Elimination Initiative 30+. Accelerating the Elimination of Communicable Diseases in the Americas

The global response to the COVID-19 pandemic is a test of our ability to unite and speak out against pandemics. Having overcome the enormous task of protecting populations from the virus, it is essential that we prepare for future outbreaks and work proactively, not only to control communicable diseases, but also to accelerate the elimination agenda by 2030, a goal within reach of the countries of the Americas. By building on and learning from successes, the Region of the Americas has the potential to eliminate many more communicable diseases in our lifetime. The PAHO Elimination Initiative points the way. Since the launch of the Elimination Initiative in 2019, we have made commendable progress, despite the tests posed by the COVID-19 pandemic. Notably, this global crisis served as a catalyst, not just a challenge. The pandemic amplified the importance of establishing stronger, more resilient health systems, leading to rapid advances, some of which include the emergence of new technologies and a pronounced shift toward community-based service delivery.

The Case for Investment in Prevention and Control of Noncommunicable Diseases and Mental Disorders in Suriname: A return-on-investment analysis

This report presents the results of the investment case for prevention and control of noncommunicable diseases (NCDs) and mental health in Suriname, and develops evidence and guidance to support the financing and implementation of national multisectoral NCDs prevention, control strategies, and treatment of mental health conditions. The study estimates the return on investment from implementing or scaling up priority interventions to reduce specific NCDs and mental health conditions, and also evaluates the political feasibility of putting these interventions into practice.

Manual on Oral Care for Pediatric Cancer Patients

This manual has been prepared within the framework of the World Health Organization (WHO) Global Initiative for Childhood Cancer, CureAll Americas, with the purpose of improving the situation of children and adolescents with cancer around the world, so that they can have the best chances of survival, enjoy a full life and, above all, achieve the best possible quality of life and die without suffering. It is aimed at health professionals who are dedicated to the treatment of pediatric cancer patients and who, directly or indirectly, must face the complications that treatment may cause at all levels. Its content can contribute to a more accurate diagnosis of oral cavity disorders, as well as to the development of strategies for the prevention and treatment of these manifestations. No direct guidelines are established for parents or caregivers, but information is presented that serves as a guide for oral care, in accordance with the structure and composition of the teams at the different cancer treatment centers.

Evaluation of the Pan American Health Organization Technical Cooperation in Noncommunicable Disease Prevention and Control in the Americas. Volume II. Annexes

This publication is the companion document to "Evaluation of the Pan American Health Organization Technical Cooperation for Noncommunicable Disease Prevention and Control in the Americas. Volume I. Final Report". The overall purpose of the evaluation was to determine the level of results attainment and performance for NCD prevention and control. The evaluation’s three objectives included documenting key achievements and challenges, examining enabling and limiting factors and providing lessons learned and evidence-based recommendations. The scope of the evaluation was determined by the scope of the POA and covered the period from 2013 and the region of the Americas including the sub-regions of the Caribbean, Central America and South America. The evaluation was conducted from July 2022 to March 2023 using a mixed methods approach. Existing indicator data was reviewed and analyzed. Primary data was collected through key informant interviews and surveys of Non-State Actors in official relations with PAHO and PAHO Collaborating Centers. A total of 231 key informants were interviewed including in “deep dives” conducted in three countries, Costa Rica, Paraguay and Trinidad and Tobago. Each “deep dive” was conducted by a two-person team made up of one of the members of the evaluation core team and an in-country consultant. These “deep dives” allowed a wider range of key informants to be interviewed in these countries than in others. Analysis of findings was conducted by the core team through meetings and reviewing and commenting on draft sections. Different core team members took responsibility for particular sections of the report.

Demographic Outlook for Population Aging in the Region of the Americas

With the object of summarizing the available knowledge about the health and well-being of older persons in the Region of the Americas at the start of the Decade on Healthy Aging 2021‑2030 and reporting on population aging, this publication provides current information on the demographic outlook in the Region. The data paint a detailed picture of the effects of the demographic transition, major trends, and population profiles, taking into account the results of the COVID-19 pandemic. Rapid population aging in Latin America and the Caribbean is shaping the capacity of countries and health systems to meet the specific demands of their populations and will continue to do so. Therefore, in order to design inclusive and sustainable systems, we must have current information to facilitate decision-making. This publication facilitates priority setting at the regional, national, and local levels, and provides reliable, evidence-based data and information to guide the adoption of effective measures, facilitate monitoring, and promote evidence‑based public health policies.

The Influence of Environments on Healthy Aging. World Health Organization Global Network for Agefriendly Cities and Communities

Promoting capacity-building for older people at the local level is one of the four enablers of the United Nations Decade of Healthy Aging 2021–2030. The World Health Organization’s Global Network for Age-Friendly Cities and Communities is a key intervention tool for this dimension. This publication presents the growth and achievements of the Global Network in the Region of the Americas. Its objective is to outline the state of current knowledge on the health situation of older people in the Americas at the beginning of this decade and the impact of environments on their well-being, and to guide policy actions towards ensuring people’s full development throughout the life course. This analysis of the evolution of the Network in the Region is based on information that active cities and communities uploaded to a website created for this purpose. In addition, present and future challenges are examined, and participants are urged to strengthen the Network across the Region and worldwide. The demographic transition in Latin America and the Caribbean is now shaping and will continue to shape the capacities of countries and health systems to respond to the specific demands of the population. It is essential to create instruments aimed at adapting environments to promote healthy aging throughout the life course, using accurate, updated, and effective information. The Decade of Healthy Aging (2021–2030) establishes a period for action aimed at generating and monitoring data. This report is framed within that strategy.

Visual and Hearing Health of Older People in the Region of the Americas

With the objective of outlining the current knowledge available on the health and well-being of older people in the Region of the Americas at the start of the United Nations Decade of Healthy Aging 2021–2030, this report details the current state of visual and hearing health of older people in the Region of the Americas. Its purpose is to inform, providing evidence and specific information on the needs of this population in these two fundamental areas of intrinsic capacity, which constitute the main causes of disability in the Region's older adults. The information provided should contribute to the implementation of strategic regional actions that promote ongoing improvement in the health of older people. Accelerated population aging in Latin America and the Caribbean shapes, and will continue to shape, the capacity of countries and health systems to respond to the specific needs of the population. In order to design inclusive and sustainable systems, it is therefore necessary to have reliable up-to date information to aid in decision-making. During the Decade of Healthy Aging 2021–2030, actions should be geared toward generating and monitoring data, and the present report contributesto this objective.

Handbook for Adapting and Implementing Evidence-Informed Guidelines. Second Edition

The Pan American Health Organization presents this manual aimed at government entities, health authorities public, health professionals, patients and other people and institutions interested in the development of guidelines informed by evidence. Its objective is to present the political and methodological strategies for the creation and strengthening national production program guidelines in the Region of the Americas. In this second edition the guidelines process is reviewed according to the latest version of the method classification of assessment, preparation and evaluation of recommendations (known as GRADE). The formulation of recommendations, the construction of evidence profiles, and creation of frameworks for moving from evidence to decisions present new conceptual frameworks for the creation or strengthening of guideline programs (logical model of the operation of the program, steps for its institutionalization and challenges for the government entities), and the key aspects of the process of implementation of guidelines developed by countries or health institutions of the Region (barriers, strategies and implementation facilitators, and indicators).

Meeting Report of the PAHO Strategic and Technical Advisory Group on Disease Elimination. Meeting Report and Recommendations. 29–30 November 2022

In September 2019, the 57th Pan American Health Organization (PAHO) Directing Council endorsed the PAHO Disease Elimination Initiative (EI), an innovative policy that promotes an integrated, sustainable approach to accelerate countries’ progress toward the elimination of communicable diseases and related conditions. The EI builds on the successful track record of disease elimination in the Americas and aims to catalyze political will and leverage the needed technical capacity to achieve a future that is free from the burden of 35 communicable diseases and/or related conditions in the Americas by 2030 and contribute to progress towards the Sustainable Development Goals. As countries recover from the impact of COVID-19 and adapt to the evolving public health context in the region, PAHO recognized the importance of convening the external Strategic and Technical Advisory Group (STAG) on Disease Elimination to take stock of the new public health landscape and recent developments in the EI and seek orientation and recommendations on priority topics to sustain the disease elimination agenda in the Americas. This report provides a summary of the proceedings, conclusions, and recommendations from the second meeting of the PAHO STAG on Disease Elimination, which took place on 29-30 November 2022.

Front-of-package warning labels save lives and resources: results from a modeling study in Barbados

Unhealthy eating has been driven largely by the widespread availability, affordability, and promotion of ultra-processed and processed food products that are excessive in sugars, fats, and sodium. As such, an essential part of the solution requires the use of laws and regulations to reduce the demand for and offer of products that contain excessive amounts of critical nutrients. One of the key policy tools to regulate such products to prevent them from unbalancing diets is the use of front-of-package labeling (FOPL) to indicate to consumers which products contain excessive amounts of sugars, total fats, saturated fats, trans fats, and/or sodium. This publication presents evidence on the expected impact of the adoption of octagonal warning labels on health and economy of a country. It features results from Barbados, showing warning labels have the potential to avert 16% of the deaths caused by noncommunicable diseases and save the country USD 732.8 million.

Action Plan for Implementation of Recommendations from the Evaluation of PAHO's Response to COVID-19. IREP-C19

An external team evaluated PAHO’s response to COVID-19 to provide an independent assessment of the Pan American Sanitary Bureau’s (PASB) performance regarding preparedness for and response to the COVID-19 pandemic. The evaluations’ final report culminates with eight recommendations for actions to future response to health emergencies. The final report of EPRC culminates with eight evidence-based recommendations of actions to strengthen future pandemic responses, while building a resilient recovery in the Region. The recommendations by the external team focus on PAHO’s governance and management, on specialized regional mechanisms, diversified funding models, and use of new technologies, among others.

Report of the Regional Meeting on the Eradication of Yaws. 1–3 March 2023

Yaws is a neglected infectious disease that affects populations living in rural areas far from health services. Poverty, low socio-economic conditions, and poor personal hygiene facilitate the spread of yaws. It is caused by the bacterium Treponema pallidum subspecies pertenue, is transmitted by skin contact, and is targeted for eradication by 2030. Report of Yaws cases has decreased remarkably after 1970 in the Region of the Americas. However, in many countries, epidemiological surveillance, which is key to detecting and responding to a possible resurgence of the disease and to certifying the interruption of the transmission, stopped after 1970. To forward the regional agenda towards completing the process to certify the interruption of Yaws transmission, countries in the Americas should start reviewing and documenting the current epidemiological situation of the disease and compile the evidence to confirm whether the interruption of transmission has occurred. This report presents the summary of the discussions and recommendations given to 13 participating countries in a meeting held in March 2023 on the main actions to progress towards confirming the interruption of Yaws transmission in the Region of the Americas.

STAR-H: Strategic Toolkit for Assessing Risks in Health Facilities

Health facilities in the Region of the Americas frequently suffer the effects of health emergencies and disasters, which jeopardize their ability to provide services to the population. The STAR-H methodology helps staff responsible for health emergency and disaster risk management to identify and assess risks as part of strategic planning to improve facility preparedness. It is intended to help them develop, with a multi-hazard approach, a response framework with operating procedures to deal with hazards of any type, scale, or frequency; determine roles and responsibilities; facilitate the effective use of resources; undertake strategic planning exercises, and improve the preparedness of facilities to effectively respond to and recover from impacts. This methodology is designed for use in health facilities of any size and capacity, and makes it possible to generate historical reports and national or subnational risk profiles. This information can be used to develop an effective health emergency and disaster risk management program.

Guidance for Developing Status Profiles on Communicable Diseases to Further Progress toward Their Elimination in the Region of the Americas

PAHO Disease Elimination Initiative: A Policy for an Integrated Sustainable Approach to Communicable Diseases in the Americas aims to end the burden of communicable diseases for future generations. This initiative includes more than 30 communicable diseases and other related conditions that are candidates for elimination and promotes a common approach that incorporates new tools and technology. Addressing these diseases supports action to achieve Sustainable Development Goal (SDG) 3: "Ensure healthy lives and promote well-being for all at all ages". Ending neglected and communicable tropical diseases epidemics falls within the scope of this goal. This publication is intended to provide guidance to countries to develop useful and uniform national status profiles to advance the national disease elimination agenda. Presenting information in this simple format is a strategic tool to raise awareness, documenting the status of communicable diseases and related conditions, as well as changes in the activities of health systems. In addition to concisely describing the progress made to date, this publication also reflects challenges and pending actions in each program that must be addressed to achieve elimination. Monitoring outcomes is critical for assessing the health of populations and measuring the impact of interventions. Accordingly, creating progress profiles on communicable disease targets will help countries design specific policies, formulate plans, and collect national and subnational health information to sustain gains and expand efforts on unmet targets, enhancing political commitment and well targeted, evidence-based investments. A current map of communicable diseases and related conditions adapted to the national context is also provided, allowing decision makers and other partners to strategize and implement a public health agenda for their elimination.

Digital Transformation Toolkit. Artificial Intelligence. Policy overview

One of the eight guiding principles for the digital transformation of the health sector promoted by the Pan American Health Organization (PAHO) is artificial intelligence (AI). This policy brief presents key concepts, recommended lines of action, and indicators to monitor to advance AI.

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 34 (1 September 2023)

[WEEKLY SUMMARY]. North America: Influenza activity has remained at low levels. Over the past 4 epidemiological weeks (EW), the predominant influenza viruses have been influenza A(H1N1)pdm09, with concurrent circulation of influenza B/Victoria. Respiratory syncytial virus (RSV) activity has remained at low levels. SARS-CoV-2 activity has shown an increase over the last 4 EWs and continues to circulate at moderate levels. Cases of influenza-like illness (ILI) and severe acute respiratory infections (SARI) have increased, with a rising proportion of cases testing positive for SARS-CoV-2. Caribbean: Influenza activity continues to exhibit a declining trend over the past 4 EWs. During this period, the predominant influenza viruses have been B/Victoria, with lesser circulation of influenza A, primarily A(H1N1)pdm09. RSV activity has remained low. SARS-CoV-2 activity shows an increasing trend with intermediate to high levels of circulation. ILI and SARI cases have demonstrated a declining trend over the past 4 EWs. Central America: Influenza activity continues to decrease over the past 4 EWs. During this period, the predominant influenza viruses have been influenza B/Victoria, with concurrent circulation of influenza A, mainly A(H1N1)pdm09, and to a lesser extent, influenza A(H3N2). RSV activity has shown a decrease in the last EWs but remains at medium-high levels of circulation. SARS-CoV-2 activity is at low levels with a declining trend. ILI activity has remained low. SARI activity is currently decreasing; however, the proportion of cases attributable to RSV continues to rise. In El Salvador, RSV activity remains high, coinciding with an increase in SARS-CoV-2 circulation. In Guatemala, RSV activity continues at moderate-high levels, with elevated ILI activity and epidemic levels of SARI cases, with most ILI cases testing positive for RSV and influenza, and most SARI cases testing positive for RSV. In Honduras, influenza activity continues to decrease, and SARS-CoV-2 activity is at high levels. SARI cases are currently decreasing below the epidemic threshold, with almost all positives related to influenza. In Nicaragua and Panama, following moderate activity levels in previous EWs, influenza positivity in both countries is currently at epidemic levels. In Panama, RSV activity is at moderate levels. Andean: Influenza activity remains stable at low levels. Over the past 4 EWs, the predominant influenza viruses have been influenza A, mainly A(H1N1)pdm09, and influenza B/Victoria. RSV activity remains at low levels. SARS-CoV-2 has shown a decline over the last 4 EWs, circulating at moderate levels, with elevated circulation in Bolivia. SARI activity continues to decline, with most cases associated with influenza and, to a lesser extent, RSV and SARS-CoV-2. ILI activity has shown a declining trend, with most cases associated with influenza. Brazil and Southern Cone: Influenza activity has decreased to low circulation levels. Over the past 4 EWs, the predominant influenza viruses have primarily been A(H1N1)pdm09, with concurrent circulation of influenza B/Victoria. RSV activity has declined in the last 4 EWs, reaching low circulation levels. SARS-CoV-2 activity has increased, although it remains low. SARI activity has continued to decline over the past 4 EWs, with most cases testing positive for RSV. ILI cases have shown a slight increase, with low positivity percentages for the monitored respiratory viruses. Argentina continues to present epidemic levels of influenza activity, with the majority of cases testing positive for influenza A(H1N1)pdm09. SARS-CoV-2 activity has increased to moderate levels, but ILI and SARI levels remain below the epidemic threshold. In Brazil, influenza activity is decreasing, while SARS-CoV-2 is on the rise, with SARI levels above the epidemic threshold. In Chile, ILI activity remains at moderate levels, showing a slight increase, with most cases related to influenza. SARI activity is currently decreasing below the epidemic threshold. In Paraguay, SARI activity has declined, reaching epidemic levels, with RSV being the primary cause among positive cases. In Uruguay, SARI activity has decreased over the past EWs, with most cases associated with RSV.

[RESUMEN SEMANAL]. Norteamérica: La actividad de influenza ha permanecido en niveles bajos. Durante las últimas 4 semanas epidemiológicas (SE) los virus influenza predominantes han sido influenza A(H1N1)pdm09, con circulación concurrente de influenza B/Victoria. La actividad del virus sincitial respiratorio (VSR) se ha mantenido en niveles bajos. La actividad del SARS-CoV-2 ha presentado un incremento en las últimas 4 SE y continúa circulando en niveles moderados. Los casos de enfermedad tipo influenza (ETI) e infección respiratoria aguda grave (IRAG) han mostrado un ligero incremento con un aumento en la proporción de casos positivos para SARS-CoV-2. En México se han detectado niveles moderados de circulación de influenza en las últimas SE, sin embrago la actividad de IRAG se mantiene baja, por encima del umbral epidémico, siendo la mayoría de los casos asociados a SARS-CoV-2. Caribe: La actividad de la influenza continúa mostrando una tendencia decreciente en las últimas 4 SE. Durante este periodo, los virus predominantes de la influenza han sido B/Victoria, con menor circulación de la influenza A, principalmente A(H1N1)pdm09. La actividad del VSR ha permanecido baja. La actividad del SARS-CoV-2 muestra una tendencia creciente con niveles intermedios de circulación. Los casos de ETI e IRAG han mostrado una tendencia decreciente en las últimas 4 SE. Centroamérica: La actividad de influenza continúa en descenso en las últimas 4 SE. Durante este periodo, los virus predominantes de influenza han sido influenza B/Victoria, con circulación concurrente de influenza A, principalmente A(H1N1)pdm09 y en menor medida de influenza A(H3N2). La actividad de VSR ha mostrado un incremnto en las últimas 4 SE, situándose en niveles medioaltos de circulación. La actividad de SARS-CoV-2 se encuentra en niveles bajos con una tendencia decreciente. La actividad de ETI se ha mantenido baja con la mayoría de los casos asociados a influenza. La actividad de IRAG se encuentra actualmente en descenso, sin embargo la proporción de casos atribuibles a VSR ha presentado un incremento. En El Salvador se ha observado un incremento en la actividad del VSR coincidente con un aumento en la circulación de SARS-CoV-2. En Honduras tras alcanzar niveles elevados en los porcentajes de positividad de influenza, en las 4 últimas SE se ha observado un descenso hasta niveles por debajo del umbral epidémico sin embargo la actividad del SARS-CoV-2 ha presentado un incremento en este periodo. Los casos de IRAG actualmente se encuentran en descenso siendo casi la totalidad de los positivos relacionados con influenza. En Guatemala la actividad del VSR continúa en ascenso con niveles moderados, y niveles de actividad de ETI e IRAG moderados, siendo los casos ETI positivos en su mayoría para influenza y los casos IRAG positivos para VSR. En Nicaragua y Panamá tras los niveles de actividad moderados alcanzados en SE previas, la positividad de influenza en ambos países se encuentra actualmente en niveles epidémicos. En Panmá la actividad de VSR ha presentado un incremento, situándose en niveles moderados. Andina: La actividad de la influenza se mantiene estable a niveles bajos. Durante las 4 últimas SE los virus influenza predominantes han sido influenza A, mayoritariamente A(H1N1)pdm09, con circulación en menor medida de influenza B/Victoria. La actividad del VSR, se mantiene en niveles bajos. El SARS-CoV-2 ha presentado un descenso en las 4 últimas SE, circulando en niveles moderados, con circulación elevada en Bolivia. La actividad de IRAG continúa en descenso con la mayoría de los casos asociados a influenza y en menor medida VSR y SARS-CoV-2. La actividad de ETI ha mostrado una tendencia decreciente con la mayoría de los casos asociados a influenza. Brasil y Cono Sur: La actividad de la influenza ha disminuido a niveles bajos de circulación. Durante las últimas 4 SE, los virus predominantes de la influenza han sido principalmente A(H1N1)pdm09, con circulación simultánea de influenza B/Victoria. La actividad del VSR ha presentado un descenso en las 4 últimas SE situándose en niveles bajos de circulación. La actividad del SARSCoV- 2 ha permanecido baja. Después de alcanzar un pico, tanto la actividad de IRAG como la de ETI han continuado en descenso en las últimas 4 SE, con la mayoría de los casos positivos para VSR en el caso de IRAG e influenza en los casos de ETI. Argentina continúa presentando niveles epidémicos en la actividad de influenza, siendo la mayoría de los casos detectados positivos para influenza A(H1N1)pdm09 con niveles de ETI e IRAG por debajo del umbral epidémico. En Brasil, la actividad de influenza se mantiene en descenso, mientras que el SARS-CoV-2 ha presentado un ligero incremento, con niveles de IRAG por encima del umbral epidémico y la mayorúa de los casos asociados a VSR y en menor medida, influenza. En Chile, la actividad de ETI se mantiene en niveles moderados con la mayoría de los casos relacionados con influenza. Tras alcanzar niveles moderados de actividad de IRAG, actualmente se encuentra en descenso en niveles epidémicos, siendo el VSR la causa más común entre los casos positivos. En Paraguay, la actividad de IRAG ha presentado un descenso situándose en niveles epidémicos, siendo el VSR la causa principal entre los casos positivos. En Uruguay la actividad de IRAG ha presentado un descenso en las últimas SE, siendo la mayoría de los casos asociados a VSR.

Strategy and Plan of Action on Ethnicity and Health 2019–2025. Impact and Process Indicators

The purpose of this publication is to provide continuity to the technical cooperation with Member States of the Pan American Health Organization (PAHO) in estimating and monitoring the targets and indicators proposed by the Strategy and Plan of Action on Ethnicity and Health 2019–2025 in the different countries and territories; and to measure the processes and impact derived from implementing the guidelines contained in the Policy on Ethnicity and Health. The compendium and technical sheets that make up this publication are aimed in particular at cooperating partners and those in the health sector and other sectors that provide support for intercultural action in health. This mainly involves the Ministries of Health of the countries and territories, along with other government ministries and institutions, together with the support of key associates and cooperating partners. The design of this technical tool, in line with the Policy on Ethnicity and Health, was guided by the basic objective of calculating and recording the progress to be achieved in the Region of the Americas between 2019 and 2025 in developing the measures necessary to guarantee an intercultural approach to access health care and services. It has taken into account the social determinants of health from a standpoint of equality and mutual respect, valuing the cultural practices of the Region’s ethnic groups, including their lifestyles, social organization, value systems, traditions, and worldviews.

Strengthening human resources for health in the Caribbean

The Caribbean has a serious need to improve the health information system, and in particular related to human resources for health. PAHO has been working with country focal points to report on the HRH indicators included in the WHO National Health Workforce Accounts (NHWA) platform. However, not all indicators in the NHWA (about 80) are relevant to the Caribbean or can be reported due to limitations in data collection and available information. The HRH Action Task Force (now HRH Caribbean Commission), with support from PAHO identified a set of 30 core indicators and sub-indicators for the Caribbean, classified in three levels of importance and complexity. This publication systematizes the process and includes the chosen core indicators and sub-indicators.

Cultural Diversity and Health​ - Virtual Health Library (VHL) for Traditional, Complementary, and Integrative Medicine

Welcome to the Americas Region! This region includes 35 Member States and 4 Associate Members. There is a great diversity of healing systems and practices in the Americas, with each country having its own recognized and institutionalized practices. The inclusion of traditional, complementary and integrative medicine (TCIM) in national health systems is part of efforts to improve people-centered health services and achieve Universal Health Coverage (UHC) for marginalized populations. Interculturality and therapeutic pluralism are key components of the region’s TCIM efforts.​

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 32 (18 August 2023)

[WEEKLY SUMMARY]. North America: Influenza activity has remained at low levels. Over the past 4 epidemiological weeks (EW), the predominant influenza viruses have been influenza A(H1N1)pdm09, with concurrent circulation of influenza B/Victoria. Respiratory syncytial virus (RSV) activity has stayed at low levels. The activity of SARS-CoV-2 has shown an increase over the last 4 EWs and continues to circulate at moderate levels. Cases of influenza-like illness (ILI) and severe acute respiratory infection (SARI) have seen a slight increase, with the majority of these cases associated with SARS-CoV-2 and to a lesser extent with influenza. In Mexico, epidemic levels of influenza circulation have been detected, which are decreasing. Caribbean: Influenza activity continues to show a decreasing trend over the past 4 EWs, with a predominance of influenza B/Victoria and, to a lesser extent, circulation of influenza A, mainly A(H1N1)pdm09. RSV activity has remained low. The activity of SARS-CoV-2 has shown an increasing trend over the last three EWs, with intermediate levels of circulation, especially in Barbados, Grenada, Guyana, Jamaica, and Saint Lucia. ILI and SARI cases have displayed a decreasing trend in the past 4 EWs. Central America: After reaching a peak in previous weeks, influenza activity has continued to decline over the last 4 EWs. During this period, the predominant influenza viruses have been influenza B/Victoria with concurrent circulation of influenza A, mainly A(H1N1)pdm09, and to a lesser extent, influenza A(H3N2). RSV activity has increased in the last 4 EWs, reaching intermediate to high levels of circulation. The activity of SARS-CoV-2 has remained low. ILI activity has remained low, with the majority of cases associated with influenza. SARI activity is currently declining, with the majority of cases associated with RSV. In Costa Rica, extraordinary levels of influenza positivity are detected with concurrent circulation of SARS-CoV-2. ILI and SARI levels remain low, with the majority of cases associated with influenza and, to a lesser extent, with SARS-CoV-2. In El Salvador, influenza activity is decreasing, with epidemic levels in reported SARI cases. Additionally, there has been an increase in RSV positivity levels with elevated activity. In Honduras, after reaching elevated levels in the percentages of influenza positivity, the last 4 EWs have seen a decline to levels below the epidemic threshold. ILI and SARI cases are currently decreasing, with almost all positive cases related to influenza. In Guatemala, RSV activity continues to rise with moderate to high levels, and ILI cases are mostly positive for influenza, while SARI cases are positive for RSV. In Nicaragua and Panama, after achieving moderate activity levels in previous EWs, influenza positivity in both countries is currently at epidemic levels. Andean region: Influenza activity remains stable at low levels. Over the last 4 EWs, the predominant influenza viruses have been influenza A, predominantly A(H1N1)pdm09, with lesser circulation of influenza B/Victoria. RSV activity remains at low levels. SARSCoV- 2 has shown a decline over the last 4 EWs, circulating at low levels, although circulation remains elevated in Bolivia. SARI activity continues to decline, with most cases associated with influenza and, to a lesser extent, RSV and SARS-CoV-2. ILI activity has shown a decreasing trend, with most cases associated with influenza.. Brazil and Southern Cone: Influenza activity has decreased to low levels of circulation. Over the past 4 EWs, the predominant viruses have been primarily influenza A(H1N1)pdm09, with simultaneous circulation of influenza B/Victoria. RSV activity has declined in the last 4 EWs, reaching low levels of circulation. SARS-CoV-2 activity has remained low, albeit with a slight increase. Both SARI and ILI activities have continued to decline over the past 4 EWs. Argentina continues to experience epidemic levels of influenza activity, with the majority of detected cases being positive for influenza A(H1N1)pdm09 and ILI and SARI levels below the epidemic threshold. In Brazil, influenza and RSV activity remains low, while SARS-CoV-2 has shown a slight increase in the last EW. In Chile, ILI activity has increased, remaining at moderate levels, with the majority of positive cases related to influenza. In Paraguay, SARI activity remains high, with RSV being the primary cause among positive cases, followed by SARS-CoV-2. In Uruguay, SARI activity remains at epidemic levels, with the majority of cases associated with RSV.

[RESUMEN SEMANAL]. Norteamérica: La actividad de influenza ha permanecido en niveles bajos. Durante las últimas 4 semanas epidemiológicas (SE) los virus influenza predominantes han sido influenza A(H1N1)pdm09, con circulación concurrente de influenza B/Victoria. La actividad del virus sincitial respiratorio (VSR) se ha mantenido en niveles bajos. La actividad del SARS-CoV-2 ha presentado un incremento en las últimas 4 SE y continúa circulando en niveles moderados. Los casos de enfermedad tipo influenza (ETI) e infección respiratoria aguda grave (IRAG) han presentado un ligero incremento, siendo la mayor parte de estos asociados a SARS-CoV-2 y en menor medida a influenza. En México se han detectado niveles epidémicos de circulación de influenza que continúa en descenso. Caribe: La actividad de la influenza continúa mostrando una tendencia decreciente en las últimas 4 SE, con predominio de influenza B/Victoria, y en menor medida circulación de influenza A, principalmente A(H1N1)pdm09. La actividad del VSR ha permanecido baja. La actividad del SARS-CoV-2 ha mostrado una tendencia creciente en las últimas tres SE con niveles intermedios de circulación, especialmente en Barbados, Grenada, Guyana, Jamaica y Saint Lucia. Los casos de ETI e IRAG han mostrado una tendencia decreciente en las últimas 4 SE. Centroamérica: Tras alcanzar un pico en semanas previas, la actividad de influenza ha continuado en descenso durante las 4 últimas SE. Durante este periodo, los virus predominantes han sido influenza B/Victoria con circulación concurrente de influenza A, principalmente A(H1N1)pdm09, y en menor medida de influenza A(H3N2). La actividad del VSR ha aumentado en las últimas 4 SE, situándose en niveles intermedios-altos de circulación. La actividad de SARS-CoV-2 se ha mantenido baja. La actividad de ETI se ha mantenido baja con la mayoría de los casos asociados a influenza. La actividad de IRAG se encuentra actualmente en descenso, con la mayoría de los casos asociados al VSR. En Costa Rica se mantienen niveles de positividad de influenza extraordinarios, coincidentes con la circulación de SARS-CoV-2. Los niveles de ETI e IRAG continúan siendo bajos con la mayoría de los casos asociados a influenza y en menor medida a SARS-CoV-2. En El Salvador la actividad de influenza se mantiene en descenso, con niveles epidémicos en los casos IRAG notificados. Adicionalmente, se ha observado un incremento en los niveles de positividad de VSR con una actividad elevada. En Honduras tras alcanzar niveles elevados en los porcentajes de positividad de influenza, en las 4 últimas SE se ha observado un descenso hasta niveles por debajo del umbral epidémico. Los casos de ETI e IRAG actualmente se encuentran en descenso siendo casi la totalidad de los positivos relacionados con influenza. En Guatemala la actividad del VSR continúa en ascenso con niveles moderados-altos, y los casos ETI positivos en su mayoría son debidos a influenza y los casos IRAG positivos para VSR. En Nicaragua y Panamá tras los niveles de actividad moderados