Accepted for Publication: December 8, 2013.
Published Online: May 12, 2014. doi:10.1001/jamainternmed.2014.344.
Study concept and design: Conklin, Sejvar, Victoria, Rodriguez, McGeehin, Schier.
Acquisition, analysis, or interpretation of data: Conklin, Sejvar, Kieszak, Sabogal, Sanchez, Flanders, Tulloch, Victoria, Rodriguez, Sosa, Schier.
Drafting of the manuscript: Conklin, Sejvar, Kieszak, Rodriguez, Schier.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Conklin, Kieszak, Flanders, Rodriguez.
Obtained funding: Conklin, Tulloch, Schier.
Administrative, technical, or material support: Conklin, Sejvar, Sabogal, Rodriguez, Sosa, McGeehin.
Study supervision: Conklin, Sejvar, Victoria, Rodriguez, Schier.
Conflict of Interest Disclosures: None reported.
Disclaimer: The findings and conclusions in this study are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Previous Presentation: Some of this content was presented orally at the 2011 Annual Meeting of the North American Congress of Clinical Toxicology; September 24, 2011; Washington, DC.
Additional Contributions: We gratefully acknowledge the tremendous help from all of our participants and support from the Panama Ministry of Health; Lauren Lewis, MD, MPH, Damon Del'Aglio, MD, and Bertram Ackermann, BS, Division of Environmental Hazards and Health Effects, National Centers for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Jorge Motta, MD, The Gorgas Memorial Institute, Panama City, Panama; Marisol Ng, MD, Donna Chen de Lee, MD, and Rosemary Jovane, Hospital Santo Tomás, Panama City, Panama; and Celia Gomez, MD, and Jose Manzanares, MD, Caja de Seguro Social, Panama City, Panama.