Pandemia de Influenza: situação e perspectivas Jarbas Barbosa da Silva Jr. Organização Pan-Americana de Saúde (OPAS)

Cronologia da pandemia A (H1N1)

10 April: outbreak of ILI in Veracruz April May June July August October September March Cronologia da pandemia A (H1N1)

4 April: outbreak of ILI in Veracruz May June July August October September March 21 April: 2 cases of H1N1 reported in California, USA 23 April: H1N1 confirmed in several patients in MX April Source: MMWR, 58(15) Cronologia da pandemia A (H1N1)

Human (H3N2) North American avian 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 Influenza A (H1N1) Fig. 4. Neumann et al. Genesis of the swine-origin influenza A (H1N1) virus Smith et al., Nature, 2009 Garten et al., Science, 2009 Dawood et al., NEJM, 2009

4 April: outbreak of ILI in Veracruz 27 April: WHO phase 4 May June July August October September March 21 April: 2 cases of H1N1 confirmed in California, USA April Cronologia da pandemia A (H1N1)

4 April: outbreak of ILI in Veracruz 29 April: WHO phase 5 27 April: WHO phase 4 May June July August October September March 21 April: 2 cases of H1N1 confirmed in California, USA April Cronologia da pandemia A (H1N1)

4 April: outbreak of ILI in Veracruz 29 April: WHO phase 5 April H1N1 in 48 countries 27 April: WHO phase 4 June July August October September March May May: H1N1 introduction in SH 21 April: 2 cases of H1N1 confirmed in California, USA Cronologia da pandemia A (H1N1)

4 April: outbreak of ILI in Veracruz 29 April: WHO phase 5 April 27 April: WHO phase 4 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries May June July August October September March 21 April: 2 cases of H1N1 confirmed in California, USA Cronologia da pandemia A (H1N1)

4 April: outbreak of ILI in Veracruz April 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries May July August October September March 1st US H1N1 peak June 21 April: 2 cases of H1N1 confirmed in California, USA Source: CDC FLUVIEW, Cronologia da pandemia A (H1N1)

4 April: outbreak of ILI in Veracruz April Argentina H1N1 winter peak 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries MayAugustOctoberSeptemberMarch June 21 April: 2 cases of H1N1 confirmed in California, USA July Chile H1N1 winter peak Cronologia da pandemia A (H1N1)

4 April: outbreak of ILI in Veracruz 29 April: WHO phase 5 April May October September March August July Active Transmission of H1N1 in Tropical Asia and Tropical Americas 21 April: 2 cases of H1N1 confirmed in California, USA June Cronologia da pandemia A (H1N1)

4 April: outbreak of ILI in Veracruz Wk 26: Chile peak ILI activity April 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries May June July October September March Southern Hemisphere Influenza transmission subsides; Brazil H1N1 winter peak August 21 April: 2 cases of H1N1 confirmed in California, USA Source: WHO FluNet Cronologia da pandemia A (H1N1)

4 April: outbreak of ILI in Veracruz April 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries May June July October September March 2nd H1N1 season begins in the US August 21 April: 2 cases of H1N1 confirmed in California, USA 2 nd H1N1 season starts in Japan Source: CDC FLUVIEW, Cronologia da pandemia A (H1N1)

4 April: outbreak of ILI in Veracruz increase in influenza activity in Mexico 29 April: WHO phase April: clusters of severe pneumonia in Mexico Wk 29: Australia and NZ peak ILI April Wk 26: Argentina peak ILI activity 27 April: WHO phase 4 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries May June July August October September March 23 April: H1N1 confirmed in several patients in MX Wk 30: UK peak ILI activity WK 24: SA H3N2 peak 21 April: 2 cases of H1N1 confirmed in California, USA Source: Mexico MoH, Cronologia da pandemia A (H1N1)

29 April: WHO phase 5 April 27 April: WHO phase 4 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries May June July August March WK 24: SA H3N2 peak Increasing activity throughout Northern Hemisphere September October Cronologia da pandemia A (H1N1)

29 April: WHO phase 5 April 27 April: WHO phase 4 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries May June July August March WK 24: SA H3N2 peak Increasing activity throughout Northern Hemisphere October September Cronologia da pandemia A (H1N1)

América do Norte USA CANADA MEXICO

América Central e o Caribe GUATEMALACAREC CAREC Member countries are : Barbados, Bahamas, Dominica, Jamaica, San Vincent and the Grenadines, and Trinidad y Tobago.

Chile Peru Argentina América do Sul

Principais características da pandemia

O vírus viaja rápido 213 países e territórios mortes

Corredor Endémico de Enfermedad Tipo Influenza. Argentina, SE O inverno faz diferença

Aspectos epidemiológicos População UTI 20% Taxa de ataque 5% - 11% ? Hospitalização 2 – 30 p/10 5 Mortes 0,8 – 2,4 p/ 10 5 Assintomáticos?

Características dos casos

Aspectos epidemiológicos Número Básico de Reprodução (Ro) Estimado ( ) Taxa de Ataque Secundária Contatos domiciliares SRA: 19% (US) ETI: 8-12% (US) ETI: % (Japão) Surtos em escolas Casos confirmados em laboratório: 13-33%

Distribución porcentual de virus respiratorios por grupos de edad. Argentina, O vírus pandêmico substitui o sazonal

Age-related distribution of deaths from severe pneumonia compared to influenza seasons Mexico Pandemia x Sazonal

Taxa de Hospitalização por Influenza em países das Américas Hospitalização

Taxa de Mortalidade por Influenza em países das Américas Taxa de Mortalidade

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 Serviços de saúde Medidas não farmacêuticas/ comunicação de risco

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)

Os primeiros casos