Update: Sudden Unexplained Death Syndrome Among Southeast Asian Re fugees -- United States
Between October 1, 1986, and April 30, 1988, 10 cases of sudden
unexplained death syndrome (SUDS) in Southeast Asian (SEA) refugees
were reported to CDC. In addition, three earlier reports were
confirmed
as SUDS based on additional information. These 13 reports bring the
total number of SUDS in SEA refugees to 117 since CDC surveillance
for
SUDS began in 1981 (1,2). Since 1982, the number of SUDS cases has
continued to decline (Figure 1). Five deaths occurred in 1987 and
two
in the first 4 months of 1988. The crude death rate in SEA males
for
1987 was 1.1 per 100,000, the lowest since 1976.
The 13 new cases occurred in nine states. California reported the
most
cases (four), followed by Minnesota (two). North Carolina and
Arizona,
which previously had not reported cases, had SUDS cases in January
and
May 1987, respectively. Otherwise, the geographic distribution of
cases
remains similar to that of previously reported cases (Table 1) (1).
Age
at death ranged from 19 to 57 years (median: 33 years). All
decedents
were men. Nine were Laotian (five Hmong, two lowland Lao, and two
unknown), and two each were Vietnamese and Kampuchean. Twelve of
the
deaths occurred either at night or during sleep. One decedent, a
Laotian man, had a cardiac arrest at night during sleep. He was
resuscitated but was comatose when hospitalized; his condition
deteriorated, and he was pronounced brain dead 4 days later.
Length of time in the United States was known for seven of the 13
decedents and ranged from 1 to 11 years (median: 4 years). The
median
length of time in the United States for the 88 of the 117 decedents
for
whom time in the United States was known was 17 months.
Reported by: Surveillance and Programs Br, Div of Environmental
Hazards
and Health Effects, Center for Environmental Health and Injury
Control,
CDC.
Editorial Note
Editorial Note: CDC continues to receive reports of sudden deaths
in
SEA refugees in the United States, although the number of reported
cases and the crude death rate continue to decline. Approximately
850,000 SEA refugees live in the United States (3). The number of
new
arrivals has declined since its peak of 151,000 in 1980 and was
only
36,000 in 1987 (4,5). The decline in SUDS cases may be related to
this
decline in newly arrived SEA refugees, since most deaths occur
within
the first 2 years after arrival in the United States. The ceiling
for
East Asian (including SEA) refugee admissions in fiscal year 1988
(October 1, 1987, to September 30, 1988) for the United States is
38,000 (5). Assuming the previous pattern continues, the number and
rate of SUDS deaths in 1988 will probably remain at 4-5 deaths and
1-2
deaths per 100,000 males, respectively. Although studies have
suggested
that a structural abnormality of the cardiac conduction system (6)
and
stress (7) may be risk factors for SUDS, the cause of the deaths
remains unknown.
Please direct case reports and questions about sudden deaths in
SEA
refugees directly to the Surveillance and Programs Branch, Division
of
Environmental Hazards and Health Effects, Center for Environmental
Health and Injury Control, CDC, telephone: (404) 488-4780.
References
CDC. Sudden unexplained death syndrome in Southeast Asian
refugees:
a review of CDC surveillance. In: CDC surveillance summaries, Feb.
1987. MMWR 1987;36(no. 1SS): 43SS-53SS.
CDC. Sudden, unexpected, nocturnal deaths among Southeast Asian
refugees. MMWR 1981;30:581-4, 589.
Refugee Resettlement Program. Report to Congress. Washington,
DC: US
Department of Health and Human Services, Social Security
Administration, 1988.
Refugee Program. Monthly summary, September 30, 1987.
Washington,
DC: Department of State, Refugee Program, Sept. 1987.
Refugee Program. Monthly summary, December 31, 1987. Washington,
DC:
Department of State, Refugee Program, Dec. 1987.
Kirschner RH, Eckner FAO, Baron RC. The cardiac pathology of
sudden,
unexplained nocturnal death in Southeast Asian refugees. JAMA
1986;256:2700-5.
Baron RC, Thacker SB, Gorelkin L, Vernon AA, Taylor WR, Choi K.
Sudden death among Southeast Asian refugees. JAMA 1983;250:2947-51.
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