time response to respiratory virus outbreaks.

Keywords: Decedent; Medical examiner; Respiratory virus; SARS-CoV-2; Surveillance.