Recent antimicrobial susceptibility testing of V. cholerae isolated in Haiti, conducted by the National Laboratory of Public Health and the Center for Disease Control and Prevention (CDC), shows resistance to trimethroprim-sulfamethoxazole, furazolidone, nalidixic acid, and streptomycin. Therefore, the purpose of this alert is to share the provisional recommendations regarding treatment of patients with cholera, based on the susceptibility pattern of the strains isolated to date in Haiti.

In the epidemiological week (EW) 30 of this year, Peru's Ministry of Health reported the death of a confirmed case of human rabies transmitted by a hematophagous bat. This case occurred in the native community of Urakusa, district of Nieva, province of Condorcanqui, department of Amazonas. Another two cases of human rabies were reported in Colombia, one in the municipality of Piedecuesta, and the second, in Lebrija – both in the department of Santander. The department did not have a record of human rabies cases until 2008 and 2009, when one case was notified in each of these years respectively.

The Ministry of Health of Argentina had confirmed new cases of Saint Louis Encephalitis (SLE) virus infection. Until 29 March 2010, it has been reported four confirmed cases of SLE infection in the nation's capital city and in Buenos Aires province. The SLE virus had previously caused outbreaks in the central part of the country (mainly in the provinces of Córdoba and Entre Ríos), and this is the first time that it has been detected in Buenos Aires.

The purpose of this Epidemiological Alert is to remember that the orientations of the Organization related to travel and international trade are still in effect.

To date, the countries of the Region have reported a total of 626,268 cases of dengue, of which 14,149 were acute dengue, with 241 deaths and a regional case-fatality rate of 1.70%. The information in this update has been obtained from data provided by the ministries of health of PAHO Member States, either through reports sent to PAHO/WHO or from updates on their respective websites.

Over the past month, we have been detecting the appearance of confirmed outbreaks of acute diarrheal disease caused by rotavirus in several countries of the Region. In view of this situation, which is occurring in the period of greatest viral circulation, the Pan American Health Organization (PAHO) recommends strengthening surveillance and implementing recommendations that contribute to controlling the spread of the disease.

This update contains new information from Guatemala: From Epidemiological Weeks (EW) 1 through 11, Guatemala reported a total of 5,195 cases (859 more cases than reported in the last alert of 23 March), out of which 1,159 were laboratory confirmed, with 3 deaths (in Izabal, Jutiapa, and Petén Norte). The most affected age group continues to be children from 1 to 4 years of age, followed by infants less than a year old and then by children from 5 to 9. The departments with the greatest number of cases are Chiquimula, Santa Rosa, Escuintla, Huehuetenango, Izabal, and Retalhuleu.

Currently, in Haiti Currently, there are cases and deaths due to cholera in the 10 departments of Haiti. The highest cumulative incidence rate as of EW 48 was observed in the department of Artibonite with 274 cases per 10,000 inhabitants, followed by Nord Ouest and Centre with 149 and 145 cases per 10,000 inhabitants, respectively. These departments also recorded the highest cumulative incidence rates in the previous week.
In Dominican Republic, From EW 46 to EW 48, the Ministry of Public Health of the Dominican Republic recorded 22 laboratory confirmed cholera cases, of which 15 were hospitalized. No deaths were recorded. Also, 2 cases have been considered imported and 20 autochthonous.

Through this epidemiological alert PAHO/WHO calls for intensified measures to control dengue and an integrated response by matching all actions in space and time to achieve greater impact. The health sector should make every effort in the diagnosis and treatment of dengue patients to prevent deaths while strengthening the structures of vector control, based on the principle that is not given a response from a unique sector, but in a comprehensive manner involving all health institutions, other ministries, NGOs, the private sector and the general population.

Although Mayaro fever is a viral disease of the South American countries, the first outbreak of human cases was given in Venezuela in 2000. Up to June 4, 2010 has reported an outbreak in a rural community of Portuguesa state a cumulative total of 77 cases with no deaths.

As of EW 44, and at the national level, a total of 544 deaths have been recorded, 57% of which have occurred at the health services level, and 43% at the community level. The daily case fatality rates observed in health services at the national level have ranged from 2.2% to 6.0% (3.8% average). Alternatively, in the department of Artibonite, this rate has ranged from 1.2% to 6.8% (3.5% average). The impact of efforts undertaken to improve case management and access to health services on recorded case fatality rates is being analyzed.

Up to the date of this report, the countries of the Region reported a total of 146,006 cases of dengue, out of which 2,706 were severe dengue. A total of 79 deaths have been reported, with a Regional fatality rate of 2.9%. Specific sections of the report are devoted to Argentina, Brazil, Colombia, El Salvador, Honduras, Paraguay, and Puerto Rico, including data and/or maps as well as indications of severity, serotypes in circulation, affected areas, and measures taken. The report also includes official recommendations for dengue prevention and control.

Durante todo el primer semestre del año, la situación epidemiológica del dengue ha presentado un comportamiento inestable, con intensos brotes de dengue en varios países de la región. Las condiciones climatológicas se han mantenido favorables para la proliferación del mosquito Aedes aegypti su agente transmisor y se han visto ciertas alteraciones inusuales en su estacionalidad, afectando desde inicio del año a países centroamericanos e islas del Caribe en periodos considerados inusuales.