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Infectious Disease Epidemiology Program

Unexplained Deaths with History of Fever (UNEX)

Surveillance of UNEX in Arizona
Unexplained deaths with a history of fever (UNEX) have been reportable in Arizona since 2004. Health care providers (including hospitals and medical examiners (ME)) are required to report UNEX to their local health department within 24 hours of detection (A.A.C. R9-6-202), after which the local health department notifies ADHS and initiates an investigation.

Purpose of UNEX Investigations
The purpose of these UNEX investigations is to identify deaths that might be of public health significance in order to prevent the spread of disease. This could include deaths due to infectious diseases:

  • transmitted person-to-person
  • requiring a public health intervention
  • representing a new or emerging infection
  • due to an act of terrorism.

What is UNEX?
The Arizona Administrative Code defines an “unexplained death with a history of fever” as the “demise of an individual who has had a fever within 48 hours before death and whose illness has not been diagnosed at time of death”. The following guidelines are used by public health agencies to identify deaths at high risk of being caused by an agent of public health significance:

  1. Hospital/facility-based death with no known cause AND history of fever (>100.4°F) OR a temperature of <96.8°F within 48 hours of death; OR
  2. Patient-reported history of fever within 48 hours of death; OR
  3. Clinical suspicion of infectious etiology by a health care provider or medical examiner.

Important Resources

Reporting UNEX Investigations
UNEX cases should be reported to your local health department within 24 hours of detection. This report should include the following:

  • Demographics
  • description of course of illness that resulted in death
  • a list of the laboratory tests completed and available results
  • the suspected cause of death(s)
  • status of autopsy
  • contact information for a family member of the deceased that can serve as a point of contact
  • Reporter contact information (A.A.C. R9-6-202).

Clinical Specimen Collection and Handling

Laboratory testing for Unexplained deaths that appear likely to have infectious disease etiologies can be done at the Arizona State Public Health Laboratory. Majority of this testing will be primarily pathology-directed. The two guidelines below provide resources for both the Medical Examiner and the local health departments to ensure appropriate pathology specimens are obtained.

Unexplained Death Forms

All Medical Examiners that are suspecting Infectious Disease etiology for an UNEX case are encouraged to complete an Autopsy Findings form when performing an autopsy. Local Health Departments report the final findings of the UNEX case using the UNEX Case Report Form once all laboratory testing has been completed.

Unexplained Death Investigation Guides and Other Resources

Unexplained Death Investigation Reports

Note: Information provided in PDF files.