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Media Briefing: Influenza A (H1N1)
(Conducted by Dr. Jon K. Andrus, Pan American Health Organization, May 4, 2009)

Photo by Harold Ruiz/PAHO  

Good afternoon. Welcome again to all members of the Press who are on the line, and thank you again for taking the time to listen to today's briefing by the Pan American Health Organization on the Influenza A (H1N1) epidemic that is currently ongoing.
  • The main purpose of these briefings will be to keep you updated with the best available information to the extent possible on the current situation, particularly as it evolves in our Region of the Americas. We also want to share with you any new scientific information that will ensure we are implementing the best strategies to control the outbreak, as well as the work we are doing to support countries. Finally, we want to re-emphasize what individuals and communities can be doing to protect themselves.
  • I will covering three major items today: a brief re-cap of the descriptive epidemiology of the outbreak, a summary of the major conclusions we presented yesterday, and finally provide you more detail what PAHO is doing to assist countries of the Americas, as well as what individuals can be doing to protect themselves and their families.
  • To summarize the epidemiologic situation:
    • Globally, the latest data show >1000 confirmed cases due to the new Influenza A (H1N1) virus have been reported from 20 countries.
    • There have been 26 deaths (25 in Mexico and 1 in the USA).
    • In our Region of the Americas, we now have 943 cases (Canada 101, Colombia 1, Costa Rica 4, El Salvador 2, Mexico 590, and USA 245 cases).
    • But we should not be spending so much time on the numbers. Numbers will rise and drop. We now know that approximately 744 probable cases are under laboratory investigation in the US, so this illustrates how rapidly the situation changes. We need to focus on preparation and prevention. And we cannot let our guard down.
    • Our data indicate, sustainable community transmission has been established in the US and Mexico.
    • The following points are important for all individuals to understand, particularly when making decisions such as should I send my child to school or should I keep them home. Should a work colleague be sent home, etc.
    • All flu outbreaks are serious. This one is especially serious because it is a new virus. This means that people have not been previously exposed to this virus, therefore have no immunity.
    • The incubation period of this disease is probably a couple of days with a range of 2-7 days or so based on seasonal influenza.
    • The period of communicability is from 1 day prior to symptom onset to 5 days after.
    • The method of transmission is by droplets, so hand washing, personal hygiene, covering mouth when coughing, and social distancing cannot be over-emphasized.
    • The clinical features remain unchanged, the infections are mild to moderate.
    • The Southern Hemisphere is about to enter its winter season, and the winter season provides better conditions for more rapid influenza virus spread.

  • So let's summarize quickly the major conclusions from yesterday. First, despite the mild to moderate nature of the illness, we know that things change very quickly and very dramatically. What we know about influenza and RNA viruses in general are predictable in their UN-predictability. And to that end, we reminded ourselves of the 1918 Flu pandemic.
  • It is very important to convey that PAHO and WHO recommend that countries NOT impose restrictions on travel or close their border. Research suggests that these types of aggressive actions will not prevent the spread of virus. The virus has already spread to a number of locations. However, people who become ill should definitely postpone travel, and people who travel and return ill should seek medical advice. This also means that adults who become ill should not go to work and avoid public gatherings. Children who become ill should be kept home from going to school.
  • We spoke briefly about the successes in the Americas, referring to control of yellow fever, the 7th global cholera pandemic that occurred in the early 1990's of last century, and the disease elimination efforts. This gives us optimism that when we have additional tools in hand, like vaccines, countries will do the job necessary to control this outbreak.
  • WHO is leading the world's efforts on a vaccine. We have antiviral medications (oseltamivir and ranamivir) that treat acute infection if given early enough.
  • We talked about a range of estimates when the vaccine will be ultimately available for community vaccination programs. Our best estimate is within the next 4-6 months.
  • Since our best estimate is 4-6 months, what can we do in the meantime?
  •  To that end, we call upon all people to practice basic hygiene such as covering the mouth when coughing, using disposal tissues, frequent hand washing, staying at home when you are sick and maintaining some measures of social distancing. Make plans to keep your children at home if they become sick with fever. Work out contingency plans with your family. Also, work with your community. Again, we cannot over-emphasize these interventions. These are interventions that individuals and communities should be doing. They are simple but highly powerful in their capacity to affect disease transmission.
  • OK, let's move on to discuss in more detail what PAHO is doing to assist countries.
  • Since the onset of the emergency, PAHO epidemiologists, virologists, and logisticians with other experts from CDC and WHO have been working around the clock with Mexican authorities and scientists in the Ministry of Health.
  • PAHO has four experts on risk communications working with the authorities to help ensure that the right messages are being conveyed given our current understanding of this virus.
  • Of high priority has been the work to clean up the backlog of specimens that flooded the Mexican public health laboratories. You are now seeing that work paying off with a clearer picture of the epidemic curve and how the outbreak is evolving within the country.
  • I should spend some time describing PAHO's network of technical cooperation in the Region. Supported by our Regional Office here in Washington, DC, and our global office in Geneva, PAHO has country offices in all our member countries. In addition, the Caribbean countries have a sub-regional office with sophisticated laboratory that services the island and countries of the Caribbean geographic area.
  • These country and sub-regional offices are staffed with experts in infectious disease epidemiology, virology and laboratory science, and logistics.
  • Our country office in Mexico City has been working around the clock supporting our colleagues in the Ministry of Health of Mexico.
  • From this network of country-based offices, PAHO has mobilized teams of experts from un-affected countries to travel to Mexico to assist with outbreak control measures.
  • Because PAHO works very closely with scientists from Public Health Canada, and from the Centers for Disease Control and Prevention of the United States Health and Human Services, experts from these offices have become vital members of PAHO's country support team response to this crisis.
  • You have been hearing over and over again that one response to this outbreak is to rapidly enhance surveillance everywhere. What that means is that we are supporting efforts to ensure all possible cases are being identified, and then more importantly being able to determine whether any particular individual is infected with the virus or not.
  • We already have a well-functioning network of National Influenza Centers throughout the hemisphere that forms the backbone of this surveillance work.
  • Guidelines to be used by public health officials and medical providers covering a wide range of topics are available on our and WHO's website, including guidelines for:
    • Health care setting infection control procedures,
    • Clinical case management,
    • Epidemiologic and laboratory surveillance of disease,
    • Outbreak response measures,
    • Communication strategies for keeping the public well-informed, and
    • Management and operations of preventive services, such as immunization programs.

  • PAHO's regional office staff in our administration, and procurement units are collecting information from all countries determining their best forecasts of demand for operational resources, antiviral medicines, and vaccines. PAHO has the machinery in place to place orders, negociate with the suppliers, and ensure that shipments arrive in time.
  • Closely related to this, is defining the gaps in resource requirements and mobilizing additional resources from our partners such Inter-American Development Bank and others.
  • I previously mentioned PAHO's collaboration with the Global Task Force on Influenza A (H1N1) Vaccine, which has met on a daily basis beginning last Sunday, 26 April.
  • In addition, we participate in a number of other global  Task Forces and other committees and working groups, including:
    • Daily conference calls with the International Health Regulations Team, involving Geneva, regional, and country offices,
    • Global Scientic Task Force on Influenza A (H1N1), which also conducts a daily teleconference call to share information with all regional offices as it emerges,
    • Daily teleconference calls with scientists of Health Canada and CDC.

  • Equitable distribution of vaccine to developing countries is an absolute top priority for PAHO. PAHO's Revolving Fund has more than 30 years of experience working with countries to provide a safe, affordable supply chain of effective vaccines. The Revolving Fund has a track record of responding to emergencies, the first urban yellow fever outbreak in the Americas in >40 years is an excellent example of a crisis we faced last year in Paraguay and neighboring countries.
  • Once Influenza A (H1N1) vaccine becomes available, by all accounts, most likely the global supply will most likely be limited. Globally, perhaps 1-2 billion doses will be become available, falling far short of the more than 6 billion people living on the planet. Vaccination strategies will need to target those individuals at higher risk. Again, the data coming out of Mexico determining risk factors for morbidity and mortality will be critical not only for Mexico, but for the rest of the world.
  • So, we are working hard with all our partners to fill gaps in information that will help ensure we are providing the best outbreak response.
  • Are we prepared? We can never be fully prepared. But the American region has never been better prepared to confront this crisis. We are seeing the benefits of the work over the last 3-4 years done by PAHO to help countries with their efforts to be as prepared as possible for a global pandemic. The situation will continue to evolve and we will keep you informed.
  • With that I will stop to answer any questions that you may have. Thanks for taking the time to listen to this briefing.


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