FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION medical history included dementia, to a makeshift bed in a wooded camp- Hypothermia-Related multiple transient ischemic attacks site with his shirt partly covered with (TIAs), hypertension, and chronic atrial snow. The temperature that day ranged Deaths—Suffolk fibrillation. Her medications included from 24°F-41°F (−4.4°C-4°C). He was County, New York, digoxin, furosemide, aspirin, colchi- fully clothed, including hat and gloves, cine, and sertraline hydrochloride. On and was lying partially in a sleeping bag January 1999– December 21, she developed adult res- on top of a canvass pool cover. The de- March 2000, and piratory distress syndrome; she died on cedent had a history of alcohol and drug January 10, 1999. The death certifi- abuse, but no drugs or alcohol were United States, cate listed the cause of death as com- found in his blood. He had been living 1979-1998 plications of environmental exposure in the woods for several years and was with aspiration. Hypertension, arterio- last seen several weeks before his death. MMWR. 2000;50:53-57 sclerotic cardiovascular disease, and de- The death certificate listed the cause of mentia were contributory. death as probable hypothermia attrib- 2 figures omitted Case 2. In January 2000, a 51-year- uted to environmental exposure with old man wearing a rain-soaked sweater, chronic alcoholism contributing. HYPOTHERMIA IS THE UNINTENTIONAL pants, and work boots was found dead lowering of core body temperature to behind a dumpster. On the day he was New York ,95°F (,35°C).1 Core body tempera- found, the temperature ranged from During 1979-1998, the age-adjusted ture normally is maintained at 97.7°F 25°F-49°F (−3.9°C-9.4°C); the day be- death rate for hypothermia was 0.2 per (36.5°C).2 Most hypothermia-related fore, it had been raining with tempera- 100,000 population (International Clas- deaths occur during the winter in states tures in the 50s. Drug paraphernalia was sification of Diseases, Ninth Revision that have moderate to severe cold tem- found in his pockets and needle track [ICD-9], codes E901.0, E901.8, and peratures (e.g., Alaska, Illinois, New marks were observed on his arms. Ac- E901.9; excludes man-made cold York, and Pennsylvania).3 During 1979- cording to the police report, the dece- [E901.1]),* compared with the me- 1998, New York had the second high- dent had a history of illegal drug use. dian of 0.4 for the United States. Suf- est number of hypothermia-related Toxicology showed 0.10% ethanol, folk County ranked fifth among New deaths in the United States. This re- morphine, codeine, and methadone in York’s 62 counties in number of hypo- port presents case reports of four hy- his body. The death certificate listed the thermia-related deaths for persons of all pothermia-related deaths during Janu- cause of death as complications of acute ages. Age-specific death rates in Suf- ary 1999-March 2000 in Suffolk County and chronic drug abuse and environ- folk County and New York increased (1999 population: 1,383,847), the larg- mental hypothermia. with age . Of all hypothermia-related est county in New York excluding New Case 3. In January 2000, a 79-year- deaths in New York and Suffolk York City, and summarizes hypother- old woman who resided in an adult County, 386 (53%; 95% confidence in- mia-related deaths in the United States home facility had been missing for 40 terval [CI]=±3.6%) and 25 (58%; 95% during 1979-1998. Such deaths can be minutes. She was found outside, unre- CI=±14.8%), respectively, occurred prevented by educating health-care pro- sponsive, wearing a blouse, sweat- among persons aged $65 years. In Suf- viders and the public to identify per- shirt, and sweatpants. The tempera- folk County, age-adjusted death rates sons at risk for hypothermia. ture that day ranged from 26°F-32°F were three times higher for men than (−3.3°C-0°C). At a hospital, her rectal women. Case Reports temperature was 81°F (27°C). She was Case 1. On December 15, 1998, an treated with hypothermic blankets but United States 89-year-old woman with a history of died 1 hour later. The decedent had a During 1979-1998, 13,970 persons died wandering was noticed missing from history of senile dementia, syncope, and from hypothermia, an average of 699 the adult home facility where she re- TIAs. Her medications included iron deaths per year (range: 420-1024 sided and was found shivering in 1 foot sulfate and aspirin. The cause of death deaths) , and the age-adjusted death of water at the edge of a pond on the was hypothermia with senile demen- rates for hypothermia decreased property. The temperature that day tia and arteriosclerotic cardiovascular significantly (p,0.001). Of all hypo- ranged from 23°F-54°F (−5°C-12.2°C). disease contributing. thermia-related deaths, 6857 (49%; On admission to a hospital, her rectal Case 4. In March 2000, a 45-year- 95% CI=±0.83%) occurred among temperature was 95°F (35°C). Her old homeless man was found dead next persons aged $65 years. The age- ©2001 American Medical Association. All rights reserved. (Reprinted) JAMA, February 28, 2001—Vol 285, No. 8 1009 Downloaded From: https://jamanetwork.com/ on 09/29/2021 FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION adjusted rate for hypothermia was ap- confusion, memory loss, drowsiness, ex- son’s principles of internal medicine. 14th ed. New York, New York: McGraw-Hill, 1999:210-2. proximately 2.5 times higher for men haustion, fumbling hands, and slurred 9. CDC. Extreme cold: a prevention guide to promote (0.5 per 100,000 population) than speech. Severe hypothermia can result in your personal health and safety. Atlanta, Georgia: US women (0.2) during the same period. loss of consciousness, apparent apnea, or Department of Health and Human Services, CDC, 1996. undetectable pulse. In infants, warning *These data were obtained from the Compressed Mor- Reported by: CV Wetli, MD, Office of the Medical signs of hypothermia include cold, bright tality File (CMF), maintained by CDC’s National Cen- Examiner, Dept of Health Svcs, Suffolk County, Haup- ter for Health Statistics, and have been prepared in pauge; P Smith, MD, State Epidemiologist, New York red skin and lethargy. accordance with the external cause-of-death codes State Dept of Health. Health Studies Br, Div of Envi- Preventive measures include wear- from the ICD-9. The CMF contains information from ronmental Hazards and Health Effects, National Cen- death certificates filed in the 50 states and the Dis- ter for Environmental Health; and an EIS Officer, CDC. ing several layers of loosely fitting cloth- trict of Columbia. ing with a tightly woven, wind- CDC Editorial Note: The findings in this resistant outer layer and wool, silk, or report indicate that hypothermia- polypropylene inner layers to hold body Outbreak of Ebola related deaths in the United States de- heat. In cold and windy climates, per- creased during 1979-1998. In addition, sons should maintain dry clothing; eat Hemorrhagic Fever— in New York and Suffolk County, hypo- well-balanced meals; drink warm, sweet, thermia-related death rates increased by nonalcoholic beverages; and avoid ex- Uganda, August age category and were higher among ertion because excess perspiration can 2000-January 2001 men, similar to trends observed in the cause chilling.9 Persons who partici- United States. All four case-patients in pate in outdoor recreation should take MMWR. 2000;50:73-77 this report had one or more risk factors appropriate precautions, such as wear- 2 figures omitted for hypothermia-related death (e.g., older ing wet suits while participating in water- age [$65 years], lack of adequate hous- related activities or carrying emer- ON OCTOBER 8, 2000, AN OUTBREAK OF ing, homelessness, mental impairment, gency shelters and heat-generating an unusual febrile illness with occa- drug overdose, and alcohol ingestion).4 devices for unexpected weather changes sional hemorrhage and significant mor- Contributing factors include malnutri- while hiking or camping. During win- tality was reported to the Ministry of tion, lack of fitness, severe illness, and ter months or in areas with low night- Health (MoH) in Kampala by the su- drug use or abuse.5 time temperatures, blankets or extra perintendent of St. Mary’s Hospital in Data in this report are limited by the clothing should be kept in vehicles when Lacor, and the District Director of underreporting of hypothermia in medi- driving. Measures to prevent hypother- Health Services in the Gulu District. A cal records and death certificates.5 Hypo- mia-related deaths include educating the preliminary assessment conducted by thermia-related deaths may be underre- public and health-care providers (e.g., MoH found additional cases in Gulu ported because (1) physical signs of emergency department, adult home fa- District and in Gulu Hospital, the re- hypothermia may not be recognized; (2) cility, and social services staff) to iden- gional referral hospital. On October 15, hospitals may not use low-temperature tify persons at risk and establishing out- suspicion of Ebola hemorrhagic fever thermometers; (3) medical personnel reach programs that provide warm (EHF) was confirmed when the Na- may be unaware of hypothermia’s sig- shelter and adequate clothing. tional Institute of Virology (NIV), Jo- nificance; and (4) an autopsy cannot hannesburg, South Africa, identified prove hypothermia as an underlying REFERENCES Ebola virus infection among speci- cause of death.6 In addition, vital record 1. Petersdorf RG. Hypothermia and hyperthermia.