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To the Editor: Dr Inglesby and colleagues¹ recommend that aerosol-generating autopsies (essentially all autopsies) performed on individuals who have died of plague should be conducted in negative-pressure rooms by prosectors wearing high-efficiency particulate air–filtered respirators. However, their recommendation points to a major limitation in our national autopsy infrastructure. Deaths from known bioterrorist events are classified as homicides and therefore fall under the jurisdiction of medical examiners and coroners, who would investigate these deaths and, unless overwhelmed by large numbers of fatalities, perform autopsies of the bodies. Similarly, medical examiners or coroners might also perform autopsies of individuals who die precipitously and unexpectedly from a covert bioterrorist attack.

Unfortunately, most offices of medical examiners and coroners and, indeed, most hospital autopsy facilities in the United States are inadequately constructed and ill prepared to perform autopsies that require respiratory precautions. Aerosol-transmitted outbreaks of tuberculosis have been traced to autopsies done in the . . . [Full Text of this Article]

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RELATED ARTICLE

Plague as a Biological Weapon: Medical and Public Health Management
Thomas V. Inglesby, David T. Dennis, Donald A. Henderson, John G. Bartlett, Michael S. Ascher, Edward Eitzen, Anne D. Fine, Arthur M. Friedlander, Jerome Hauer, John F. Koerner, Marcelle Layton, Joseph McDade, Michael T. Osterholm, Tara O'Toole, Gerald Parker, Trish M. Perl, Philip K. Russell, Monica Schoch-Spana, Kevin Tonat, and for the Working Group on Civilian Biodefense
JAMA. 2000;283(17):2281-2290.
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