This report was prepared based on the indicators in the document Human infection with pandemic (H1N1)2009 virus: updated interim WHO guidance on global surveillance.
The qualitative indicators for surveillance of the Pandemic (H1N1) 2009 are described in Table 3 of this report. The information presented herein has been obtained through the official sites of the Ministries of Health of the countries in the Region as well as official reports submitted by the International Health Regulation (IHR) National Focal Points.
Update on the Qualitative Indicators
As of Epidemiological Week 28 (EW 28, July 12 to 18) 34 of the 35 countries in the Region of the Americas have reported presence of the pandemic (H1N1) 2009 virus.
For many countries in the Region, not all of the information is available regarding the qualitative indicators for the monitoring of pandemic (H1N1) 2009. The data that have been used to evaluate the indicators for intensity and trend of respiratory disease activity, as well as virologic monitoring, correspond to epidemiological week 26 to 28, depending on each country. As countries become familiar with the new notification requirements, it is expected that more complete and up-to-date information will become available.
Of the countries with available information, 19 exhibit widespread geographical distribution, four more than in epidemiological week 27 (Colombia, Paraguay, Peru and Uruguay) (Map 1).
Regarding the trend of respiratory disease in the Region, information is available for 18 countries (Map 2); six of these (Argentina, Belize, Chile, Haiti, Paraguay and Venezuela) display an increasing trend.
As to the intensity of acute respiratory disease, information is available for only 15 countries (Map3). Of these, two display very high intensity (Chile and Argentina) while five are categorized as having high intensity (Canada, El Salvador, Mexico, Paraguay and Uruguay). Nineteen countries do not have information available for this indicator.
Ten countries have provided information regarding the impact on health-care services (Map 4), none of which were categorized as high; however, three countries were categorized as moderate.
Of the countries for which information is available, the situations in Chile and Argentina are worthy of note as both exhibit widespread geographical distribution, an increasing trend and a very high intensity of acute respiratory disease. Also worth mentioning is that Canada, Mexico, El Salvador, Paraguay and Uruguay all exhibit widespread distribution and a high intensity of acute respiratory disease (which in the case of Paraguay is also accompanied by an increasing trend in respiratory disease activity).
The World Health Organization (WHO) does not recommend any restrictions to travel or the closing of borders due to pandemic (H1N1) 2009.
Update on the number of cases and deaths
During epidemiological week 28, Belize, Haiti and Saint Kitts and Nevis reported the presence of the pandemic (H1N1) 2009 virus for the first time; and Bolivia reported the first deaths in the country.
As of July 22, 2009, a total of 88,408 confirmed cases have been notified in 34 countries in the Americas Region. Grenada remains the only country that has not notified confirmed cases of the pandemic (H1N1) 2009 virus. Also, a total of 737 deaths have been notified, from the confirmed cases, in 20 countries of the Region.
In addition to the figures displayed in Table 2, the following territories have reported cases caused by the pandemic (H1N1) 2009 virus: American Samoa (8); Guam, USA (1); Puerto Rico, USA (18); Virgin Islands, USA (44); Bermuda, UK (1); Cayman Islands, UK (14); Virgin Islands, UK (2); Martinica, FR (15); Guadeloupe, FR (11); Saint-Martin, FR (1); Netherlands Antilles, Bonaire (4); Netherlands Antilles, Curaçao a (13); Netherlands Antilles, Aruba (13); Netherlands Antilles, St. Eustatius (1) and Netherlands Antilles, St. Marteen (12).
a Three cases were registered on a cruise ship.
The distribution of cases and deaths at the first subnational level can be found in the interactive map available through the following link: http://www.paho.org/hq/images/atlas/en/atlas.html
Update on the Virologic Situation
Information on surveillance of the virologic situation of the pandemic is available for Canada, CAREC1, Chile, Colombia and the United States, for epidemiological weeks 26 to 28. An analysis of this information will be included in the next Regional Update. 1 CAREC: Caribbean Epidemiological Centre On July 21, 2009, Canada reported the first case of oseltamivir resistant pandemic (H1N1)2009 virus in the Americas Region. It was found in a 59 year old male from Quebec with underlying medical conditions who received post-exposure prophylaxis following illness in a family member (the man's son).
The isolate had a mutation at the H274Y location. Sequencing data for the son showed that his stain was sensitive to oseltamivir. It has not been reported whether the resistant isolate is sensitive to zanamivir.
Definitions of the qualitative indicators for Pandemic (H1N1) 2009
|No activity:||no laboratory confirmed case(s) of influenza, or evidence of increased or unusual respiratory disease activity.|
|Localized:||limited to one administrative unit of the country (or reporting site) only.|
|Regional:||appearing in multiple but <50% of the administrative units of the country (or reporting sites).|
|Widespread:||appearing in ≥50% of the administrative units of the country (or reporting sites).|
|No information available: no information available for the previous 1 week period.|
|Trend of respiratory disease activity compared to the previous week|
|Increasing:||evidence that the level of respiratory disease activity is increasing compared with the previous week.|
|Unchanged:||evidence that the level of respiratory disease activity is unchanged compared with the previous week.|
|Decreasing:||evidence that the level of respiratory disease activity is decreasing compared with the previous week.|
|Generalizada:||ocurre en ≥50% de las unidades administrativas del país (o sitios notificantes).|
|No information available.|
|Intensity of Acute Respiratory Disease in the Population|
|Low or moderate:||a normal or slightly increased proportion of the population is currently affected by respiratory illness.|
|High:||a large proportion of the population is currently affected by respiratory illness.|
|Very high:||a very large proportion of the population is currently affected by respiratory illness.|
|No information available.|
|Impact on Health-Care Services|
|Low:||demands on health-care services are not above usual levels.|
|Moderate:||demands on health-care services are above the usual demand levels but still below the maximum capacity of those services.|
|Severe:||demands on health care services exceed the capacity of those services.|
|No information available.|
Download the Full Report
Update. Influenza A (H1N1) Regional Report (July 22 2009)