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

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