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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.  

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

For Epidemiological Week 34 (EW 34), from 23 August to 29 August, 20 countries reported updated information to the Pan American Health Organization (PAHO) regarding the qualitative indicators  to monitor pandemic (H1N1) 2009 (Table 1).  Only those 20 countries were included in this analysis.

Presently, 16 countries in the Region report having widespread geographical distribution of the pandemic (H1N1) 2009 virus, with Belize including itself in this category for the first time. Both Saint Kitts and Nevis and Dominica report having no activity of pandemic influenza last week (Map 1).

Four countries reported an increasing trend of respiratory disease, namely Bolivia, Ecuador, Paraguay, and Venezuela. While Paraguay had reported a decreasing trend in the previous three weeks, this week they report a shift to increasing trend (Map 2).

Regarding the intensity of acute respiratory disease, four countries report high intensity—Bolivia, El Salvador, Mexico, and Paraguay.  Bolivia increased their reported status from low or moderate intensity to high this week. Conversely, three countries reported experiencing lower intensity than last week: Mexico changed its status to high intensity after three weeks of very high intensity; and Argentina and Costa Rica changed their status from high intensity to low or moderate (Map 3).


Of the 19 countries for which there is available information, 9 countries (Belize, Bolivia, Brazil Costa Rica, Ecuador, El Salvador, Mexico, Paraguay, and Peru) reported experiencing moderate impact on health care services. This week, no countries reported experiencing a severe impact on health care servicess (Map 4).


Bolivia and Paraguay both reported widespread geographic spread, increasing trends of respiratory disease, high intensity of acute respiratory disease, and moderate impact on health care services.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

As of 4th September 2009, a total of 120,653 confirmed cases have been notified in all 35 countries in the Americas Region. A total of 2,467 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 (44); Guadeloupe, French Overseas Community (17); Guyane, French Overseas Community (29); Saint-Martin, French Overseas Community (15); Netherlands Antilles, Aruba (13); Netherlands Antilles, Bonaire (29); Netherlands Antilles, Curaçao* (46)*; Netherlands Antilles, St. Eustatius (1); and Netherlands Antilles, St. Maarten (22).
* 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

Description of severe pandemic (H1N1) 2009 confirmed cases in selected countries

The characteristics of severe or hospitalized confirmed cases for Canada, Chile, and Brazil are displayed in Table 3. Based on information provided during the reporting period, the majority of hospitalized cases in Canada and Chile were young adults (median age of 25 and 31 years of age, respectively). For these two countries, the proportion of women was slightly greater than fifty percent. The percentage of patients having at least one underlying medical condition varied between 36.9% to 57.2%. In Brazil and Canada, less than thirty percent of the fertile- age female cases were pregnant.

Update on the Virological Situation

Influenza virus antiviral susceptibility testing is done routinely as part of the surveillance activities carried out by the WHO collaborating center for Surveillance, Epidemiology & 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 o 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.

All the 127 pandemic (H1N1) 2009 viruses isolated in Latin America and the Caribbean and tested by the CDC for antiviral susceptibility so far have shown sensitivity to both oseltamivir and zanamivir.  Also, all 132 pandemic (H1N1) 2009 viruses tested for susceptibility to adamantanes have shown resistance to these antivirals.

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 September 4, 2009)

Last Updated on Tuesday, 02 March 2010 05:48

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