H1N1 in the Americas: Transmission patterns, vaccine production plans, and popular responses
November 14, 2009
With more than 4,500 deaths attributed to infection with the new H1N1 influenza virus, Latin America is among the world regions hardest hit by the 2009 influenza pandemic. Mexico reported the world’s first infections with H1N1 last April. While the United States, Canada, and Mexico all struggled to investigate and respond to the outbreak in the spring, Mexico faced particular challenges. A high number of confirmed infections and deaths early on, along with emergency measures that closed schools and businesses in an effort to contain the transmission of the virus, led tourists to cancel travel to Mexico and exacerbated economic difficulties in a country already struggling to cope with the effects of the global financial crisis.
The arrival of winter in the southern hemisphere in June intensified the circulation of H1N1 in South America. By the end of August all countries in the region had confirmed H1N1 infections among patients with respiratory ailments, and the number of infections and fatalities in the Southern Cone rose quickly. To date, Argentina (5.8%) and Brazil (7.9%) have reported the highest H1N1 case fatality rates in the world, and Brazil has reported the greatest number of H1N1 deaths worldwide – 1,368 as of November 6, 2009.
The Caribbean and Central American countries are also feeling the effects of the pandemic. Cuba has reported seven H1N1-associated deaths, and the Dominican Republic has reported 22 deaths so far. Nicaragua, El Salvador and Barbados have recently reported several patients co-infected with H1N1 and dengue fever, the latter of which alone causes significant morbidity and mortality in the region each year.
The Pan American Health Organization (PAHO) estimates that at least 200 million people in the Americas will need to be immunized against the H1N1 virus and has organized regional meetings to discuss country needs with respect to the H1N1 vaccine. Once the vaccine becomes available, the organization will offer it free of charge to some of the region’s poorest countries, including Haiti, Nicaragua, Honduras, Guatemala, Paraguay, and Bolivia. Other countries will have the opportunity to purchase vaccine at discount prices through PAHO’s Revolving Fund for Vaccine Procurement. Shipments of vaccine are expected to start arriving in the region at the beginning of December, although most vaccine will be delivered within the first few months of 2010.
Efforts to strengthen regional capacity to produce and distribute vaccines are advancing. The pharmaceutical manufacturer Sanofi Pasteur has struck a deal with the São Paulo-based Butantan Institute to produce and supply H1N1 vaccine for the Government of Brazil. In Mexico, Sanofi Pasteur will partner with the parastatal company Laboratorios de Biológicos y Reactivos de México to produce vaccines for domestic use. Mexican research teams at the Teconológico de Monterrey and the Universidad Nacional Autónoma de Mexico (UNAM) are working to develop their own H1N1 vaccines, which could be produced and marketed at lower costs than those supplied by international firms. Argentine president Cristina Fernández de Kirchner has called for pharmaceutical companies to waive patent protections for their vaccines in an effort to promote more widespread vaccine development and production in the region.
Evidence suggests that indigenous populations in the region are particularly vulnerable to H1N1 infection. Venezuela and Brazil have recently reported outbreaks of acute respiratory infections, including some confirmed H1N1 cases, among the Yanomami community, who inhabit a remote region that straddles the border between the two countries. It is not clear whether indigenous populations appear more vulnerable to H1N1 because of the scarcity of health resources in indigenous settlements or because of indigenous communities’ lack of previous exposure to related influenza strains. However, it will be important to ensure delivery of vaccines, along with other preventive measures, to the isolated and impoverished areas where indigenous populations are located.
With the approach of winter in the northern hemisphere, the influenza pandemic in Canada, the United States and Mexico is intensifying, even as the imminent arrival of summer in South America is associated with a decrease of influenza activity across most of the region. However, with many families planning to travel within the region or from north to south to visit friends and relatives over the Christmas and New Year’s holidays, the H1N1 virus may continue to circulate along common travel routes.
In the meantime popular concerns about H1N1 are prompting innovative prevention strategies – in Argentina, the familiar custom of enjoying Yerba mate tea with friends by passing around a common drinking vessel and straw has given way, among some mate consumers, to a preference for single cup servings. Fashion designers in Mexico have acknowledged H1N1 by featuring surgical masks in their fall line-ups. And across the region, where greeting a friend with one or two kisses on the cheek is customary, some worry that the business-like handshake, or just a nod of the head, will become the new norm.