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      Trends in Encephalitis-Associated Deaths in the United States, 1999-2008

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          Abstract

          Background: While encephalitis may be caused by numerous infectious, immune and toxic processes, the etiology often remains unknown. Methods: We analyzed multiple cause-of-death mortality data during 1999-2008 for the USA, using the 10th revision of International Classification of Diseases codes for encephalitis, listed anywhere on the death record, including ‘specified' and ‘unspecified' encephalitis. Annual and average annual age-adjusted and age-specific death rates were calculated. Results: For 1999-2008, 12,526 encephalitis-associated deaths were reported with 68.5% as unspecified encephalitis. The average annual age-adjusted encephalitis-associated death rate was 4.3 per 1 million persons, 1.3 for specified and 2.9 for unspecified encephalitis. Annual encephalitis-associated death rates had a significant downward trend (p < 0.01). The most common specified encephalitis deaths were herpesviral encephalitis (36.7%), Toxoplasma meningoencephalitis (27.8%) and Listeria meningitis/meningoencephaltis (6.8%). HIV was colisted with 15.0% of encephalitis-associated deaths, 58.4% of these with a specified code. Conclusion: Encephalitis-associated death rates decreased during 1999-2008, and herpesvirus was the most commonly identified infectious agent associated with encephalitis deaths. The high proportion of unspecified encephalitis deaths highlights the continued challenge of laboratory confirmation for causes of encephalitis and the importance of monitoring trends to assess the impact of new diagnostics and guide potential interventions.

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          Most cited references 15

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          The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America.

          Guidelines for the diagnosis and treatment of patients with encephalitis were prepared by an Expert Panel of the Infectious Diseases Society of America. The guidelines are intended for use by health care providers who care for patients with encephalitis. The guideline includes data on the epidemiology, clinical features, diagnosis, and treatment of many viral, bacterial, fungal, protozoal, and helminthic etiologies of encephalitis and provides information on when specific etiologic agents should be considered in individual patients with encephalitis.
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            West Nile virus: epidemiology and clinical features of an emerging epidemic in the United States.

            West Nile virus (WNV) was first detected in North America in 1999 during an outbreak of encephalitis in New York City. Since then the virus has spread across North America and into Canada, Latin America, and the Caribbean. The largest epidemics of neuroinvasive WNV disease ever reported occurred in the United States in 2002 and 2003. This paper reviews new information on the epidemiology and clinical aspects of WNV disease derived from greatly expanded surveillance and research on WNV during the past six years.
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              The sex differential in morbidity, mortality, and lifestyle.

               D W Wingard (1983)
              In the United States women live longer than men, and they have lower death rates at virtually every age and for most causes of death. Similar relationships prevail in most developed nations. The sex differential in mortality has been increasing since the early 1900s , especially for those 15-24 and 55-64 years of age. Since 1970, however, that trend has slowed for persons 45-74, and in 1980 the sex differential was actually lower than in 1970 among those 55-64. Although the female sex advantage in respect to most causes of death has been increasing, the differential for coronary heart disease has recently stabilized; and the lung cancer mortality rate among women is now increasing faster than that among men. Recent statistics for these two important causes of death may indicate that the previous, more favorable trend in women than in men may be reversing in response to changes in lifestyle. Women's health may be improving at a slower rate because they are exposed to more job stresses and other risk factors, such as cigarettes, than before; alternatively, men's health may be improving at a faster rate because they are exercising more, smoking cigarettes less, and following healthier diets in recent decades. Despite their continuing mortality advantage, women experience more illness than men. This may reflect women's greater utilization of medical services, and physicians' diagnostic patterns, as well as women's greater willingness to acknowledge and report illness. Sex differences in illness persist, however, when physical examinations are used for assessment in population-based samples. Women appear to have higher rates of conditions that rarely cause death, for example, rheumatoid arthritis; whereas men tend to have more fatal conditions, such as coronary heart disease. At least two categories of lifestyle characteristics are associated with male-female differences in health: (a) social roles, such as marriage, parenthood, and employment; and (b) behaviors, such as cigarette smoking and Type A behavior. Preliminary evidence indicates that some of these lifestyle characteristics may act synergistically on health. Several aspects of lifestyle thus underlie sex differences in morbidity and mortality. There is also evidence that biological factors influence male/female mortality differences, particularly in infancy and prenatal life. A substantial sex differential remains, however, even after adjusting for numerous lifestyle and biological variables. This is especially true for heart disease mortality.(ABSTRACT TRUNCATED AT 400 WORDS)
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                Author and article information

                Journal
                NED
                Neuroepidemiology
                10.1159/issn.0251-5350
                Neuroepidemiology
                S. Karger AG
                0251-5350
                1423-0208
                2014
                October 2014
                24 June 2014
                : 43
                : 1
                : 1-8
                Affiliations
                aEpidemic Intelligence Service and bDivision of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Ga., USA
                Author notes
                *James J. Sejvar, E-Mail zea3@cdc.gov
                Article
                362688 Neuroepidemiology 2014;43:1-8
                10.1159/000362688
                24968857
                © 2014 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 1, Tables: 3, Pages: 8
                Categories
                Original Paper

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