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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.  

Update on the Qualitative Indicators

For Epidemiological Week 32 (EW 32), August 9 to August 15, 20 countries reported updated information to the Pan American Health Organization (PAHO) regarding the qualitative indicators  to monitor pandemic (H1N1) 2009 (Table 1).

Based on the most recent information provided by 34 countries on the geographical spread of pandemic (H1N1), 23 countries report widespread distribution. Belize is the only country reporting an increase in the spread from localized to regional. Information from Trinidad and Tobago was previously not available, but it is now reporting widespread distribution. Saint Kitts and Nevis and Dominica continue to report no activity (Map 1).

The trends in respiratory diseases were available for 30 countries. Argentina, Canada, Costa Rica, Dominican Republic, El Salvador, Jamaica, Mexico, Panama, Paraguay, Saint Lucia, United States, Uruguay, and Venezuela report decreasing trends, while Haiti, Honduras, and Bolivia reported increasing trends. Belize and Peru which reported increasing trends for EW 31 informed an unchanged trend, while Saint Lucia informed a decreasing trend for EW 32 (Map 2).

Regarding the intensity indicator, information has been provided by 29 countries.  Low or moderate intensity was reported by 23. Five countries (Argentina, Costa Rica, El Salvador, Guatemala, and Paraguay) reported high intensity. Mexico reported very high intensity for the second consecutive week (Map 3).

Impact on health care services indicator is available for 28 countries. Eleven countries informed a moderate impact on health care services, three more in comparison with EW 31 (Belize, Costa Rica, and Peru). Among these countries, Peru reported a low impact to present and Belize and Costa Rica did not have information available up to date. No country reported a severe impact (Map 4). 

Update on the number of cases and deaths

As of August 21, 2009, a total of 110,113 confirmed cases have been notified in all 35 countries in the Americas Region. A total of 1,876 deaths have been reported among the confirmed cases in 22 countries of the Region.

In addition to the figures displayed in Table 2, the following overseas territories have confirmed cases of pandemic (H1N1) 2009: The following overseas territories have confirmed cases of pandemic (H1N1) 2009: American Samoa, U.S. Territory (8); Guam, U.S. Territory (1); Puerto Rico, U.S. Territory (20); Virgin Islands, U.S. Territory (49);  Bermuda, UK Overseas Territory (1); Cayman Islands, UK Overseas Territory (14); British Virgin Islands, UK Overseas Territory (2); Turks and Caicos Islands (3); Martinique, French Overseas Community (25); Guadeloupe, French Overseas Community (5); Guyane, French Overseas Community (12);Saint-Martin, French Overseas Community (12); Netherlands Antilles, Aruba (13); Netherlands Antilles, Bonaire (29); Netherlands Antilles, Curaçao* (44); Netherlands Antilles, St. Eustatius (1); and Netherlands Antilles, St. Maarten (20).
* Three cases were reported 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.

Analysis of pandemic (H1N1) 2009 associated deaths in selected countries

In Argentina, Bolivia, Brazil, Canada, Chile, Costa Rica, Mexico, and Peru, additional information was available about deaths amongst confirmed cases of pandemic (H1N1) 2009 (Table 3). For most countries, the proportion of males to females was similar. In Bolivia, there was a greater proportion of males amongst those who died. Conversely, in Canada the proportion of females was greater. The median age for the cases who died varied by country. For countries which provided information about the type of underling co-morbidity, the most common reported conditions were: metabolic diseases (mainly diabetes mellitus), obesity, cardiovascular diseases, respiratory diseases (asthma and chronic obstructive pulmonary disease), and cancer. Should be highlighted the proportion of pregnant women which varied from country to country. 

Virological update  - Pattern of viral circulation
 
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. For the purposes of this analysis, only countries or laboratories that reported Influenza A by subtype were selected. In the calculations of the percentages, laboratory results of influenza cases not subtyped or un-subtypeable were excluded.

Virological information for countries or laboratories that provided that level of detail is included in the Figure 1. In spite of the limitations of the available data, the graphs in figure 1 show a progressive increase of pandemic (H1N1) 2009 among the subtyped influenza A isolates (seasonal H1/H3 and pandemic (H1N1) 2009).

Antiviral susceptibility

On July 21, 2009, Canada reported the first case of oseltamivir-resistant pandemic (H1N1) 2009 virus in the Americas Region. Since then, the United States reported on August 14, 2009 the detection of oseltamivir-resistant pandemic (H1N1) 2009 virus in two immunosuppressed patients in the State of Washington. While both patients were being treated with oseltamivir, they were treated in different hospitals and were not epidemiologically linked. The virus in both patients had been initially documented as being susceptible to oseltamivir, and resistance developed subsequently during antiviral treatment.

Influenza virus antiviral susceptibility testing is done routinely as part of the surveillance activities carried out by the WHO collaborating center for Surveillance, Epidemiology and Control of Influenza at the U.S. Centers for Disease Control and Prevention.  Susceptibility to neuraminidase inhibitors is carried out for the neuraminidase inhibition assay and resistant viruses are sequenced for determine the presence of established molecular marker of resistance. The susceptibility to adamantanes is carried out by determining the presence of established molecular markers of resistance.

In total, 89 pandemic (H1N1) 2009 isolates from 16 countries from Latin America and Caribbean were tested by CDC for anti-viral susceptibility. These isolates tested for antiviral susceptibility so far have shown sensitivity to both oseltamivir and zanamivir.

Qualitative indicators for the monitoring of pandemic (H1N1) 2009

Geographical spread: refers to the number and distribution of sites reporting influenza activity.
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: refers to changes in the level of respiratory disease activity compared with 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.
No information available.  

Intensity of Acute Respiratory Disease in the Population: is an estimate of the proportion of the population with acute respiratory disease, covering the spectrum of disease from influenza‐like illness to pneumonia.

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: refers to the degree of disruption of health‐care services as a result of acute respiratory disease.

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.  

Source: Updated interim WHO guidance on global surveillance of human infection with pandemic (H1N1) 2009 virus. 10 July 2009.

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.

Download the Full Report
icon Regional Update. Pandemic (H1N1) 2009. (published on August 21, 2009) 

Last Updated on Tuesday, 02 March 2010 05:40

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