|Regional Update. Pandemic (H1N1) 2009. (published on July 31, 2009)|
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 available at this link.
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 29 (EW 29, July 19 to 25) all the 35 countries in the Region of the Americas have reported presence of the pandemic (H1N1) 2009 virus. Grenada was the last country to report pandemic influenza activity in the Region, as it reported its first case this week.
In accordance with the changes in reporting requirements announced by the World Health Organization (WHO) on July 16th, 2009, this report includes qualitative indicators to monitor the pandemic (H1N1) 2009 (Table 5). Updated information has been submitted by 14 countries to the Pan American Health Organization (PAHO) on the most recent epidemiological week for which information is available (EW 27 – 29).
Currently, 19 countries in the Region report having widespread geographical distribution of the pandemic (H1N1) 2009 virus. Colombia reports that the geographical distribution is more limited during this epidemiological week, reason for which its status has changed from widespread to regional spread. Conversely, the Dominican Republic reports an expansion in the geographical distribution this week for the first time since the start of the pandemic (Map 1).
Regarding the trend of respiratory disease in the Region, information is available for 24 countries (Map 2); seven countries report an increasing trend (Belize, Bolivia, El Salvador, Guatemala, Haiti, Paraguay and Peru), four more countries than the previous report.
Information on the intensity of acute respiratory illness is available for only 21 countries (Map 3). Of these countries, two report very high intensity (Argentina and El Salvador), while seven report having high intensity (Canada, Chile, Cuba, Guatemala, Mexico, Paraguay and Uruguay).
Of the 19 countries reporting information on the impact on health-care services (Map 4), El Salvador is the only country reporting severe impact this week. Six countries (Bolivia, Chile, Cuba, Guatemala, Paraguay y Uruguay) report moderate impact, while the remaining 12 countries (Antigua y Barbuda, Colombia, Dominica, Dominican Republic , Haiti, Jamaica, Panama, Peru, Saint Kitts and Nevis, Saint Lucia, United States and Venezuela) report a low impact on health-care services .
Argentina and El Salvador report having very high intensity of respiratory illness; and, in the case of El Salvador, an increasing trend of disease and a severe impact on health-care services during the same time period. Guatemala and Paraguay report an increasing trend and high intensity of acute respiratory activity. While Canada, Chile and Mexico report high intensity in acute respiratory disease, in all three a decreasing trend in respiratory disease is observed.
Update on the number of cases and deaths
During epidemiological week 29,Grenada reported its first case of the pandemic (H1N1) 2009, rendering the presence of the virus in every country of the Region of the Americas.
As of July 29, 2009, a total of 98,179 confirmed cases have been notified in all 35 countries in the Americas Region. A total of 1,008 deaths have been detected among the confirmed cases in 20 countries of the Region. Panama reported its first two deaths this week.
In addition to the figures displayed in Table 2, the following territories have reported cases of pandemic (H1N1) 2009 virus: American Samoa (8); Guam, USA (1); Puerto Rico, USA (20); Virgin Islands, USA (49); Bermuda, UK (1); Cayman Islands, UK (14); Virgin Islands, UK (2); Turks and Caicos Islands, UK (3) Martinique, FR (15); Guadeloupe, FR (11); Saint-Martin, FR (1); Netherlands Antilles, Bonaire (4);Netherlands Antilles, Curaçaoa (13); Netherlands Antilles, Aruba (13); Netherlands Antilles, Bonaire (10); Netherlands Antilles, Curacao (30)a; Netherlands Antilles, St. Eustatius (1) and Netherlands Antilles, St. Marteen (14).
a cases were registered on a cruise ship.
The distribution of cases and deaths at the first sub-national level can be found in the interactive map available through the following link: http://www.paho.org/hq/images/atlas/en/atlas.html
The virus continues to predominantly affect young persons, with 60% of the confirmed cases being detected in persons with less than 20 years of age in 7 selected countries of the Region.
Information on the characteristics of the deceased cases of pandemic (H1N1) 2009 is critical to identify the factors that increase the risk of death. However, data are not always available, since they are not compiled routinely by surveillance systems.
Information reported to PAHO on deaths among confirmed cases was gathered from epidemiological reports or presentations shared by Member States. Main findings are summarized in Table 3.
In spite of limitations to the availability of data, it should be highlighted that the percentage of deaths with underlying conditions in Argentina, Chile, and Mexico, is between 53 and 59%; drawing attention to the complementary proportion of healthy people who are at risk of suffering clinical complications from influenza.
Update on the Virologic Situation
Virological data obtained from Ministry of Health websites, from Ministry of Health reports sent to PAHO and notifications from National Influenza Centers (NICs) is included below.
On July 21, 2009, Canada reported the first case of oseltamivir resistant pandemic (H1N1) 2009 virus in the Americas Region. Nevertheless, all other pandemic (H1N1) 2009 viruses isolated in the Region of the Americas so far have shown sensitivity to both oseltamivir and zanamivir.
The data and information in this report will be updated on a weekly basis and available here.
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 available here.
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 (2005) National Focal Points.
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Regional Office for the Americas of the World Health Organization