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Pandemia de Influenza: situação e perspectivas. Jarbas Barbosa da Silva Jr. Organização Pan-Americana de Saúde (OPAS). Cronologia da pandemia A (H1N1). Cronologia da pandemia A (H1N1). March. April. 10 April: outbreak of ILI in Veracruz. May. June. August. September. July. October.
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Pandemia de Influenza: situação e perspectivas Jarbas Barbosa da Silva Jr.Organização Pan-Americana de Saúde (OPAS)
Cronologia da pandemia A (H1N1) March April 10 April: outbreak of ILI in Veracruz May June August September July October
Cronologia da pandemia A (H1N1) April 21 April: 2 cases of H1N1 reported in California, USA 4 April: outbreak of ILI in Veracruz May June August March September July October 23 April: H1N1 confirmed in several patients in MX Source: MMWR, 58(15)
Genesis of the swine-origin influenza A (H1N1) virus North American avian Human (H3N2) Classical swine (derived from the 1918 virus) Eurasian avian-like swine PB2 - North American avian PB1 - Human H3N2 PA - North American avian H1 - Classical swine NP - Classical swine N1 - Eurasian avian-like swine M - Eurasian avian-like swine NS - Classical swine Dawood et al., NEJM, 2009 Garten et al., Science, 2009 Smith et al., Nature, 2009 Influenza A (H1N1) Fig. 4. Neumann et al.
Cronologia da pandemia A (H1N1) April 21 April: 2 cases of H1N1 confirmed in California, USA 27 April: WHO phase 4 4 April: outbreak of ILI in Veracruz May June August March September July October
Cronologia da pandemia A (H1N1) April 21 April: 2 cases of H1N1 confirmed in California, USA 27 April: WHO phase 4 4 April: outbreak of ILI in Veracruz 29 April: WHO phase 5 May June August March September July October
Cronologia da pandemia A (H1N1) May 21 April: 2 cases of H1N1 confirmed in California, USA 27 April: WHO phase 4 4 April: outbreak of ILI in Veracruz 29 April: WHO phase 5 May: H1N1 introduction in SH April June August March September July October H1N1 in 48 countries
Cronologia da pandemia A (H1N1) June 21 April: 2 cases of H1N1 confirmed in California, USA 27 April: WHO phase 4 4 April: outbreak of ILI in Veracruz 29 April: WHO phase 5 11 June: WHO phase 6 pandemicdeclared; H1N1 in 74 countries April May August March September July October
Cronologia da pandemia A (H1N1) June 21 April: 2 cases of H1N1 confirmed in California, USA 4 April: outbreak of ILI in Veracruz 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries April May August March September July October 1st US H1N1 peak Source: CDC FLUVIEW, http://www.cdc.gov/flu/weekly/
Cronologia da pandemia A (H1N1) July June 21 April: 2 cases of H1N1 confirmed in California, USA Chile H1N1 winter peak 4 April: outbreak of ILI in Veracruz 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries March April May August September October Argentina H1N1 winter peak
Cronologia da pandemia A (H1N1) June August September July 21 April: 2 cases of H1N1 confirmed in California, USA 4 April: outbreak of ILI in Veracruz 29 April: WHO phase 5 Active Transmission of H1N1 in Tropical Asia and Tropical Americas April May March October
Cronologia da pandemia A (H1N1) August 21 April: 2 cases of H1N1 confirmed in California, USA Wk 26: Chile peak ILI activity 4 April: outbreak of ILI in Veracruz Southern Hemisphere Influenza transmission subsides; Brazil H1N1 winter peak 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries April May June March September July October Source: WHO FluNet
Cronologia da pandemia A (H1N1) August 2nd H1N1 season begins in the US 21 April: 2 cases of H1N1 confirmed in California, USA 2nd H1N1 season starts in Japan 4 April: outbreak of ILI in Veracruz 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries April May June March September July October Source: CDC FLUVIEW, http://www.cdc.gov/flu/weekly/
Cronologia da pandemia A (H1N1) September 21 April: 2 cases of H1N1 confirmed in California, USA 27 April: WHO phase 4 4 April: outbreak of ILI in Veracruz 29 April: WHO phase 5 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries April May June August March July October Wk 30: UK peak ILI activity WK 24: SA H3N2 peak Wk 29: Australia and NZ peak ILI 15-17 April: clusters of severe pneumonia in Mexico Wk 26: Argentina peak ILI activity increase in influenza activity in Mexico 23 April: H1N1 confirmed in several patients in MX Source: Mexico MoH, http://portal.salud.gob.mx/descargas/pdf/influenza/situacion_actual_epidemia_121009.pdf
Cronologia da pandemia A (H1N1) September 27 April: WHO phase 4 29 April: WHO phase 5 Increasing activity throughout Northern Hemisphere 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries April May June August March July October WK 24: SA H3N2 peak
Cronologia da pandemia A (H1N1) October 27 April: WHO phase 4 29 April: WHO phase 5 Increasing activity throughout Northern Hemisphere 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries April May June August March September July WK 24: SA H3N2 peak
América do Norte USA CANADA MEXICO
América Central e o Caribe GUATEMALA CAREC CAREC Member countries are : Barbados, Bahamas, Dominica, Jamaica, San Vincent and the Grenadines, and Trinidad y Tobago.
América do Sul Chile Peru Argentina
O vírus viaja rápido • 213 países e territórios • 16700 mortes
O inverno faz diferença Corredor Endémico de Enfermedad Tipo Influenza. Argentina, SE 35. 2009
0,8 – 2,4 p/ 105 Mortes 20% UTI 2 – 30 p/105 Hospitalização 5% - 11% ? Taxa de ataque Aspectos epidemiológicos População Assintomáticos?
Aspectos epidemiológicos • Número Básico de Reprodução (Ro) • Estimado (1.5 - 1.7) • Taxa de Ataque Secundária • Contatos domiciliares • SRA: 19% (US) • ETI: 8-12% (US) • ETI: 4.8-7.6% (Japão) • Surtos em escolas • Casos confirmados em laboratório: 13-33%
O vírus pandêmico substitui o sazonal Distribución porcentual de virus respiratorios por grupos de edad. Argentina, 2009.
Pandemia x Sazonal Age-related distribution of deaths from severe pneumonia compared to influenza seasons 2006-08. Mexico
Hospitalização Taxa de Hospitalização por Influenza em países das Américas
Taxa de Mortalidade Taxa de Mortalidade por Influenza em países das Américas
Influenza Sazonal x Pandemia • Catastrofismo x negligência • Gripe espanhola x gripe comum • Infectividade \ Patogenicidade \ Virulencia • Magnitude \ Transcendência \ Vulnerabilidade
Lições aprendidas Coordenação da resposta Vigilância/RSI /Laboratório Medidas não farmacêuticas/ comunicação de risco Serviços de saúde
Resumo • Maioria dos casos é leve e moderado • Epidemiologicamente diferente da influenza sazonal • “Proteção” dos mais velhos para casos, mas letalidade alta • Hospitalizações e mortes entre crianças, adolescentes e adultos jovens • “Picos” no inverno • Letalidade geral baixa, mortalidade muito diferente entre os países • Dinâmica de transmissão parece semelhante à influenza sazonal
Desafios para o futuro • Novas ondas • Vigilância do vírus • Evidências • RSI(2005)