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INFLUENZA A (H1N1)
SANITARY EMERGENCY
JUNIO 2009
• Sometimes Nature gives us ... ... .. SECONDS
PANDEMIA H1N1MEXICO
• Sometimes Nature gives us ... ... .. MINUTES
PANDEMIA H1N1MEXICO
• Sometimes Nature gives us ... ... .. HOURS
PANDEMIA H1N1MEXICO
• SometimesNature gives us ... ... .. DAYS
PANDEMIA H1N1MEXICO
• Sometimes Nature gives us ... ... .. YEARS
INFLUENZA VIRUS “A”H5N1, H1N1…
PANDEMIA H1N1MEXICO
PANDEMIAS DEL SIGLO XX
SPANISH FLU - 1918
• The Spanish Flupandemic H1N1 is avirus that killed morethan 40 millionpeople, a numbermuch higher thanWorld War I deaths
Miller M et al. N Engl J Med 2009;360:2595-2598
Mortality Distributions and Timing of Waves of Previous Influenza Pandemics
Mortality Distributions and Timing of Waves of Previous Influenza Pandemics. Proportion of the total influenza-associated mortality burden in each wave for each of four previous pandemics is shown above the blue bars. Mortality waves indicate the timing of the deaths during each pandemic. The 1918 pandemic (Panel B) had a mild first wave during the summer, followed by two severe waves the following winter. The 1957 pandemic (Panel C) had three winter waves during the first 5 years. The 1968 pandemic (Panel D) had a mild first wave in Britain, followed by a severe second wave the following winter. The shaded columns indicate normal seasonal patterns of influenza.
Source: The New England of Journal of Medicine
PANDEMIA H1N1MEXICO
APRIL 25, 2009
• The CDC reported 6 new cases linked to H1N1 in Mexico
• WHO receives information from Mexico with 884 suspected cases of swine influenza and 62 deaths
• The Mexican government closed all schools in Mexico City
• WHO declared an internationalpublic health emergency
MEXICO INFLUENZA SITUATION
DISTRIBUTION OF CASES CONFIRMED FROM THE DATE AT ONSET
FUENTE: Base de datos InDRE, SSA. 2009
PANDEMIA H1N1MEXICO
29 APRIL
• La OMS increased phase 4 to phase 5
• Ten countries reported confirmed cases, including South Korea
• Ms. Margaret Chan (WHO Director ) and companies around the world through a teleconference discussed vaccine production.
Distribution of deaths and confirmed cases by age
13FUENTE: Casos confirmados: Base de datos InDRE.; Defunciones: CONAMED.
Confirmed cases and deaths by age group (2.656 cases and 64 deaths)
732 679
505
294237
14749 135 4 20 13 9 9 4 0
0-9 10-19 20-29 30-39 40-49 50-59 60+
ConfirmadosDefunciones
% womendeaths
40.0 50.0 55.0 53.8 55.6 77.8 25.0
Unavailable
• 64 confirmed deaths• Deaths correspond to 2.4% of
total confirmed cases• 54.7% women
Deaths distribution by date
date of ocurrance
12
01
0 01
4
01
3 3
1 12
8
56
3
5
1
5
1
3
1 1
3
10 0
10 0
0123456789
10/0
4/20
0911
/04/
2009
12/0
4/20
0913
/04/
2009
14/0
4/20
0915
/04/
2009
16/0
4/20
0917
/04/
2009
18/0
4/20
0919
/04/
2009
20/0
4/20
0921
/04/
2009
22/0
4/20
0923
/04/
2009
24/0
4/20
0925
/04/
2009
26/0
4/20
0927
/04/
2009
28/0
4/20
0929
/04/
2009
30/0
4/20
0901
/05/
2009
02/0
5/20
0903
/05/
2009
04/0
5/20
0905
/05/
2009
06/0
5/20
0907
/05/
2009
08/0
5/20
0909
/05/
2009
10/0
5/20
0911
/05/
2009
12/0
5/20
09
N = 64
Total cases: 2,656 confirmed
Caso
s
probable Cases
confirmed Cases
FUENTE: Base de datos InDRE.
0
200
400
600
800
1000
1200
1400
11-0
3-09
13-0
3-09
15-0
3-09
17-0
3-09
19-0
3-09
21-0
3-09
23-0
3-09
25-0
3-09
27-0
3-09
29-0
3-09
31-0
3-09
02-0
4-09
04-0
4-09
06-0
4-09
08-0
4-09
10-0
4-09
12-0
4-09
14-0
4-09
16-0
4-09
18-0
4-09
20-0
4-09
22-0
4-09
24-0
4-09
26-0
4-09
28-0
4-09
30-0
4-09
02-0
5-09
04-0
5-09
06-0
5-09
08-0
5-09
10-0
5-09
12-0
5-09
14-0
5-09
Samples processed
Fecha de inicio de síntomas
Epidemiological curve with confirmed cases, probable cases, and processed samples (onset date)
15
FATALITY RATE HUMAN INFLUENZA A (H1N1)
Fatality Rate•Mexico 1.73%•United States 0.25%•Canada 0.13%•Costa Rica 0.96%•Colombia 2.38%•Guatemala 0.84%•Chile 0.11%•Rep. Dominicana 1.07 %
Fatality Rate Worldwide 0.45%
NOTE: The fatality rate is calculated only with confirmed cases. No cases are taken into account with minor cases or moderated cases
Datos tomados de la Organización Mundial de la Salud
Sanitary Surveillance
in the Transport System
JUNIO 2009
TRANSPORT AUTHORITY
Close sanitary surveillance wasinitiated from march 23th
Medical checkpoints inTransport Terminals DuringSanitary Emergencies
The Health Authority providedthe Definition for Suspect Case
OBJECTIVES
1. Maintain Society activity and economy,supporting the transport system
2. To minimize the spread of communicabledisease
3. Identify passengers suspect of carryingcommunicable disease and refer them toproper medical attention
4. Establish a permanent EpidemiologicalSurvey System in the transport nodes
PROCEDURES
•Inbound, and/or outboundpassengers
•Airplanes or shipsreporting symptomaticsuspicious passengers onboard
PROCEDURES
Level of actions according to the Severity Scale
LOW•Sanitary event category 1
•Information and promotion activities, medical self declaration •Medical services available
INTERMEDIATE•Sanitary event category 2•Information and promotion activities, medical self declaration •Medical services available•Body temperature assessment
PROCEDURES
HIGH• Sanitary event category 3 or 4
Information and promotionactivities, medical selfdeclaration
• Medical services available• Body temperature assessment
• Visual inspection by medical personnel
• Medical assessment through history physical examination, rapid swab
test, etc.
HUMAN RESOURCES
• Distribution of selfdeclaration and healthpromotion material.
• Body temperatureassessment
• Clinical direct inspection
FACILITIES
ENTRADA A TERMINAL
ÁREA DE TRANSITO
ÁREAS DE DOCUMENTACIÓN
11
1 Mesas para llenado de cuestionario por pasajeros
MO
STR
AD
OR
ES
2
2 Pasillo confinado
3
3 Cámara térmica o toma de temperatura y revisión de cuestionario
4
4 Mesas de sellado de cuestionario
Salida a mostradores
5
5 Bandas de confinamiento
67
6
7 Salida a módulo de valoración médica
Nota: esta propuesta podrá adecuarse según con la infraestructura de cada terminal
Self Declaration and medical assessment procedures
CONTACTS
• 1) Internal
• Local public health authorityAirport medical service providers
• Airlines• Handling agents
Air traffic management• Local hospital (s)• Emergency medical services• Police• Customs• Immigration• Security• Airport retailers• Information/customer relations
services• Other stakeholders as necessary
AIRPORT PROCEDURES
EXTERNAL
Travelers before reaching the airport
Travel agents
International organizations involved with migration
Other airports Media
AIRPORT PROCEDURES
d) Medicalassessmentprocedures
• Visual inspection• Self declaration
questionnaire• Body temperature
assessment
AIRPORT PROCEDURES
Airplane commander must:
• Inform air traffic control if a suspect o evident case of acommunicable disease is on board
• Aircraft ID• Airport of origin• Airport of destination• Time of arrival• Number of passengers and crew• Number of suspect cases on board
AIRLINE PROCEDURESIf cabin crew identifies a probable case of a communicable disease onboard
• Contact a consulting physician
• Relocate the passenger to an isolated position –if posible-
• Change crew tasks and activities according to the needs of sick passenger(s)
• Use of adequate personal protection equipment
AIRLINE PROCEDURES
AIRLINE PROCEDURES
The airport authority will issue notification to:
– Sanitary authority– Airport medical
services– Medical authority of
SCT
ON EVALUATION PROCEDURE FOR AIRPLANES WITH SUSPECT PASSENGERS BOARD
Passenger screening
• Termographic assessment is useful to assess temperature
• Body temperature is not a useful indicator in airports
• Clinical inspection and self declarations have high screening sensibility