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Encephalitis Surveillance through the Emerging Infections Program, 1997–2010 - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC


Encephalitis Surveillance through the Emerging Infections Program, 1997–2010 - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 9—September 2015
Emerging Infections Program

CME ACTIVITY - Emerging Infections Program

Encephalitis Surveillance through the Emerging Infections Program, 1997–2010

Karen C. BlochComments to Author  and Carol A. Glaser
Author affiliations: Vanderbilt University, Nashville, Tennessee, USA (K.C. Bloch)Kaiser Permanente, Oakland, California, USA (C.A. Glaser)


Encephalitis is a devastating illness that commonly causes neurologic disability and has a case fatality rate >5% in the United States. An etiologic agent is identified in <50% of cases, making diagnosis challenging. The Centers for Disease Control and Prevention Emerging Infections Program (EIP) Encephalitis Project established syndromic surveillance for encephalitis in New York, California, and Tennessee, with the primary goal of increased identification of causative agents and secondary goals of improvements in treatment and outcome. The project represents the largest cohort of patients with encephalitis studied to date and has influenced case definition and diagnostic evaluation of this condition. Results of this project have provided insight into well-established causal pathogens and identified newer causes of infectious and autoimmune encephalitis. The recognition of a possible relationship between enterovirus D68 and acute flaccid paralysis with myelitis underscores the need for ongoing vigilance for emerging causes of neurologic disease.
Encephalitis is a potentially devastating illness: the related case-fatality rate in the United States is >5% (1), and substantial neurologic disability is common among survivors. Historically, this syndromic illness has been difficult to diagnose: an etiologic agent was identified in <50% of encephalitis cases in the United States diagnosed during 1987–1998 (2). A major barrier to diagnosis during that period was the lack of sensitive, noninvasive laboratory techniques to identify central nervous system pathogens. However, by the early 1990s, PCR was proven to be comparable to brain biopsy for the diagnosis of herpes simplex virus (HSV) encephalitis, without the need for an invasive surgical procedure (3). There was optimism that application of PCR could also improve microbiologic diagnoses of encephalitis infections caused by other pathogens and, by extension, the outcome of the illnesses. The Emerging Infections Program (EIP), which is funded by the Centers for Disease Control and Prevention, initiated the Encephalitis Project, a syndromic surveillance program for encephalitis in existing EIP sites beginning in New York in 1997, California in 1998, and Tennessee in 2000, and all ending by 2010.

Dr. Bloch is an Associate Professor in Medicine (Infectious Diseases) and Health Policy at Vanderbilt University in Nashville. She served as the principal investigator for the Tennessee Unexplained Encephalitis Surveillance Project. Her research interests focus on the study of encephalitis and arthropod-borne infections.
Dr. Glaser is a pediatric infectious disease physician at Kaiser Permanente in Oakland, California who served as the principal investigator for the California Encephalitis Project. Her primary research interests are zoonotic illness and neurologic disease.


Support for the EIP Encephalitis Project was provided by a grant from the Centers for Disease Control and Prevention Emerging Infections Program to the California Department of Health (U50/CCU915546-09) and to the Tennessee Department of Health (U50/CCU416123-09).


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Suggested citation for this article: Bloch KC, Glaser CA. Encephalitis surveillance through the Emerging Infections Program, 1997–2010. Emerg Infect Dis. 2015 Sep [date cited]. http://dx.doi.org/10.3201/eid2109.150295
DOI: 10.3201/eid2109.150295

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