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Michael D. Kluger, MPH, Andre N. Sofair, MD, MPH, Constance J. Heye, MPH, James I. Meek, Rajesh K. Sodhi, MPH and James L. Hadler, MD

At the time of the study, Michael D. Kluger and Rajesh K. Sodhi were with the Connecticut Emerging Infections Program, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn. Andre N. Sofair is with the Departments of Internal Medicine and Epidemiology and Public Health and the Connecticut Emerging Infections Program, Yale University School of Medicine. Constance J. Heye is with Urban Policy Strategies, New Haven, CT. James I. Meek is with the Connecticut Emerging Infections Program, Department of Epidemiology and Public Health, Yale University School of Medicine. James L. Hadler is with the Bureau of Community Health, Infectious Diseases Division, State of Connecticut Department of Public Health, Hartford.

Correspondence: Requests for reprints should be sent to Andre N. Sofair, MD, MPH, Connecticut Emerging Infections Program, Yale University School of Medicine, Department of Epidemiology and Public Health, 40 Temple St, Suite 1B, New Haven, CT 06510 (e-mail: andre.sofair{at}yale.edu).

Objectives. This study investigated retrospective validation of a prospective surveillance system for unexplained illness and death due to possibly infectious causes.

Methods. A computerized search of hospital discharge data identified patients with potential unexplained illness and death due to possibly infectious causes. Medical records for such patients were reviewed for satisfaction of study criteria. Cases identified retrospectively were combined with prospectively identified cases to form a reference population against which sensitivity could be measured.

Results. Retrospective validation was 41% sensitive, whereas prospective surveillance was 73% sensitive. The annual incidence of unexplained illness and death due to possibly infectious causes during 1995 and 1996 in the study county was conservatively estimated to range from 2.7 to 6.2 per 100 000 residents aged 1 to 49 years.

Conclusions. Active prospective surveillance for unexplained illness and death due to possibly infectious causes is more sensitive than retrospective surveillance conducted through a published list of indicator codes. However, retrospective surveillance can be a feasible and much less labor-intensive alternative to active prospective surveillance when the latter is not possible or desired.

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