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LATIN AMERICA: H1N1 Flu Spreading, but
Mild
By Fabiana Frayssinet
RIO DE JANEIRO (IPS) - The H1N1 flu virus
has begun its southward march in Latin
America, carried by passengers travelling
from areas hit by the outbreak. But the
mortality rate is much lower than in Mexico,
and there are no signs of "sustained
domestic transmission" in the rest of the
region.
According to infectious disease expert Dr.
Gabriel Levy at the Durand Hospital in
Buenos Aires, who is the coordinator of the
Infectious Disease Network in the Argentine
capital, the new H1N1 influenza A virus -
popularly known as swine flu – got off to a
ferocious start in Mexico, but its impact
has gradually weakened as it moves
southward.
Brazilian President Luiz Inácio Lula da
Silva drew angry reactions when he said the
flu outbreak is serious, but it does not
have the magnitude that it appeared to have
at first.
In Brazil, eight cases have been confirmed
so far, none of them serious.
Dr. Alberto Chebabo, an expert in infectious
diseases, told IPS in Brazil that most of
the cases involved young adults who had
travelled to the United States or Mexico,
while others had arrived from other infected
areas, such as a woman who returned from
Europe, where she had visited several
countries.
Two of the patients did catch the H1N1 virus
in Brazil. But Chebabo, who works at the
Clementino Fraga Filho Hospital in Rio de
Janeiro, said "there is no epidemic in
Brazil," pointing out that the two cases in
question were the friend of one of the
patients who had travelled to Mexico, and
the patient’s mother.
Of the 34 countries around the world that
have reported laboratory-confirmed cases,
nine have involved "isolated in-country
transmission": Brazil, Canada, Germany,
Italy, Mexico, Panama, Spain, the United
Kingdom and the United States.
But only three of them have "sustained
community-level human-to-human
transmission": Mexico, the United States and
Canada.
The flu has behaved in a similar manner in
other Latin American countries, like
Colombia, where the Social Protection
Ministry confirmed one new case, which
brought the total there to seven.
The latest case is a man who had travelled
to Mexico City, and "like the rest of the
cases in Colombia, he has completely
recovered," the ministry reported.
Brazil, like other countries in the region,
has stepped up airport controls, while
putting an emphasis on follow-up of everyone
who has come into close contact with the
patients.
Neighbouring Argentina took a more radical
approach, cancelling all flights from Mexico
after the first, and so far only, case of
H1N1 virus in Argentina – a man who returned
from Mexico on Apr. 24 and has already
recovered. Another 100 cases are under
study.
Argentina lifted the suspension of flights
to and from Mexico on Friday.
In Brazil, the cases have been relatively
mild, with the exception of one woman who
had pneumonia but is in stable condition,
said Chebabo.
But the expert did not rule out the
possibility of the virus evolving into a
more virulent strain, which means the
mortality rate could still rise.
In Costa Rica, the situation is similar to
the rest of the region: there are nine
confirmed cases and five "probable" cases
still awaiting the results of the lab tests.
The cases involved people who either
travelled to Mexico or came into contact
with people from Mexico or the United
States.
Like in Brazil, health authorities in Costa
Rica say there is no evidence of sustained
community-level human-to-human transmission.
However, one of the cases was fatal: a
53-year-old man who suffered from diabetes
and chronic lung disease.
As of Friday, the World Health Organisation
(WHO) reported a total of 7,520
laboratory-confirmed cases around the world.
Mexico, where the first cases appeared, had
reported 2,446 confirmed cases, including 66
deaths; the United States, 4,298 cases,
including three deaths; and Canada, 449
cases, including one death.
Costa Rica was the only other country that
had reported a fatal case.
Mexico reported Friday that the number of
cases there had risen to 2,895.
The Latin American countries where cases
have been confirmed so far are Argentina
(one), Brazil (eight), Colombia (seven),
Costa Rica (eight), Cuba (one), El Salvador
(four), Guatemala (three), and Panama (29).
Experts say the most vulnerable population
group is young adults, and that there have
been few cases among children or the
elderly, although they admit that they
cannot yet explain the phenomenon. In
addition, they say, the virus appears to be
mild but highly contagious.
"It is still early, but the virus would
appear to be easily transmitted. On the
other hand, the cases (in Latin America)
appear to be less severe than what was
initially observed in Mexico," said Chebabo.
Outside of Mexico, cases "have been mild and
the deaths were in patients who were at risk
due to complications" and underlying health
conditions, he added.
However, the experts have not ventured to
predict what might happen. Virologist
Marilda Siqueira with the Oswaldo Cruz
Foundation, a Brazilian government
institute, said the virus could continue to
circulate simultaneously with seasonal flu
viruses, "making the genetic exchange
between them possible."
"A milder (or more virulent) strain could
emerge as a result of that combination. For
example, the virus could circulate for a few
months and later mutate into a more severe
form, as has been observed on other
occasions," she said.
Chebabo said that more virulent strains of
the virus have not been observed. But he did
not rule out the possibility, "because the
influenza virus undergoes frequent mutations
which could lead the A/H1N1 virus to become
more severe in the next waves of the
epidemic."
"For now it has been contained," virologist
Laya Hun Opfer, at the University of Costa
Rica Microbiology Faculty, told IPS. But the
flu virus is unpredictable, and could mutate
into a totally new form, she acknowledged.
In any of the possible future scenarios, say
experts, the important thing is not to let
down the guard and to stay alert, for
example by preparing the public health
system for an eventual epidemic.
Keeping mortality down depends on other
factors, such as the hospital network’s
response capacity.
The question is whether the countries of
Latin America, several of which are
currently suffering from epidemics of dengue
fever, and a number of which have health
systems with serious shortcomings, would be
able to deal with a severe flu outbreak.
Dr. Hun Opfer said that because Costa Rica
has a "first world" health system, it will
not see a mortality rate like that of
Mexico. Besides, the virus "is being kinder"
for the moment, she added.
The prevention measures taken by the
authorities in Costa Rica have been praised
by the WHO, she pointed out. The Costa Rican
social security institute announced a
700,000 dollar investment in health
equipment to confront the flu outbreak.
In addition, 3,500 government health agents
are dedicated to searching out suspected
cases in that small Central American country
of 4.5 million people known as the
"Switzerland of Central America".
And in Argentina, said Levy, "the response
capacity is strong; there is good
information and organisation."
Because of the swift response by authorities
in Argentina, there should be no mortality
along the lines of what has been seen in
Mexico, he said.
In addition, "there is always a major impact
at the start of an epidemic, but later the
impact declines," he added. Indeed, in
Mexico, the infection rate has declined
sharply since late April, he noted.
Chebabo, by contrast, has doubts with
respect to the Brazilian health system’s
response capacity.
"If the cases remain mild, like the ones
seen so far, there won’t be major problems
in care. But if the number of
hospitalisations goes up, we will likely
have problems, because the health network is
already overburdened," he warned.
According to the Brazilian Health Ministry,
800 beds have been set aside for H1N1 flu
cases in 54 hospitals, and nine million
doses of antiviral drugs have been
stockpiled in this country of 189 million
people.
Chebabo said that an overlapping of
epidemics, like dengue fever and the flu, is
unlikely. The mosquito-transmitted "dengue
is more common in summer, and influenza is
more common in winter," he pointed out.
But the Health Ministry in Costa Rica is
worried about such a scenario, with the
arrival of the rainy season, which could
bring other threats, like dengue or malaria,
on top of the H1N1 influenza virus.
Another concern in Latin America is the
availability of laboratories and materials
to test suspected cases.
In Costa Rica and Colombia, for example,
samples from suspected cases have been sent
to labs in the United States up to now.
But according to authorities in Colombia,
the test kits will arrive by the end of the
month. And Costa Rican Deputy Health
Minister Ana Morice reported Friday that her
country had received a shipment of test kits
that would soon be available for use.
In Brazil, the tests are carried out in
three national laboratories with kits
provided by the WHO. Other labs are
interested in working with their own
diagnostic kits, which have been developed
on the basis of international protocols.
In Mexico, which accounts for more than 90
percent of the flu deaths, the last death
occurred on May 10.
In Mexico City, people have largely stopped
wearing surgical masks and "day-to-day life
is returning to normal," said Miguel Ángel
Lezana, director of the National Centre for
Epidemiological Surveillance and Disease
Control. "But we insist that although the
figures are positive, because of the
reduction in the number of cases, we must
remain on epidemiological alert as long as
this new virus continues to circulate."
"Everything is like it was before; luckily
the paranoia has resided and business is
rallying," Jaime Cabrera, the owner of a
small restaurant that serves typical Mexican
food in the capital, told IPS.
In Brazil, all patients with possible
symptoms are being tested so far, since the
number of cases is still small. But, said
Chebabo, if an outbreak occurs, "the routine
will probably be like in Mexico and the
United States, with random samplings or
tests on seriously ill patients."
* With additional reporting from Marcela
Valente (Buenos Aires), Daniel Zueras (San
José) and Diego Cevallos (Mexico City).
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