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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.


  1. 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.

  2. CDC. Sudden, unexpected, nocturnal deaths among Southeast Asian refugees. MMWR 1981;30:581-4, 589.

  3. Refugee Resettlement Program. Report to Congress. Washington, DC: US Department of Health and Human Services, Social Security Administration, 1988.

  4. Refugee Program. Monthly summary, September 30, 1987. Washington, DC: Department of State, Refugee Program, Sept. 1987.

  5. Refugee Program. Monthly summary, December 31, 1987. Washington, DC: Department of State, Refugee Program, Dec. 1987.

  6. Kirschner RH, Eckner FAO, Baron RC. The cardiac pathology of sudden, unexplained nocturnal death in Southeast Asian refugees. JAMA 1986;256:2700-5.

  7. 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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