Outbreak of Bolivian Hemorrhagic Fever (BHF) Confirmed in the Department of Beni, Itenez Province, Bolivia.

The National Health Information System of the Ministry of Health and Sports of Bolivia reported the occurrence of two cases of Bolivian Hemorrhagic Fever (BHF) in the Department of Beni, Itenez Province, localities of Huacareje and Magdalena—an endemic area for BHF.

Both patients, aged 30 and 16 respectively, died between 11 and 17 June 2004; to date, no more human cases have been reported in the above areas. On 23 June, the laboratory reported the serological confirmation for the Machupo Virus in one of the cases; the other is still pending.
The health authorities are undertaking control actions, capturing rodents, and actively seeking cases in the affected areas, as well as using rodent-killers in the urban areas of the endemic zone.

Source: Report to PAHO by the National System of Health Information (Sistema Nacional de Información en Salud) of the Ministry of Health and Sports (Ministerio de Salud y Deportes) of Bolivia.

On December 25, the bovine spongiform encephalopathy (BSE) world reference lab in Weybridge, England, confirmed preliminary diagnosis of BSE in a Holstein cow. The cow was slaughtered on December 9 at Vern's Moses Lake Meats in Washington State. This case would represent the first case of BSE in the United States.

As a precautionary measure, the farm from which the sick cow originated, in the town of Mabton, was quarantined following a preliminary diagnosis made by the United States Department of Agriculture (USDA). Mandatory tests for EEB have been imposed in cases of bovine cattle deaths in commercial farming. The Food Safety and Inspection Service (FSIS) ordered a recall of 10,410 pounds of meat from the group of 20 animals slaughtered on December 9 at Verns Moses Lake Meats.

Preliminary results of the Animal and Plants Health Inspection Service (APHIS) epidemiological investigation suggest that the affected animal likely entered the United States as part of a group of 74 dairy cattle imported through Eastport, ID, from Canada in 2001. USDA is working with Canada to ascertain the accurate age of the animal, and initiating DNA testing, and is working to trace the whereabouts of all other animals from the same shipment. It must be emphasized that there is nothing to suggest that any of the other animals in the group were affected by BSE. The USDA established the disposition of the three calves born of the index animal: one died shortly after birth in October 2001; the second, a yearling heifer, is in the index herd in Mabton, WA, under State quarantine. The third animal, the most recently born bull calf, is in a herd in Sunnyside, WA, also under State quarantine.

Risk analysis studies carried out in a number of Latin-American countries confirm that both that region and the Caribbean are free of BSE and its human form, variant Creutzfeldt-Jakob disease (vCJD). For this reason, PAHO emphasizes the need to maintain surveillance systems on the alert to detect any signs of the disease. The introduction of BSE would represent an important public health problem and could also raise the threat of commercial embargoes.

PAHO’s work in this area includes:

• Dissemination of technical information and guides on adoption of policies formulated by international organizations and government institutions.
  
  
• Technical cooperation with the countries of Latin America and the Caribbean to help organize epidemiological surveillance of BSE.
  
  
• Development of a network of laboratories to optimize surveillance systems.
  
  
• Development of shared methods among countries for confronting any detected risk.

  In 2001, PAHO organized a meeting of health and agriculture ministers and BSE experts from around the world in Montevideo, Uruguay, where a report establishing the scientific bases for decision-making on BSE and meat safety in the Americas was presented.

Sources:

• BSE Information and Resources. United States Department of Agriculture
• Food safety. Veterinary Public Health. Pan-American Health Organization.
• News Press releases. Pan-American Health Organization, December 2003.
• World Organization for Animal Health.

Central America: The following outbreaks of viral hemorrhagic conjunctivitis are still active:

• Guatemala: To 29 September 2003, there have been 2,269 cases in 18 health districts. The national incidence rate is 18 cases per 100,000 inhabitants, and the trend is still rising. The health districts with the greatest number of cases are Izabal (247), Petén Suroriente (200) Chiquimula (77), Santa Rosa (34), Petén Norte (30), San Marcos (23) and Escuintla (18). The illness is primarily affecting persons over the age of five.
  
  
• El Salvador: To 30 September 2003, the health districts most affected continue to be El Centro (84), Santa Ana (52) and Nueva Concepción (52). The age group most affected is from 20 to 59 years; and regarding gender, the cumulative number of cases reported among women is higher than among men

Sources:

• Boletín epidemiológico de Guatemala (Epidemiological Bulletin of Guatemala) No. 38, 2003.
• Boletín epidemiológico de El Salvador (Epidemiological Bulletin of El Salvador), 30 September 2003.

Mexico: The conjunctivitis outbreak has affected 32 states. To 26 September 2003, 67,513 cases of conjunctivitis were reported. The three states with the highest number of cases are Campeche (14,309), Quintana Roo (11,169), and Tabasco (11,092).

Source: Boletín epidemiológico de México (Epidemiological Bulletin of Mexico), No. 38, 2003.

Since last month and continuing to present, several outbreaks of hemorrhagic conjunctivitis have been reported in various Central American and Caribbean countries. In Central America, the disease has mainly affected four countries:

• Nicaragua presented a radical increase during the month of May. People from 5 to 14 years were the most affected, and the counties with the highest number of cases were Managua and Chontales. Honduras suffered a big outbreak mainly among factory workers. The cities most affected were San Pedro Sula, El Progreso, La Lima, and Chomola.
  
  
• Guatemala reported 2,035 cases to 20 September 2003 in the 14 health zones. The national incidence rate is 13 cases per 100,000 inhabitants. Of the cases, 81% are concentrated in five areas: Izabal, Chiquimula, San Marcos, Petén Suroriente and Guatemala City.
  
  
• In El Salvador, 335 cases of hemorrhagic conjunctivitis occurred up to 16 September. The more affected health zones were the Center zone, Santa Ana and New Concepción. Samples have been taken from three health zones. Results to identify the causal agent are pending, although viral infection is suspected by the symptoms presented.
  
  
• In the Caribbean, eight countries reported having had cases of hemorrhagic conjunctivitis. The start and end of the outbreaks, and the description of them, are showed in the following table:

 

Sources

• Caribbean Epidemiology Center (CAREC): Caribbean Surveillance Network (Carisurvnet).
  
  
• Laboratory reports and Department of Epidemiology of the respective countries.
  
  
• Boletín Epidemiológico de Guatemala (Guatemala Epidemiological Bulletin), Week 37-03.
  
  
• Boletín Epidemiológico de El Salvador (El Salvador Epidemiological Bulletin), Week 38-03.

Considering the start of the rainy season in Central America and the Caribbean, which increases the risk of transmission for various diseases, including cholera, the Pan American Health Organization/World Health Organization (PAHO/WHO) encourages Member States the continuation of surveillance efforts to detect the occurrence of outbreaks and implementing intervention actions to reduce cholera spread determinants.

Read the full document:  4 May 2012 Cholera

Given the increasingly frequent occurrence of meningococcal meningitis clusters in different countries of the Region and the need for information to characterize the situation and direct public health actions, the Pan American Health Organization / World Health Organization (PAHO/WHO) encourages Member States to strengthen surveillance and laboratory capacity to enable the detection of outbreaks and to implement an appropriate response in a timely manner.

Read the Document:

 24 April 2012 Meningococcal Meningitis (Cerebrospinal fever) 

The Pan American Health Organization / World Health Organization (PAHO/WHO) recommends Member States (especially those located in the regions of Central America and the Caribbean), that could have a greater risk of dengue outbreaks during the second half of 2012, to begin preparing and establish integrated response mechanisms for the prevention of dengue caused deaths.

 28 March 2012 Dengue

Influenza outbreaks occur annually, which affect public health and can have social and economic impacts. The weekly influenza in the Americas situation reports produced by PAHO/WHO demonstrate that influenza viruses A and B are currently circulating. Among the influenza A subtype viruses circulating are influenza A(H3N2) and A(H1N)pdm09.

To reduce the impact caused by outbreaks of seasonal influenza PAHO/WHO reminds Member States facing intense circulation of influenza viruses to maintain their routine surveillance activities, promote appropriate clinical management and disseminate information to the public on preventative measures. Member States of the Southern Hemisphere are also called upon to begin prevention and control preparations prior to the start of the season with the greatest circulation of influenza viruses.

 13 March 2012 Explanatory note on seasonal influenza

In 2011 and the start of 2012, an increase in pertussis cases has been reported in several countries of the Region, with cases predominantly in adolescents and newborns. In light of this situation, the Pan American Health Organization/World Health Organization (PAHO/WHO) reiterates the recommendations issued by the Technical Advisory Group (TAG) on Vaccine-Preventable Diseases during their XIX Meeting in July 2011.

 2 March 2012 Pertussis (Whooping Cough)

In the last years, human rabies transmitted by bats has resurfaced as a public health problem in the Americas. During 2011, events of human rabies transmitted by bats were reported in Ecuador and Peru and bats infected with rabies virus were detected in Argentina, Brazil, Chile, Cuba, Costa Rica and Honduras. Additionally, cases of human rabies transmitted by dogs were reported in Bolivia, Brazil, Guatemala, Haiti and Peru. As such, the Pan American Health Organization/World Health Organization (PAHO/WHO) reiterates the recommendations made through the 30 August 2010 Epidemiological Alert, concerning prevention and control strategies.

 22 December 2011 Human rabies transmitted by wildlife

On 22 November, the United States of America - International Health Regulation National Focal Point reported a cluster of influenza like illness cases among three children. Rapid influenza diagnostic tests performed were positive for influenza A. Molecular testing confirmed an influenza triple reassortant (influenza A (H3N2) (SOtrH3N2)) virus, and genomic sequencing confirmed they were S-OtrH3N2 viruses with the M segment gene from the pH1N1 virus. In this regard, the Pan American Health Organization/World Health Organization (PAHO/WHO) would like to stress to its Member States the importance of the recommendations specified in the PAHO-CDC Generic Protocol for Influenza Surveillance.

 25 November 2011 Influenza Like Illness

Due to the recent finding of carbapenemases of New Delhi metallo-β-lactamase (NDM) type in isolations of Klebsiella pneumoniae in Guatemala, the Pan American Health Organization/World Health Organization (PAHO/WHO) emphasizes the importance of the surveillance and detection in the Region of this resistance mechanism that increases morbidity and mortality of healthcare associated infections.

 Read the document in PDF Version

Dengue and severe dengue pose a public health problem in the tropical and subtropical areas of the Region of the Americas. During 2011, Member States reported 979,774 cases of dengue, of which 15,860 presented serious forms requiring hospitalization and 692 deaths. Historical data on the number of cases and deaths registered was surpassed this year with dengue outbreaks in Paraguay, Panama and in the countries and in the non-Hispanic Caribbean, such as Aruba, the Bahamas, and Saint Lucia. The introduction of Dengue 4 was also observed in Panama and in some states of Brazil where it had not previously circulated.

In light of this situation, the Pan American Health Organization/World Health Organization (PAHO/WHO) reminds Member States, especially those located in the southern hemisphere of the recommendations to reduce morbidity, fatality and the social and economic burden generated by dengue outbreaks and epidemics.

 28 October 2011 Dengue in the Americas

The Protocol for responding to imported cases of poliomyelitis due to wild poliovirus has the following objective: Prevent the occurrence of national poliomyelitis epidemics caused by the importation of wild polio virus, prevent the outbreak from spreading among countries in the Americas and prevent renewed circulation of wild polio virus in any country that experiences an imported case.

 3 October 2011 Poliomyelitis due to wild polio virus – Response Protocol

In light of the current reality of transmission of wild poliovirus at global levels and due to events hosted in the Americas that bring together large groups of people, the Pan American Health Organization / World Health Organization (PAHO / WHO) emphasizes the continued importance to maintain immunization coverage above 95% and to keep surveillance systems alerted to the risk of the introduction of imported cases of wild polio virus in the Region.

 22 September 2011 Poliomyelitis due to wild poliovirus

The purpose of this alert is to provide an update on the 2011 dengue situation in the Region and to call upon national authorities from the countries which at the beginning of this year’s second semester could be in a greater risk of dengue (Central America, Mexico and the Caribbean) to prepare their integrated response mechanisms to prevent deaths from dengue.

As of epidemiological week (EW) 31 of 2011, a total of 890,756 dengue cases, including 10,840 severe dengue cases and 488 dengue caused deaths, had been reported in the Region of the Americas.

 19 August 2011 Dengue in the Americas – update EW 31

In Haiti, the national number of cases and hospitalizations has decreased in the past three weeks, following the increase which occurred between EW 20 and 25. At the local level two departments, Nord and Nord Ouest, recorded an increase in the number of new cholera cases and new hospitalizations since EW 22. Meanwhile, Port-au-Prince and the Centre, Grand Anse and Nippes departments which had recorded an increase in cases between EW 22 and 23, have recorded a decline for the past three weeks.

While in Dominican Republic, the Ministry of Public Health reported that since the beginning of the outbreak up to EW 29 of 2011 they recorded a total of 13,200 suspected cholera cases and confirmed 87 deaths due to cholera. The Distrito Nacional and the provinces of Elías Piña, San Cristóbal, San Juan, San Pedro de Macoris, Santiago and Santo Domingo Este and Oueste registered the highest rates of cholera transmission.

 Epidemiological Alert: Update on the Cholera situation in Haiti and the Dominican Republic (26 July 2011)

In light of the identification by scientific communities of a strain of gonorrhea resistant to all microbial treatments available for sexually transmitted infections (STIs), the Pan American Health Organization recommends informing health workers, institutions, and nongovernmental organizations that work in the prevention and control of STIs about the risk of resistance in this strain, and in particular strengthen the surveillance in each country regarding the appearance of strains with an unusual profile. The Organization also recommends promoting the use of STI prevention methods.

 Epidemiological Alert: Multi-Resistant Neisseria gonorrhoeae (15 July 2011)

Since epidemiological week 23, the number of new HUS and non-HUS STEC cases has declined significantly in the European Union states. Nevertheless, the cumulative number of cases from Germany continues to rise, primarily owing to delays in notification. Investigations conducted by the German authorities indicate that the vehicle of the bacterium responsible for the outbreak, is bean and seed sprouts.

On 24 June, France reported a cluster of 8 cases, all adults (six women and two men) presenting bloody diarrhea; of which seven have developed HUS. E. coli O104:H4 has been confirmed in three patients. Preliminary investigative findings suggest that locally grown sprouts might be involved.

In the Americas Region, a total of nine E. coli O104:H4 STEC cases have been identified, of which six cases are confirmed (five in the United States and one in Canada).

 Epidemiological Alert: Haemolytic Uraemic Syndrome (HUS) and infection by Enterohaemorrhagic E. coli (EHEC) (Published on 28 June 2011)

In Haiti, the Ministry of Public Health and Population (MSPP) case surveillance system reported that as of EW 19 there was an increase in the number of new cholera cases and new hospitalizations in Port-au-Prince and in the Centre and Sud Est departments. For EW 22 and 23, five other departments (Arbonite, Grand Anse, Nippes, Nord and Nord Ouest) experienced an increase in the number of new cases and new hospitalizations. This increase coincides with the start of the rainy season in Haiti.

In Dominican Republic, the Ministry of Public Health reported that since the beginning of the outbreak up to EW 23 of 2011 there were 1,727 confirmed cases (191 in 2010 and 1,536 in 2011), including 46 deaths. The municipalities of Santa Domingo Este and Oeste, Distrito Nacional, San Pedro de Macoris, Santiago and San Cristóbal registered the highest rates of cholera transmission in the past two weeks.

 Epidemiological Alert: Update on the Cholera situation in Haiti and the Dominican Republic (Published on 22 June 2011)

New Case Definition

Starting 8 June 2011, European Union (EU) Members States are reporting case according to a new case-definition.

Possible Epidemic Case: Any person who developed in or after 1 May 2011;

• STEC diarrhea defined as acute inset of diarrhea or bloody diarrhea AND at least one of the following criteria:

1. Isolation of an E coli strain that produces Shiga toxin 2 (Stv2) or stx2 gene.
2. Direct detection of stx2 gene nucleic acid in feces without strain isolation.

• STEC HUS defined as hemolytic uremic syndrome (HUS) defined as acute renal failure and at least one of the following clinical criteria

1. Microangiopatic hemolytic anemia
2. Thrombocytopenia

Probable Epidemic Case Any possible epidemic case of STEC diarrhea or STEC HUS AND during the exposure period of 14 days before the onset of illness, meeting at least one of the following epidemiological criteria:

• Stay in Germany or any other country where a confirmed case has probably acquired infection;
• Consumption of food product obtained from Germany;
• Close contact (e.g., in a household) with a confirmed epidemic case.

Confirmed Epidemic Case Any person meeting the criteria for a possible case, AND Isolation of a STEC strain of serotype O104:H4

OR isolation of a STEC strain of serotype O104 AND fulfilling epidemiological criteria for a probable case. EU Members States are reporting number of probable and confirmed cases and deaths.

 Epidemiological Alert: Haemolytic Uraemic Syndrome (HUS) and infection by Enterohaemorrhagic E. coli (EHEC) (Published on 8 June 2011)

In Haiti, the Haitian Ministry of Public Health and Population (MSPP) case surveillance system eported that as of EW 19 there was an increase in the number of hospitalized patients in Port-au-Prince and the Centre department. This increase coincides with the beginning of the rainy season in Haiti.

While in Dominican Republic, the Ministry of Public Health informs that since the beginning of the outbreak up to EW 20 of 2011 there were 1,329 laboratory confirmed cases (191 in 2010 and 1,138 in 2011), including 27 deaths. The Distrito Nacional and the provinces of Santiago, San Pedro de Macorís, La Romano and the border provinces of Independencia and Elías Piña also registered an increase in cases with respect to the previous weeks.

 Epidemiological Alert: Update on the Cholera situation in Haiti and the Dominican Republic (Published on 7 June 2011)

Case Definition

Developed by the Robert Koch Institute to be applied to HUS-cases associated with the 2011 Germany outbreak.

HUS Clinical criteria: A clinical picture of acute enteropathogenic HUS is defined by the presence of at least two of the following three criteria:

1. Hemolytic anemia
2. Thrombocytopenia ≤ 150,000 cells/mm3,
3. Renal dysfunction.

Laboratory confirmed cases: Positive result in at least one of the following tests:

Detection of Shigatoxin

1. Culture of the pathogen and isolation only from stool AND detection of Shigatoxin Stx2 using ELISA on the E. coli culture,
2. Mixed culture of the pathogen, enriched stool cultures or isolation of E. coli AND nucleic acid amplification test (e.g. PCR) for detection of the shigatoxin gene stx2 from the same sample

Indirect (serological) detection

1. Detection of ant-LPS-IgM-antibodies against E.coli Serogroups (once markedly increased titre/concentration, e.g., using ELISA, Western Blot)
2. Marked change between two consecutive samples in titreconcentrarion of anti-LPS-IgG-antibodies against E.coli serogroups e.g.; using ELISA)

Suspect HUS case: Case with a clinical picture of acute enteropahogenic HUS as assessed by the attending physician, but not formally meeting the clinical criteria (at least two of three) identified above, are classified as suspect cases regardless of laboratory confirmation.

 Epidemiological Alert: Haemolytic Uraemic Syndrome (HUS) and infection by Enterohaemorrhagic E. coli (EHEC) (Published on 7 June 2011) 

Haemolytic uraemic syndrome (HUS): It is a life-threatening disease characterized by acute renal failure (uraemia), haemolytic anaemia, and a low platelet count (thrombocytopenia). It results from EHEC infection, and it is estimated that up to 10% of EHEC-affected patients may develop HUS. The mortality rate has decreased during the last few years and with appropriate treatment is between the 3% and 5%.

It can cause neurological complications (such as seizure, stroke and coma) in 25% of HUS patients and chronic renal sequelae, usually mild, in around 50% of survivors. EHEC or STEC is a severe strain of E. coli bacterium that is commonly found in the gut of animals, mainly ruminants. EHEC produces toxins, known as verotoxins or Shiga-like toxins because of their similarity to the toxins produced by Shigella dysenteriae. They can cause severe foodborne disease. STEC is transmitted to humans primarily through consumption of contaminated foods, such as raw or undercooked ground meat products and raw milk, contaminated water, direct contact with animals or contact with infected people. Symptoms of disease include abdominal cramps and diarrhoea, which may be bloody. Fever and vomiting may also occur.

 Epidemiological Alert: Haemolytic Uraemic Syndrome (HUS) and infection by Enterohaemorrhagic E. coli (EHEC) (Published on 3 June 2011)

In Haiti, since the beginning of the cholera outbreak, starting epidemiological week (EW) 42 in 2010, until May 10th, 2011, the MSPP registered a total of 302,401 cholera cases of which 53.8% (162,651) required hospitalization and 1.7% (5,234) died (global case-fatality rate). Since EW 19 an increase in the number of new hospitalizations is observed in comparison with previous weeks, especially in the South-East and North-West departments and in the capital city, Port-au-Prince. Additionally, Artibonite and Centre continue to report new cases.

Since epidemiological week (EW) 16, the Dominican Republic’s surveillance system is registering an increase in the number of suspected cases of cholera, principally in the peripheral area of Santo Domingo, near the river Ozama and Isabela. The increase of cases in Santo Domingo concurs with a raise in the temperature and frequency of rains, which originated flooding in different areas of Santo Domingo.

 Epidemiological Alert: Update on the Cholera situation in Haiti and Dominican Republic (Published on 20 May 2011)

Due to various cultural and sporting events that will be hosted by countries in the Americas, PAHO urges all travelers visiting any country in the Region to get vaccinated for measles and rubella before arriving in the Americas, in order to reduce the risk of reintroducing these diseases that have already been eliminated in the Americas. In addition, any resident of the Americas planning to travel to other regions of the world should be protected against measles and rubella prior to departing on their trip.

 Epidemiological Alert: Recommendations to the travelers to preserve the Americas without Measles or Rubella (Published on 28 April 2011)

Since the beginning of 2011, in the region of the Americas, there have been significant outbreaks of influenza A (H1N1) 2009, that while geographically limited, have generated a significant demand on health services. This situation is not unexpected. Since the end of the pandemic (2009-2010), the influenza A (H1N1) 2009 virus, continues to circulate on a global level like a seasonal strain, periodically causing important outbreaks in various continents. Considering the possibility of outbreaks occurring on account of the influenza A (H1N1) 2009 virus in the countries of the Region, national authorities should be prepared to mitigate the resulting impact.

 Epidemiological Alert: On Probable Influenza A(H1N1) 2009 Outbreaks (Published on 20 April 2011)

The high activity of dengue during the first trimester of 2011 in several countries in the southern hemisphere in the Region of the Americas has necessitated the rapid implementation of management plans on both the local and national levels. This allows for an opportunity to reiterate the importance of the Integrated Management Strategy for the prevention and control of dengue (IMS-Dengue).

Up to Epidemiological Week (EW) 9 of 2011, in the Region of the Americas a total of 206,097cases of dengue have been reported, including 2,744 cases of severe dengue and 223 fatalities.

 Epidemiological Alert: Update on Dengue Situation in the Americas (Published 18 March 2011)

During Epidemiological Week 8 of 2011, at the national level, Haiti registered a decrease in the weekly incidence rate, which decreased from 10.2 cholera cases per 10,000 inhabitants in EW 7 to 7.6 cases per 10,000 inhabitants in EW 8. This was linked to an increase of 3.1% in the new cases registered as compared to the previous week. At the sub-national level, five departments (Grand Anse, Nord Est, Nord Ouest, Sud Este y Nord) registered an increase in their weekly incidence rate.

While in the Dominican Republic, the Ministry of Health reported a total of 568 laboratory-confirmed cases of cholera, including six fatal cases, since the beginning of the outbreak up to EW 9.

 Epidemiological Alert: Weekly Update on the Cholera Situation EW 8 (February 8 to 26, 2011) (Published on March 17 2011)

During Epidemiological Week 7 of 2011, at the national level, Haiti registered an increase in the weekly incidence rate, which increased from 5.1 cholera cases per 10,000 inhabitants in EW 6 to 10.2 cases per 10,000 inhabitants in EW 7. This was linked to an increase of 4.2% in the new cases registered as compared to the previous week. At the sub-national level, five departments (Centre, Nippes, Ouest, Sud y Nord) registered an increase in their weekly incidence rate.

While in the Dominican Republic, the Ministry of Health reported a total of 470 laboratory-confirmed cases of cholera, including four fatal cases, since the beginning of the outbreak up to EW 7.

 Epidemiological Alert: Weekly Update on the Cholera Situation EW 7 (February 13 to 19 2011) (Published on 8 March 2011)

During the epidemiological week 6 of 2011, at the national level, Haiti registered a decrease in the weekly incidence rate, which went from 11.4 cholera cases per 10,000 inhabitants in EW 5 to 5.1 cases per 10,000 inhabitants in EW 6. This was linked to an increase of 2.2 % in the new cases registered as compared to the previous week. At sub-national level, two departments registered an increase in their weekly incidence rate (Centre y Grand Anse).

While in the Dominican Republic, the Ministry of Health reported a total of 426 laboratory-confirmed cases of cholera from the beginning of the outbreak to EW 6. 

 Epidemiological Alert: Weekly Update on the Cholera Situation EW 6 (February 6 to 12, 2011) (Published on March 1st 2011)

Through this epidemiological alert, the Pan American Health Organization is reporting the current Dengue situation in the Region and recommending to its Member States to continue and reinforce the actions of prevention and control that involve all government actors and/or non gubernamental and above all, the community.

 Epidemiological Alert: Update on Dengue Situation in the Americas (Published on 17 February 2011)

In Haiti,during the third EW of 2011 Haiti registered an increase in the weekly incidence rate at the national level, which went from 10.1 cholera cases per 10,000 inhabitants in EW 2 to 13.6 cases per 10,000 inhabitants in EW 3, which is an increase of 6.9% in the new case registrered when compared to the previous week. Of all the departments, six, increased their weekly incidence rate (Centre, Ouest, Nippes, Sud Est, Nord-Est, and Nord-Ouest) and four showed a decrease (Artibonite, Grande Anse, Nord and Sud). The hospitalization case fatality rate at the national level in EW 3 of 2011 was 1.5%, two decimals above the previous week.

While in the Dominican Republic, the Ministry of Public Health informed that since the beginning of the outbreak in EW 45 of 2010 to EW 2 of 2011, there were 263 cases confirmed by laboratory and one death that happened in EW 2.

 Epidemiological Alert: Weekly update on the Cholera situation EW 3 (January 16 to January 22 2011) (Published on 31 January 2011)

In Haiti, during the second EW of 2011 and for the third consecutive week, Haiti has registered a decrease in the weekly incidence rate at the national level. It decreased from 24.1 to 12.7 and to currently 10.1 cholera cases per 10,000 inhabitants. Three departments located in the north of the country, increased their weekly incidence rate (Nord, Nord Est, and Artibonite). At the national level, the in-hospital case fatality rate for week 2 of 2011 stayed at 1.3%. Very similar to the previous week which was 1.2%.

While in the Dominican Republic, the Ministry of Public Health reported the first death caused by cholera in the province of Altagracia. Since the beginning of the outbreak in SE 45 of 2010 and as of to SE 2 of 2011 there were 244 laboratory confirmed cases.

 Epidemiological Alert: Weekly update on the Cholera situation EW 2 (January 9 to January 15 2011) (Published on 26 January 2011)

In Haiti, during the first EW of 2011 a decrease of 47% in the national incidence rate in comparison to previous week was reported. The departments with the highest weekly incidence rate (Nord Est, Grande Anse y Ouest) also registered a decrease that ranged from 22% to 56%. At national level, the in-hospital case fatality rate declined to 1.2%. Nonetheless several departments maintained higher rates, especially Nord (4.7%) and Grande Anse (3.4%).

While in Dominican Republic, the Ministry of Public Health informed that in the first week of the 2011 8 new cases were confirmed, raising the cumulative incidence to 160 cases. No deaths have been reported.

 Epidemiological Alert: Weekly update on the Cholera situation EW 1 (January 2 to January 8 2011) (Published on 18 January 2011)

In Haiti, during this 52nd epidemiological week, there has been a decrease in the incidence rate in two departments in the north and a turn in the departments in the south. While Dominican Republic, registered 154 cases of cholera distributed in 13 of the 31 provinces of the country; 66.9% of the cases were hospitalized.

 Epidemiological Alert: Weekly update on the Cholera situation EW 52 (December 26 2010 to January 1st 2011) (Published on 11 January 2011)

During the epidemiological week (EW) 51, at a national level, the MSPP registered 16,838 new cases, 26.5% less than the previous week (22,920 new cases).
According to the Ministry of Public Health from Dominican Republic , since the beginning of the detection of the first case of cholera in the Dominican Republic (EW 46 ), until the 28th of December of 2010, the Ministry of Public Health of the Dominican Republic has registered 131 cases of cholera with laboratory confirmation, of which 78% (103) were hospitalized. Up to this date no deaths have been registered.

 Epidemiological Alert: Weekly Update on the Cholera Situation EW 51 (19 – 25 of December) (3 January 2011)

Currently, all ten departments of Haiti have reported cases and deaths due to cholera. During the previous three epidemiological weeks, the highest cumulative incidence was observed in the departments of Artibonite (305 cases per 10,000 inhabitants) followed by Nord Ouest, Nord and Centre (with 190 and 185 and 167 cases per 10,000 inhabitants, respectively).
In Dominican Republic, from EW 465 to EW 50, the Ministry of Public Health of the Dominican Republic recorded 73 laboratory confirmed cholera cases, of which 75% (55) were hospitalized. No deaths were ecorded. Also, 4 cases have been considered imported and 69 autochthonous.

 Epidemiological Alert: Weekly Update on the Cholera Situation EW 50 (12 to 18 December) (23 December 2010)

Currently, there are cases and deaths due to cholera in the 10 departments of Haiti. The highest cumulative incidence rate as of EW 49 was observed in the department of Artibonite with 290 cases per 10,000 inhabitants, followed by Nord Ouest, Centre and Nord with 172 and 146 and 143 cases per 10,000 inhabitants, respectively. These departments also recorded the highest cumulative incidence rates in the previous weeks.
In Dominican Republic, from EW 46 to EW 49, the Ministry of Public Health of the Dominican Republic recorded 38 laboratory confirmed cholera cases, of which 27 were hospitalized. No deaths were recorded. Also, 2 cases have been considered imported and 36 autochthonous.

 Epidemiological Alert: Update on the Cholera Situation as EW 49 (5 to 11 December) (Published on December 16, 2010)

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 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.

 Epidemiological Alert: Update on Cholera Situation (7 December 2010)

Currently, in Haiti there are cholera cases in the 10 departments of Haiti and deaths in 9 departments. The highest incidence rate registered is in the Artibonite department with 246 cases per 10,000 inhabitants, followed by Nord Ouest with 114 cases per 10,000 inhabitants and Centre with 102 cases per 10,000 inhabitants.
In Dominican Republic, from the laboratory confirmation of the first case of cholera in EW 46, and as part of enhanced surveillance implemented by the Ministry of Public Health, a total of 9 cholera cases were detected of which four required hospitalizations. One case has been considered imported while the remaining eight cases were considered autochthons.

 Epidemiological Alert: Update on Cholera Situation (1 December 2010)

The present report contains update information about the cholera cases in Haiti and the Dominican Republic. In Haiti the number of deaths at the national level, of the 1,415 deaths recorded by the MSPP, 67% occurred at the health services level, and 33% at the community level. The in-hospital case fatality rate at the national level is 2.3%. In the DOminican Repúblic, the IHR National Focal Point reported a confirmed imported cholera case in a 32-year-old male who was hospitalized after presenting an acute diarrheal syndrome. Later, other two cases were confirmed, all of them in Santo Domingo.

 Epidemiological Alert: Update on Cholera Situation (23 November 2010)

In the EW 45 the first cholera cases were recorded in Port-au-Prince, with a total of 953 hospital admissions and 46 deaths, as of November 15. In Port-au Prince, the communities which currently register an increase in cases are Carrefour, Cité Soleil, Delmas, Kenscoff, Petion Ville and Tabarre.

 Epidemiological Alert: Update on Cholera Situation in Haiti (17 November 2010)

The purpose of this alert is to call upon the countries throughout the Region to undertake sustainability plans for its activities under the Integrated Management Strategies for the Dengue Prevention and Control (EGI-Dengue), involving other government and / or non-governmental actors and mainly to the community.

 Epidemiological Alert: Update on Dengue Situation in the Americas (15 November 2010)

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.

 Epidemiological Alert: Update on Cholera in Haiti (07 November 2010)

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, as well as to encourage the countries to implement them.

 Epidemiological Alert: Cholera (31 October 2010)

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.

 Epidemiological Alert: Cholera (28 October 2010)

The purpose of this alert is to share the recommendations published by the World Health Organization in its document “WHO statement relating to international travel and trade to and from countries experiencing outbreaks of cholera.”

 Epidemiological Alert: Cholera (27 October 2010)

In this situation, and given the risk of the reintroduction of cholera in the Region, the Pan American Health Organization recommends to its Member States to step up efforts in surveillance, update preparedness and response plans and to implement appropriate prevention and health promotion measures.

 Epidemiological Alert: Cholera (24 October 2010)

The Global Polio Eradication Initiative is currently registering 574 cases caused by wild poliovirus type 1 (WPV1) and 3 (WPV3) in non-endemic countries: Angola, central-Asian countries, Russia, Chad, Sudan, Democratic Republic of Congo, Nepal, and western-African countries.

 Epidemiological Alert: Poliomyelitis (20 October 2010)

The first occurrence of the disease was described in Tanzania in 1952. Starting in 2004, intense outbreaks have been constantly reported in Africa, islands of the Indian Ocean, and the Pacific region, including Australia and Southeast Asia (India, Indonesia, Myanmar, Maldives, Sri Lanka, and Thailand). In 2007, the virus extended to Italy, where it produced an outbreak transmitted by Ae albopictus in the Emilia-Romagna region. Recent Chikungunya fever outbreaks have shown important impacts on Public Health, mainly in health services.

 Information Sheet: Chikungunya Fever (23 September 2010).

During the first semester of 2010, the epidemiological situation of dengue in the Region has displayed unstable behavior, with intense outbreaks of dengue in various countries of the Region. The climatological conditions have remained favorable for the proliferation of the Aedes aegypti mosquito – its transmitting agent – while certain unusual alterations have been observed in its seasonality, where, since the beginning of the year, Central American countries and Caribbean islands have been affected during periods that are considered unusual.

 Epidemiological Alert: Update on Dengue Outbreaks in the Americas (8 September 2010)

During this year, measles cases, imported and imported related, have been registered in Argentina, Brazil, Canada, the United States, and French Guyana. From January to 21 August, 2010, 143 confirmed measles cases have been registered, 40 of which were imported, 37 imported-related, and 66 which are still under investigation or whose source of infection is unknown.

 Epidemiological Alert: Measles (2 September 2010)

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.

 Epidemiological Alert: Rabies (30 August 2010)

On Epidemiological Week (EW) 32 of this year, the Ministry of Health and Sports of the Plurinational State of Bolivia registered a confirmed case of bubonic plague in a male of 14-year-old from the municipality of Apolo, department of La Paz who died on 7 August, 2010. To date, not new cases were reported.

Regarding the plague outbreak in Peru, from the EW 32 until to date, the Ministry of Health registered 27 cases of plague, of which 11 were laboratory confirmed. Of these 27 registered cases, 21 were bubonic plague (including one deceased), 4 pneumonic plague and two died from septicemic plague. 25 of them acquired the infection in the province of Ascope and 2 in Trujillo. The last case of pneumonic plague symptoms began on August 11, 2010 and there were no new cases thereafter.

 Epidemiological Alert: Plague (Updated as of 25 August 2010)

During Epidemiological Week (EW) 28 of this year, the Ministry of Health of Peru confirmed the first case of pneumonic plague in a 29 year old patient from the district of Chocope, province of Ascope, department La Libertad. The presence of buboes had not been identified in the patient. Subsequently 3 more cases were registered. They were confirmed by rapid test.

 Epidemiological Alert: Plague Outbreak in Peru (2 August 2010)

Equine encephalitides are a group of viral diseases transmitted to humans by arthropods. Eastern equine encephalitis (EEE), Western equine encephalitis (WEE) and Venezuelan equine encephalitis (VEE) are considered the most important for their distribution and impact on public health in the Americas.The etiologic agent of these viral diseases belongs to the genus Alphavirus, family Togaviridae.

 Epidemiological Alert: Equine Encephalitis transmitted by Arthropods (20 July 2010)

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.

 Epidemiological Alert: Dengue Outbreaks in the Americas (7 July 2010)

In light of the increase in carbapenemases in enterobacteria detected in several countries of the Region, the Pan American Health Organization (PAHO) emphasizes the importance of the detection of this mechanism of resistance, which increases considerably morbidity and mortality of the infections by Klebsiella pneumoniae.

 Epidemiological Alert: Dissemination of Carbapenemases in Klebsiella Pneumoniae in Latin-America (2 July 2010)

In the Americas, outbreaks of the Oropuche fever virus have been described in rural and urban communities of Brazil, Ecuador, Panama, Peru, and Trinidad and Tobago.Outbreaks that were registered in the last ten years as due to the Oropuche virus have occurred mainly in the Amazon region.

 Epidemiological Alert: Outbreak of Oropouche Fever (22 June 2010)

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.

 Epidemiological Alert: Outbreak of Mayaro Fever in the Americas (7 June 2010)

To date, the countries of the Americas 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.

 Epidemiological Alert: Dengue Outbreaks in the Americas (4 June 2010).

This update contains new information from Guatemala: From Epidemiological Weeks (EW) 1 through 17, Guatemala reported a total of 6,657 cases of which 1,123 were laboratory confirmed, with 3 deaths (in Izabal, Jutiapa, and Petén Norte).The age group most affected were children from 1 to 4 years of age, follow by infants less than a year old and then by children 5 to 9 years old.

 Epidemiological Alert: Update on Rotavirus Diarrheal Syndrome (19 May 2010)

The purpose of this alert is to inform those intending to travel to South Africa for the upcoming FIFA World Cup as to health recommendations or other useful information from the World Health Organization, the Pan American Health Organization, and the Department of Health of South Africa. Links are provided to relevant information that travelers can consult.

Epidemiological Alert: Information for Persons Intending to Travel to South Africa to Attend the 2010 FIFA World Cup (13 May 2010)

To date, the countries of the Region have reported a total of 344,346 cases of dengue, of which 7,838 are severe dengue. They have reported 144 deaths, with a regional fatality rate of 1.84%. This updates provides a breakdown by subregion (Central America and Mexico, Andean Subregion, Southern Cone, Caribbean) with the number of cases, severity, serotypes in circulation, affected areas, and measures taken, concluding with general recommendations for dengue prevention and control.

Epidemiological Alert: Update on Dengue Outbreaks in the Americas (22 April 2010)

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.

 Epidemiological Alert: Update on Rotavirus Diarrheal Syndrome (7 April 2010)

Epidemiological Alert: New Confirmed Cases of Saint Louis Encephalitis in Capital City and Province of Buenos Aires, Risk of Viral Circulation (31 March 2010).

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.

 Epidemiological Alert:New Confirmed Cases of Saint Louis Encephalitis in Capital City and Province of Buenos Aires, (31 March 2010)

Epidemiological Alert: Confirmed Cases of Saint Louis Encephalitis in Buenos Aires, Argentina, Risk of Viral Circulation (24 March 2010)

On 19 March 2010, the Ministry of Health of Argentina reported the occurrence of two confirmed cases of Saint Louis Encephalitis (SLE) infection in the nation’s capital city of Buenos Aires. The SLE virus has 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. This virus has epidemic potential.

 Epidemiological Alert: Confirmed Cases of Saint Louis Encephalitis in Buenos Aires, Argentina, Risk of Viral Circulation (24 March 2010)

Epidemiological Alert: Rotavirus Diarrheal Syndrome (23 March 2010)

In the past month there has been detecting the confirmed outbreaks of acute diarrhea caused by rotavirus in countries of the region. Dominican Republic showed an increase of 25% in 9 provinces. In Mexico, although the cases are distributed in 23 states, the largest percentage of these occurred in Chiapas (30%), Baja California (13%), among others. While in Guatemala were a total of 4,336 cases, of which 964 have been confirmed by laboratory.

 Epidemiological Alert: Rotavirus Diarrheal Syndrome (23 March 2010)

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 recommendations for dengue prevention and control.

Epidemiological Alert: Dengue Outbreaks in the Americas (8 March 2010)

Brotes de Dengue

La información contenida en esta actualización, se obtiene a partir de los datos proporcionados por los Ministerios de Salud de los Estados Miembros a través de los informes enviados a la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) o de actualizaciones en sus páginas Web.

Hasta la semana epidemiológica (SE) Nº 45 del año 2009 se reportaron 853.468 casos de dengue en la región de las Américas, incluyendo 20.832 casos de dengue hemorrágico y formas complicadas de dengue y 326 defunciones, con una tasa de letalidad regional de 1,56%. Tabla 1.

Ante el inicio de la temporada de mayor transmisión de conjuntivitis hemorrágica en países tropicales, la Organización Panamericana de la Salud (OPS) enfatiza en la necesidad de reforzar la vigilancia e implementar las recomendaciones que contribuyen a controlar la diseminación de la enfermedad.

1. Situación Regional del dengue en las Américas, Año 2009

Hasta la semana epidemiológica (SE) Nº 40 del año 2009 se reportaron 730.609 casos de dengue en la región de las Américas, incluyendo 16.545 casos de dengue hemorrágico y formas complicadas de dengue y 289 defunciones, con una tasa de letalidad regional de 1,75%.

This brief two-page report is an update of information published yesterday on influenza A(H1N1) activity in the United States, Mexico, and Canada, indicating the number of cases, affected areas, and laboratory results, as well as surveillance and outbreak control measures being taken and how this outbreak fits the criteria of the International Health Regulations (IHR) as a public health emergency of international concern.

 Influenza Cases by a New Subtype: Update for the Americas (27 April 2009, 1 pm EST)

Since 18 April, cases of influenza A(H1N1) have been reported in the United States, Mexico, and Canada. Read on for more information on the outbreak with number of cases, affected areas, and laboratory results, as well as surveillance and outbreak investigation underway and how this outbreak is defined in terms of the International Health Regulations (IHR).

 Influenza Cases by a New Subtype: Regional Update (26 April 2009, 1:30 pm EST)

On 7 April 2009, the Ministry of Public Health and Social Welfare of Paraguay received laboratory confirmation of a case of cholera arising from Vibrio cholerae O:1 Ogawa, biotype El Tor, toxin producing. The date on onset of symptoms was 6 March, originating in an indigenous community in the Paraguayan Chaco region. Since then, three outbreaks of acute diarrheal disease were detected, with 15 reported cases (though the total number is undetermined) and 3 deaths. Regional health authorities have taken successful measures to assure safe drinking water in the affected areas (chlorination, boiling water, purchase of mineral water) and the situation has been contained, which leads us to believe that transmission was water borne.

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This four-page report provides the most up-to-date information on dengue activity in the Region of the Americas, with a data table by subregion and a chapter on each one with details and country data. (Epidemiological Alerts, Vol. 6, No. 9)

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This brief update provides epidemiogical data for 2009 on reported dengue outbreaks in the various subregions of the Americas, by country and area within the affected country when deemed relevant, up to 3 April (EW 13) 2009. It also briefly describes the activities on which PAHO is working with the countries.

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This ten-page report, with numerous graphs and tables, summarizes the situation of dengue in the Americas by subregion and country, comparing it to last year. It includes a summary of actions taken at individual and community level as well as activities planned in the countries for this year.

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This update describes the status of the yellow fever outbreaks that have taken place this year in Argentina, Brasil, Colombia, Paraguay, Peru, Trinidad and Tobago, and Venezuela, as well as the response to them and recommendations to be followed to control them.

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This brief report describes the situation of dengue in the Americas up to 5 March 2009, with descriptions on each subregion and country affected and a variety of tables and figures, along with technical cooperation offered by PAHO/WHO to combat the situation and what recommendations to follow.

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Since beginning of the year up to 20 February 2009 the following have been reported:

• 25,287 cases of suspected dengue fever.
• 2,831 cases of classic dengue fever.
• 80 suspected cases of dengue hemorrhagic fever (DHF)
• 18 deaths

Fatality rate: 22.5%

Identified serotypes: DEN 1, 2 and 3

 Update: Dengue situation in Bolivia (20 february 2009)

Since beginning of the year up to 16 February 2009 (Epidemiological Week No. 1 to 6) the following have been reported:

• 19,590 cases of suspected dengue fever
• 2238 cases of classic dengue fever
• 66 suspected cases of dengue hemorrhagic fever (DHF)
• 9 deaths (including 1 study).
  
  

Fatality rate: 13.6%

Identified serotypes: DEN 1 and DEN 3

 Dengue Situation in Bolivia (17 February 2009)

This update report focuses on the yellow fever situation in South America and the Caribbean and on current measures being taken for surveillance, response, and disease and vector control, as well as vaccination for people at risk.

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Up to 6 February 2009 (Epidemiological Weeks/ EWs 1–5), reports indicate:

• 12,372 suspected cases of dengue.
• 1,326 confirmed cases of classic dengue.
• 55 suspected cases of dengue hemorrhagic fever (DHF).
•  7 deaths under investigation.
• Fatality Rate: 12.7 %
• Serotypes identified: DEN 1 and 3

Departments affected: Beni, Chuquisaca, Cochabamba, La Paz, Oruro, Pando, Potosi, Santa Cruz de la Sierra, Tarija.  The increase in incidence is mostly concentrated in Santa Cruz de la Sierra.

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2. Response

3. Recommendations

4. Map of Yellow Fever Events in South America and the Caribbean, by first administrative level, January 2009

 Update: Situation of Yellow Fever in the Americas (30 January 2009)

Since October 2008, an intense increase in the circulation of the jungle yellow fever (JYF) virus has been observed in the Americas, affecting Argentina and Brazil in the southern part of the continent, Colombia and Venezuela in the Andean region, and Trinidad and Tobago in the Caribbean. 

 
The objective of this communication is to alert the countries of the Region so that they can strengthen their surveillance, prevention, and control activities for yellow fever within their territories and for persons traveling towards affected or risk areas. 

 Epidemiological Alert: Increase in Circulation of Jungle Yellow Fever Virus in the Americas