The Caribbean and Mesoamerica Biogeochemical Isotope Overview (CAMBIO).

The Caribbean & Mesoamerica Biogeochemical Isotope Overview (CAMBIO) is an archaeological data community designed to integrate published biogeochemical data from the Caribbean, Mesoamerica, and southern Central America to address questions about dynamic interactions among humans, animals, and the environment in the region over the past 10,000 years. Here we present the CAMBIO human dataset, which consists of more than 16,000 isotopic measurements from human skeletal tissue samples (δ13C, δ15N, δ34S, δ18O, 87Sr/86Sr, 206/204Pb, 207/204Pb, 208/204Pb, 207/206Pb) from 290 archaeological sites dating between 7000 BC to modern times. The open-access dataset also includes detailed chronological, contextual, and laboratory/sample preparation information for each measurement. The collated data are deposited on the open-access CAMBIO data community via the Pandora Initiative data platform ( https://pandoradata.earth/organization/cambio ).

Human resources for health and maternal mortality in Latin America and the Caribbean over the last three decades: a systemic-perspective reflections.

BACKGROUND: The role of human resources for health in the operation of health systems is crucial. However, training and incorporating them into institutions is a complex process due to the continuous misalignment between the supply and demand of health personnel. Taking the case of the Latin American and Caribbean region countries, this comment discusses the relationship between the availability of human resources for health and the maternal mortality ratio for the period 1990-2021. It proposes the need to resume planning exercises from a systemic perspective that involves all areas of government and the private sector linked to the training and employment of health workers. MAIN TEXT: We used secondary data from a global source to show patterns in the relationship between these two aspects and identify gaps in the Latin American and Caribbean regions. The results show enormous heterogeneity in the response of regional health systems to the challenge of maternal mortality in the region. Although most countries articulated specific programs to achieve the reduction committed by all countries through the Millennium Development Goals, not all had the same capacity to reduce it, and practically none met the target. In addition, in the English Caribbean countries, we found significant increases in the number of health personnel that do not explain the increases in the maternal mortality rate during the period. CONCLUSIONS: The great lesson from the data shown is that some countries could articulate responses to the problem using available resources through effective strategies, considering the specific needs of their populations. Although variations in maternal mortality rate cannot be explained solely through the provision of health personnel, it is important to consider that it is critical to find new modalities on how human resources for health could integrate and create synergies with other resources to increase systems capacity to deliver care according to conditions in each country.

Risk factors associated with severe COVID-19 outcomes in Jamaica: a cross-sectional study of national surveillance data / Factores de riesgo asociados a la COVID-19 grave en Jamaica: estudio transversal de datos nacionales de vigilancia / Fatores de risco associados a desfechos graves da COVID-19 na Jamaica: estudo transversal de dados de vigilância nacional

[ABSTRACT]. Objectives. To describe the characteristics and outcomes of COVID-19 cases in Jamaica and to explore the risk factors associated with severe COVID-19 from 9 March to 31 December 2020. Methods. A cross-sectional analysis of national surveillance data was conducted using confirmed COVID-19 cases in Jamaica. Definitions of a confirmed case, disease severity, and death were based on World Health Organization guidelines. Chi-square and Fisher exact tests were used to determine association with outcomes. Logistic regression models were used to determine predictors of severe COVID-19. Results. This analysis included 12 169 cases of COVID-19 (median age, 36 years; 6 744 females [ 55.4%]) of which 512 cases (4.2%) presented with severe disease, and of those, 318 patients (62.1%) died (median age at death, 71.5 years). Severe disease was associated with being male (OR 1.4; 95% CI, 1.2-1.7) and 40 years or older (OR, 6.5; 95% CI, 5.1-8.2). COVID-19 death was also associated with being male (OR, 1.4; 95% CI, 1.1-1.7), age 40 years or older (OR, 17.9; 95% CI, 11.6-27.7), and in the Western versus South East Health Region (OR 1.7; 95% CI, 1.2-2.3). Conclusions. The findings of this cross-sectional analysis indicate that confirmed cases of COVID-19 in Jamaica were more likely to be female and younger individuals, whereas COVID-19 deaths occurred more frequently in males and older individuals. There is increased risk of poor COVID-19 outcomes beginning at age 40, with males disproportionately affected. COVID-19 death also varied by geographic region. This evidence could be useful to other countries with similar settings and to policymakers charged with managing outbreaks and health.

[RESUMEN]. Objetivos. Describir las características y los resultados de los casos de COVID-19 en Jamaica y explorar los factores de riesgo asociados a la COVID-19 grave desde el 9 de marzo hasta el 31 de diciembre del 2020. Métodos. Se realizó un análisis transversal de datos nacionales de vigilancia a partir de los casos confirma- dos de COVID-19 en Jamaica. Las definiciones de caso confirmado, gravedad de la enfermedad y muerte se basaron en las directrices de la Organización Mundial de la Salud. Para determinar la asociación con los criterios de valoración se utilizó la prueba de χ2 y la prueba exacta de Fisher. Se usaron modelos de regresión logística para determinar los factores predictivos de la COVID-19 grave. Resultados. Se incluyeron en el análisis 12 169 casos de COVID-19 (mediana de edad, 36 años; 6 744 mujeres [55,4%]), de los que 512 (4,2%) fueron de enfermedad grave. De estos pacientes, 318 (62,1%) fall- ecieron (mediana de edad al morir, 71,5 años). Se observó una asociación de la enfermedad grave con el sexo masculino (OR de 1,4; IC del 95 %, 1,2-1,7) y con la edad igual o superior a 40 años (OR de 6,5; IC del 95 %, 5,1-8,2). La muerte por COVID-19 también mostró una asociación con el sexo masculino (OR de 1,4; IC del 95%, 1,1-1,7), con la edad igual o superior a 40 años (OR de 17,9; IC del 95%, 11,6-27,7) y con la Región de Atención de Salud Occidental en comparación con la Sudoriental (OR de 1,7; IC del 95%, 1,2-2,3). Conclusiones. Los resultados de este análisis transversal indican que los casos confirmados de COVID-19 en Jamaica correspondieron una mayor probabilidad a mujeres y personas más jóvenes, mientras que las muertes por COVID-19 fueron más frecuentes en varones y personas de mayor edad. Hay un mayor riesgo de evolución desfavorable de la COVID-19 a partir de los 40 años, que afecta de manera desproporcionada a los varones. Las muertes por COVID-19 también variaron según la región geográfica. Esta evidencia podría ser de utilidad para otros países con entornos similares y para los responsables de la formulación de políticas en materia de gestión de brotes y salud.

[RESUMO]. Objetivos. Descrever as características e os desfechos dos casos de COVID-19 na Jamaica e explorar os fatores de risco associados à COVID-19 grave de 9 de março a 31 de dezembro de 2020. Métodos. Análise transversal de dados de vigilância nacional usando casos confirmados de COVID-19 na Jamaica. As definições de caso confirmado, gravidade da doença e morte foram baseadas nas recomendações da Organização Mundial da Saúde. Foram usados testes de qui-quadrado e exato de Fisher para determinar a associação com os desfechos. Modelos de regressão logística foram usados para deter- minar os preditores de COVID-19 grave. Resultados. Esta análise incluiu 12.169 casos de COVID-19 (idade mediana: 36 anos; 6 744 do sexo feminino [55,4%]), dos quais 512 casos (4,2%) apresentaram doença grave; desses, 318 pacientes (62,1%) morreram (idade mediana ao morrer: 71,5 anos). A doença grave estava associada a ser do sexo masculino (razão de chances [RC]: 1,4; intervalo de confiança de 95% [IC 95%]: 1,2–1,7) e ter 40 anos ou mais de idade (RC: 6,5; IC 95%: 5,1–8,2). A morte por COVID-19 também estava associada a ser sexo masculino (RC: 1,4; IC 95%: 1,1–1,7), ter 40 anos ou mais (RC: 17,9; IC 95%: 11,6–27,7) e estar na Região Sanitária Oeste em comparação com a Região Sanitária Sudeste (RC: 1,7; IC 95%: 1,2–2,3). Conclusões. Os achados desta análise transversal indicam que a probabilidade de casos confirmados de COVID-19 na Jamaica era maior em indivíduos do sexo feminino e mais jovens, ao passo que as mortes por COVID-19 ocorreram com mais frequência em indivíduos do sexo masculino e mais velhos. Há um risco maior de resultados desfavoráveis em relação à COVID-19 a partir dos 40 anos, e indivíduos do sexo masculino são desproporcionalmente mais afetados. A morte por COVID-19 também variou de acordo com a região geográ- fica. Essas evidências podem ser úteis para outros países com cenários semelhantes e para os formuladores de políticas encarregados de manejar surtos e gerenciar a saúde.

Gene expression plasticity facilitates acclimatization of a long-lived Caribbean coral across divergent reef environments.

Local adaptation can increase fitness under stable environmental conditions. However, in rapidly changing environments, compensatory mechanisms enabled through plasticity may better promote fitness. Climate change is causing devastating impacts on coral reefs globally and understanding the potential for adaptive and plastic responses is critical for reef management. We conducted a four-year, three-way reciprocal transplant of the Caribbean coral Siderastrea siderea across forereef, backreef, and nearshore populations in Belize to investigate the potential for environmental specialization versus plasticity in this species. Corals maintained high survival within forereef and backreef environments, but transplantation to nearshore environments resulted in high mortality, suggesting that nearshore environments present strong environmental selection. Only forereef-sourced corals demonstrated evidence of environmental specialization, exhibiting the highest growth in the forereef. Gene expression profiling 3.5 years post-transplantation revealed that transplanted coral hosts exhibited profiles more similar to other corals in the same reef environment, regardless of their source location, suggesting that transcriptome plasticity facilitates acclimatization to environmental change in S. siderea. In contrast, algal symbiont (Cladocopium goreaui) gene expression showcased functional variation between source locations that was maintained post-transplantation. Our findings suggest limited acclimatory capacity of some S. siderea populations under strong environmental selection and highlight the potential limits of coral physiological plasticity in reef restoration.

Prevalence and incidence of diabetic retinopathy in patients with diabetes of Latin America and the Caribbean: A systematic review and meta-analysis.

OBJECTIVES: This systematic review aimed to assess the prevalence and incidence of diabetic retinopathy in patients with diabetes of Latin America and the Caribbean. METHODS: We searched Web of Science (WoS)/Core Collection, WoS/MEDLINE, WoS/Scielo, Scopus, PubMed/Medline and Embase databases until January 16, 2023. We meta-analyzed prevalences according to type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). RESULTS: Forty-three prevalence studies (47 585 participants) and one incidence study (436 participants) were included. The overall prevalence of retinopathy in patients with T1DM was 40.6% (95% CI: 34.7 to 46.6; I2: 92.1%) and in T2DM was 37.3% (95% CI: 31.0 to 43.8; I2: 97.7), but the evidence is very uncertain (very low certainty of evidence). In meta-regression, we found that age (T1DM) and time in diabetes (T2DM) were factors associated with the prevalence. On the other hand, one study found a cumulative incidence of diabetic retinopathy of 39.6% at 9 years of follow-up. CONCLUSIONS: Two out of five patients with T1DM or T2DM may present diabetic retinopathy in Latin America and the Caribbean, but the evidence is very uncertain. This is a major public health problem, and policies and strategies for early detection and opportunely treatment should be proposed.

Barriers to engagement with testing for sexually transmitted infections within a UK-based young adult Black Caribbean community: a qualitative study.

BACKGROUND: The Black Caribbean population have a disproportionately high burden of sexually transmitted infections (STIs) compared with other ethnic groups. The aim of this study was to explore barriers to engagement with STI testing within a UK-based young adult Black Caribbean community. METHODS: Semi-structured interviews were carried out with 14 young adults from the Black Caribbean community and six sexual healthcare professionals. Data were analysed thematically. A focus group of five young adults was conducted to refine themes. RESULTS: Data analysis generated three themes: (1) culturally embedded stigma; (2) historically embedded mistrust; and (3) lack of knowledge. Perceived as 'dirty', particularly for females, infection with STIs was stigmatised by religious conceptions of 'purity' and shame. This presented challenges in terms of cultural acceptability of talking about STI testing with partners, friends, and family. Legacies of colonialism, medical racism and malpractice compromised young people's trust in medical intervention and confidentiality of data management. A lack of knowledge related to STIs and their treatment, and in how to access and perform STI tests further served as a barrier. Culturally tailored interventions targeting these factors and delivered by radio, podcasts and social media were highlighted as having potential to improve engagement with STI testing. DISCUSSION: Engagement with STI testing by young adults from the Black Caribbean community is impacted by historically and culturally embedded teachings, practices and beliefs inherited through generations. Targeting these factors within culturally tailored interventions may be effective for increasing STI-testing, and thus reducing rates of STI-infection in this population.

Preserving the spots: Jaguar (Panthera onca) distribution and priority conservation areas in Colombia.

The jaguar (Panthera onca) is a charismatic species considered Vulnerable in Colombia but yet largely unknown in the country. The species is mostly threatened by the continuous decline in its habitats, mostly derived from deforestation and habitat loss, additional to hunting and conflicts with humans. Thus, the future of jaguars in Colombia depends on protecting and recovering existing habitats. The aims of this study were to 1) evaluate jaguar distribution and identify the remnant patches of habitat in Colombia, 2) define an ecological connectivity network within the country, and 3) propose a priority areas portfolio for the conservation and recovery of jaguars. We used a presence background model for estimating species potential distribution and subsequently identified remaining habitat patches across the country based on land cover and species-specific ecological attributes. We then created an ecological connectivity network based on circuit theory and following a multi-criteria approach identified jaguar priority areas for conservation (JPCA) and recovery (JPRA). Jaguar potential distribution comprises 1103122.43 km2, from which 56.71% maintain suitable patches of potential habitat. We identified 960 corridors between remnant patches of natural or semi-natural vegetation. Based on the criteria, JPCAs with greater importance were identified in each of the five Colombian regions. JPRAs were located mainly towards the Andean and Caribbean regions. These JPCAs and JPRAs could serve as a guide for designing and implementing management strategies for the long-term conservation and recovery of the species in Colombia.

Severe hurricanes increase recruitment and gene flow in the clonal sponge Aplysina cauliformis.

Upright branching sponges, such as Aplysina cauliformis, provide critical three-dimensional habitat for other organisms and assist in stabilizing coral reef substrata, but are highly susceptible to breakage during storms. Breakage can increase sponge fragmentation, contributing to population clonality and inbreeding. Conversely, storms could provide opportunities for new genotypes to enter populations via larval recruitment, resulting in greater genetic diversity in locations with frequent storms. The unprecedented occurrence of two Category 5 hurricanes in close succession during 2017 in the U.S. Virgin Islands (USVI) provided a unique opportunity to evaluate whether recolonization of newly available substrata on coral reefs was due to local (e.g. re-growth of remnants, fragmentation, larval recruitment) or remote (e.g. larval transport and immigration) sponge genotypes. We sampled A. cauliformis adults and juveniles from four reefs around St. Thomas and two in St. Croix (USVI). Using a 2bRAD protocol, all samples were genotyped for single-nucleotide polymorphisms (SNPs). Results showed that these major storm events favoured sponge larval recruitment but did not increase the genetic diversity of A. cauliformis populations. Recolonization of substratum post-storms via clonality was lower (15%) than expected and instead was mainly due to sexual reproduction (85%) via local larval recruitment. Storms did enhance gene flow among and within reef sites located south of St. Thomas and north of St. Croix. Therefore, populations of clonal marine species with low pelagic dispersion, such as A. cauliformis, may benefit from increased frequency and magnitude of hurricanes for the maintenance of genetic diversity and to combat inbreeding, enhancing the resilience of Caribbean sponge communities to extreme storm events.

Epilepsy Care in Latin America and the Caribbean: Overcoming Challenges and Embracing Opportunities.

The burden of epilepsy in the Latin America and the Caribbean (LAC) region causes a profound regional impact on the health care system and significantly contributes to the global epilepsy burden. As in many other resource-limited settings worldwide, health care professionals and patients with epilepsy in LAC countries face profound challenges due to a combination of factors, including high disease prevalence, stigmatization of epilepsy, disparities in access to care, limited resources, substantial treatment gaps, insufficient training opportunities for health care providers, and a diverse patient population with varying needs. This article presents an overview of the epidemiology of epilepsy and discusses the principal obstacles to epilepsy care and key contributors to the epilepsy diagnosis and treatment gap in the LAC region. We conclude by highlighting various initiatives across different LAC countries to improve epilepsy care in marginalized communities, listing strategies to mitigate treatment gaps and facilitate better health care access for patients with epilepsy by enhancing the epilepsy workforce.

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 11 (22 March 2024)

[WEEKLY SUMMARY]. Regional Situation: Over the past four Epidemiological Weeks (EWs), the Americas region has experienced intermediate levels of Influenza-Like Illness (ILI) activity, showing a decreasing trend. Concurrently, there has been a decline in Severe Acute Respiratory Infection (SARI) activity, currently at low levels. Both ILI and SARI activities have been associated with positive cases of influenza and SARS-CoV-2. ILI activity has been notably influenced by moderate activity in North America and the Caribbean, while SARI activity has been particularly impacted by trends in North America. Regarding respiratory virus circulation, regional SARS-CoV-2 activity has decreased after an observed increase in previous weeks, although it remains moderate compared to previous epidemic waves. Additionally, an epidemic activity of influenza has been observed for this time of year, alongside a declining activity of Respiratory Syncytial Virus (RSV), which is currently at low levels. North America: Despite a slight decline in previous EWs, ILI cases have maintained medium-high levels, primarily attributed to influenza. SARI cases and respiratory virus-related hospitalizations have continued to decline. Influenza activity has remained at epidemic levels, showing a slight decrease over the past four EWs. Predominant influenza viruses during this period have been type A , with A(H1N1)pdm09 and A(H3N2) circulating concurrently, along with lesser circulation of influenza B/Victoria. RSV activity has declined over the past four EWs, maintaining moderate levels. SARS-CoV-2 activity has decreased over the same period to low levels compared to previous waves. By countries: In Canada, SARS-CoV-2 activity has significantly decreased over the past four EWs to medium-low levels. Influenza activity has remained epidemic, gradually declining, while RSV activity has also decreased to moderate levels. In Mexico, influenza circulation has fluctuated at epidemic levels over the past four EWs, with SARS-CoV-2 circulation remaining at intermediate levels compared to previous waves. In the United States, influenza activity has consistently remained above the epidemic threshold, while RSV and SARSCoV- 2 activities have decreased to low levels. ILI cases have remained stable at medium levels. Hospitalization rates for influenza, RSV, and SARS-CoV-2 have shown a downward trend over the past four EWs after reaching similar elevated levels as the previous season. Caribbean: Following a previous increase, ILI cases have markedly decreased over the past four weeks, primarily attributed to influenza. SARI cases have continued to decline, with most positive cases associated with influenza. Influenza activity has decreased over the past four EWs, reaching low circulation levels. Predominant viruses during this period have been influenza A(H1N1)pdm09, with concurrent circulation of A(H3N2) and B/Victoria to a lesser extent. RSV activity has remained low, and SARS-CoV-2 activity has also declined to low levels. By countries: Increased influenza activity has been observed in Suriname and the Cayman Islands. Elevated SARS-CoV-2 activity has been observed in Dominica, Saint Lucia, Guyana, and Saint Vincent and the Grenadines. Central America: ILI activity has remained stable at low levels, primarily attributed to influenza. SARI cases have shown a slight increase but remain at low levels, with most positive cases attributed to influenza. Influenza activity has increased to intermediate levels over the last four EWs. During this period, predominant influenza viruses have been type A(H1N1)pdm09, with concurrent circulation of A(H3N2) and to a lesser extent, B/Victoria. RSV activity has remained at low levels. SARS-CoV-2 activity has also remained at low levels. By countries: In El Salvador, SARS-CoV-2 activity has decreased over the past four EWs to low levels, while SARI activity has remained at epidemic levels. In Guatemala, an increase in ILI cases associated with influenza has been observed, reaching moderate levels, while SARI cases have remained at epidemic levels, primarily associated with influenza. In Honduras, there has been a new increase in SARI cases, reaching epidemic levels, associated with a rise in positive cases for influenza. In Nicaragua, activity for both RSV, influenza, and SARS-CoV-2 has decreased to low levels. In Panama, influenza activity has shown a pronounced increase to moderate levels over the past four EWs, while ILI and SARI cases have remained low. have continued to decline to low levels, with the majority of positive cases attributable to SARS-CoV-2 and, to a lesser extent, influenza. Influenza activity has remained at low levels over the last four EWs. During this period, predominant influenza viruses have been type A(H1N1)pdm09, with concurrent circulation of A(H3N2) and, to a lesser extent, B/Victoria. RSV activity has remained at low levels. SARS-CoV-2 activity has remained on the decline to moderate levels. By countries: In Bolivia, an increase in ILI and SARI cases has been observed, reaching levels around the epidemic threshold associated with positive cases for influenza. Influenza has shown a marked increase in activity, surpassing the elevated threshold. In Colombia, SARS-CoV-2 activity has decreased over the last four EWs to medium-low levels; SARI activity has been around the epidemic threshold during these last four EWs, with positive cases attributable to influenza and, to a lesser extent, SARS-CoV-2 and RSV. In Ecuador, SARS-CoV-2 activity has increased to medium-high levels, influenza activity has remained below the epidemic threshold, and RSV activity has remained at moderate levels over the last four EWs. SARI activity has fluctuated around the moderate threshold, with positive SARI cases attributable to influenza, SARS-CoV-2, and, to a lesser extent, RSV. In Peru, after a marked increase in SARS-CoV-2 activity in previous weeks, a decrease has been observed in the last four EWs to low levels. In Venezuela, fluctuating influenza activity has been observed below the epidemic threshold over the last four EWs. Brazil and Southern Cone: SARI and ILI activity have remained at low levels over the last four EWs, with the majority of positive cases attributable to SARS-CoV-2. Influenza activity has shown an increase over the last four EWs, reaching levels around the epidemic threshold in some countries. During this period, the predominant influenza viruses have been type A(H3N2) and A(H1N1)pdm09 followed by B/Victoria. RSV activity has remained at low levels. SARS-CoV-2 activity has remained on the decline with elevated levels. By countries: In Argentina, ILI and SARI levels have remained below the epidemic threshold. The percentage of SARS-CoV-2 positivity, although remaining at moderate levels, has shown a marked decrease over the last four EWs, and influenza activity is below the epidemic threshold. In Brazil, SARS-CoV-2 activity has remained at elevated levels, albeit decreasing, and influenza activity has shown an increase during the last four EWs, surpassing the epidemic threshold. In Chile, an increase in SARS-CoV-2 activity has been observed over the last four EWs at moderate levels, along with an increase in influenza activity, which has surpassed the epidemic threshold. ILI cases have shown a pronounced increase with epidemic levels; SARI cases have slightly surpassed the epidemic threshold, with the majority of positive cases for both ILI and SARI attributable to SARS-CoV-2 and to a lesser extent, influenza. In Paraguay, the circulation of SARS-CoV-2 has shown a decrease over the last four EWs, reaching low levels, while influenza and RSV activity have remained low. ILI and SARI activity have remained below the epidemic threshold. In Uruguay, SARI activity has continued below the epidemic threshold, albeit with a slight increase in the last four weeks, with the majority of the few positive cases attributable to SARS-CoV-2.

[RESUMEN SEMANAL]. Situación regional: Durante las últimas cuatro semanas epidemiológicas (SE) se han observado niveles intermedios en la actividad de la Enfermedad Tipo Influenza (ETI) en la región de las Américas, con una tendencia decreciente. A su vez se ha observado una disminución en la actividad de Infección Respiratoria Aguda Grave (IRAG), actualmente en niveles bajos. En ambos casos la actividad observada se ha asociado a casos positivos de influenza y SARS-CoV-2. La actividad de ETI se ha relacionado principalmente con la actividad moderada observada en Norteamérica y Caribe, mientras que la actividad de IRAG se ha visto especialmente influenciada por la actividad detectada en Norteamérica. En cuanto a la circulación de virus respiratorios, a nivel regional tras un ascenso observado en semanas previas, la actividad de SARS-CoV-2 ha disminuido, aunque que se mantiene moderada en comparación con olas epidémicas previas. Asimismo, se ha observado una actividad epidémica de influenza para esta época del año, y una actividad en descenso del Virus Respiratorio Sincitial (VRS) que se encuentra actualmente en niveles bajos. América del Norte: Los casos de ETI, tras un ligero descenso en SE previas, se han mantenido en niveles medio-altos con la mayoría de los casos atribuibles a influenza. Los casos de IRAG y hospitalizaciones asociadas a virus respiratorios se han mantenido un descenso. La actividad de influenza se ha mantenido en niveles epidémicos de circulación mostrando un ligero descenso durante las cuatro últimas SE. Durante este periodo, los virus de influenza predominantes han sido del tipo A, circulando de forma concurrente influenza A(H1N1)pdm09 e influenza A(H3N2), y con circulación en menor medida de influenza B/Victoria. La actividad del VRS ha mostrado un descenso en las últimas cuatro SE, manteniéndose en niveles moderados. La actividad del SARS-CoV-2 ha presentado un decremento en las últimas cuatro SE hasta niveles bajos en comparación con ola previas. Por países: En Canadá, la actividad del SARS-CoV-2 ha presentado un marcado descenso en las últimas cuatro SE hasta niveles mediobajos. La actividad de influenza se ha mantenido en niveles epidémicos con un descenso paulatino y la actividad del VRS ha mantenido un descenso encontrándose en niveles medios. En México, la circulación de influenza se ha mantenido fluctuante en niveles epidémicos en las cuatro últimas SE, y la circulación del SARS-CoV-2 se ha mantenido en niveles intermedios en comparación con olas previas. En Estados Unidos, la actividad de influenza se ha mantenido constante por encima del umbral epidémico y la actividad del VRS y del SARS-CoV-2 han mantenido un descenso hasta niveles bajos. Los casos de ETI se han mantenido estables en niveles medios. Las tasas de hospitalización por influenza, VRS y SARS-CoV-2 tras alcanzar niveles elevados similares a la temporada previa han presentado una tendencia a la baja en las cuatro últimas SE. Caribe: Tras el incremento observado en SE previas, los casos de ETI han mostrado un marcado descenso en las cuatro últimas semanas hasta niveles bajos. Los casos de IRAG han permanecido en descenso, siendo la mayoría de los casos positivos atribuibles a influenza. La actividad de influenza ha presentado un descenso en las últimas cuatro SE, alcanzando niveles bajos de circulación. Durante las cuatro últimas SE, los virus predominantes han sido de tipo A(H1N1)pdm09, y se ha observado circulación concurrente en menor medida de influenza tipo A(H3N2) y B/Victoria. La actividad del VRS se ha mantenido en niveles bajos. La actividad del SARS-CoV-2 ha permanecido en descenso hasta niveles bajos. Por países: Se ha observado una actividad elevada de influenza en Surinam y las Islas Caimán. Se ha observado una actividad elevada de SARS-CoV-2 en Dominica, Santa Lucia, Guyana y San Vicente y las Granadinas. América Central: La actividad de ETI se ha mantenido estable en niveles bajos con la mayoría de los casos positivos atribuibles a influenza. Los casos de IRAG han presentado un ligero incremento, aunque se mantiene en niveles bajos, siendo la mayor proporción de casos positivos atribuibles a influenza. La actividad de influenza ha presentado un incremento situándose en niveles intermedios en las cuatro últimas SE. Durante este periodo, los virus de influenza predominantes han sido de tipo A(H1N1)pdm09 con circulación concurrente de A(H3N2) y en menor medida de B/Victoria. La actividad del VRS se ha mantenido en niveles bajos. La actividad de SARS-CoV-2 se ha permanecido en niveles bajos. Por países: En El Salvador, la actividad de SARS-CoV-2 has descendido durante las cuatro últimas SE hasta niveles bajos y la actividad de IRAG se encuentra en torno a niveles epidémicos. En Guatemala, se ha observado un incremento en los casos de ETI asociados a influenza, encontrándose en niveles de actividad moderados; en cuanto a los casos de IRAG se mantienen en niveles epidémicos, siendo la mayoría asociados a su vez a influenza. En Honduras, se ha observado de nuevo un incremento en los casos de IRAG que se encuentran en niveles epidémicos, asociado a un ascenso en los casos positivos a influenza. En Nicaragua, la actividad tanto del VRS, influenza y SARS-CoV-2 ha descendido hasta niveles bajos. En Panamá, la actividad de influenza ha mostrado un pronunciado incremento hasta niveles moderados en las cuatro últimas SE, los casos de ETI e IRAG se han mantenido bajos en las cuatro últimas SE. Andina: La actividad de ETI se ha mantenido estable en niveles bajos con la mayoría de los casos positivos atribuibles a influenza. Los casos de IRAG se han mantenido en descenso con niveles bajos siendo la mayor proporción de casos positivos atribuibles a SARS-CoV- 2 e influenza. La actividad de influenza ha permanecido en niveles bajos en las cuatro últimas SE. Durante este periodo, los virus de influenza predominantes han sido de tipo A(H1N1)pdm09 con circulación concurrente de A(H3N2) y en menor medida de B/Victoria. La actividad del VRS se ha mantenido en niveles bajos. La actividad de SARS-CoV-2 se ha mantenido en descenso con niveles medios. Por países: En Bolivia, se ha observado un incremento en los casos de ETI e IRAG asociado a casos positivos a influenza y con niveles en torno al umbral epidémico. La influenza ha mostrado un marcado incremento en la actividad, superando el umbral elevado. En Colombia, la actividad de SARS-CoV-2 ha presentado un descenso en las cuatro últimas SE situándose en niveles medio-bajos; la actividad de IRAG se ha mantenido en descenso en torno al umbral epidémico durante estas últimas cuatro SE, con los casos positivos atribuibles a influenza y en menor medida SARS-CoV-2 y VRS. En Ecuador, el SARS-CoV-2 ha presentado un incremento en la actividad situándose en niveles medio-altos, la actividad de influenza se ha mantenido por debajo del umbral epidémico y la actividad del VRS se ha mantenido en niveles medios en las cuatro últimas SE. La actividad de IRAG ha fluctuado en torno al umbral moderado, los casos IRAG positivos han sido atribuibles a influenza, SARS-CoV-2 y en menor medida a VRS. En Perú tras un marcado incremento en la actividad del SARS-CoV-2 en semanas previas, se ha mostrado un descenso en las cuatro últimas SE hasta niveles bajos. En Venezuela durante las cuatro últimas SE se ha observado una actividad fluctuante de influenza por debajo del umbral epidémico. Brasil y el Cono Sur: La actividad de IRAG y ETI ha permanecido y en niveles bajos en las últimas cuatro SE, con la mayoría de los casos positivos atribuibles a SARS-CoV-2. La actividad de influenza ha mostrado un incremento en las últimas cuatro SE con niveles en torno al umbral epidémico en algunos países. En este periodo, los virus de influenza predominantes han sido de tipo A(H3N2) y A(H1N1)pdm09 seguidos de B/Victoria. La actividad del VRS se ha mantenido en niveles bajos. La actividad del SARS-CoV-2 se ha mantenido en descenso con niveles elevados. Por países: En Argentina, los niveles de ETI e IRAG han permanecido por debajo del umbral epidémico. El porcentaje de positividad de SARS-CoV-2, aunque permanece con niveles moderados, ha mostrado un marcado descenso en las cuatro últimas SE y la actividad de influenza se encuentra por debajo del umbral epidémico. En Brasil, la actividad del SARS-CoV-2 se ha mantenido en niveles elevados, aunque en descenso, y la actividad de influenza ha mostrado un ascenso durante la cuatro últimas SE superando el umbral epidémico. En Chile, se ha observado un incremento en la actividad del SARS.CoV-2 en las cuatro últimas SE con niveles moderados, y a su vez se ha observado un ascenso en la actividad de influenza que ha superado el umbral epidémico. Los casos de ETI han presentado un ascenso pronunciado con niveles epidémicos; los casos de IRAG han superado ligeramente el umbral epidémico, la mayoría de los casos positivos tanto de ETI como de IRAG son atribuibles a SARS-CoV-2 y en menor medida a influenza. En Paraguay, la circulación del SARS-CoV-2 ha mostrado un descenso en las cuatro últimas SE, encontrándose en niveles bajos y la actividad de influenza y VRS se han mantenido bajas. La actividad de IRAG y ETI se han mantenido por debajo del umbral epidémico. En Uruguay, la actividad de IRAG ha continuado con niveles por debajo del umbral epidémico, aunque con un ligero incremento en las cuatro últimas semanas siendo la mayoría de los escasos casos positivos atribuibles a SARS-CoV-2.

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 8 (1 March 2024)

[WEEKLY SUMMARY]. Regional Situation: Over the past four Epidemiological Weeks (EWs), there has been a decline in lnfluenza-Like lllness (ILI) activity in the Americas region, stabilizing at medium levels. Similarly, a decrease has been observed in the activity of Severe Acute Respiratory lnfection (SARI), currently at low leveis. ln both cases, the observed activity has been associated with positive cases of influenza and SARS-CoV-2. ILI activity has been mainly linked to moderate activity observed in North America, which showed a mild decrease in the past four weeks. Regarding the circulation of respiratory viruses, SARS-CoV-2 activity has remained moderate at the regional level compared to previous epidemie waves. Influenza activity has decreased over the period; respiratory syncytial virus (RSV) activity, while remaining moderate, has also declined. North America: ILI cases have remained at medium-high levels, with most cases attributable to influenza, although showing a decline in this proportion. SARI cases have decreased, with most cases attributable to influenza and, to a lesser extent, SARS-CoV-2. Influenza activity has remained at epidemie levels after a slight decrease in recent EWs. During this period, the predominant influenza viruses have been type A(H 1 N 1)pdm09, with concurrent circulation of influenza A(H3N2) and, to a lesser extent, influenza B/Victoria. RSV activity has declined in the last four EWs, remaining at moderate levels. SARS-CoV-2 positivity has decreased in the last four EWs and remains below late 2023 levels. By countries: ln Canada, SARS-CoV-2 activity has markedly decreased in the last four EWs to medium leveis. Influenza activity remains at epidemie levels, and RSV activity has declined during this period. ln Mexico, influenza circulation has remained fluctuating at epidemie levels in the last four EWs, while an increase in SARS-CoV-2 circulation has been observed. ln the United States, influenza activity has decreased in the past four EWS and remained above the epidemie threshold, RSV activity has decreased to moderate levels, and although SARS-CoV-2 has remained at high levels, it has shown a decreasing trend. Hospitalization rates for influenza, RSV, and SARS-CoV-2, after reaching similar high levels to the previous season, have shown a downward trend in the last four EWs. Caribbean: ILI cases have declined from high levels in preceding weeks to moderate levels in the most recent EW associated with decreases in positive influenza and SARS-Co-V-2 cases; SARI cases have remained on the decline. Influenza activity has increased in the last four EWs, reaching low circulation levels. During the last four EWs, the predominant viruses have been type A(H1 N1)pdm09, followed by A(H3N2) and, to a lesser extent, B/Victoria. RSV activity has remained at low levels. SARS-CoV-2 activity has declined to moderate levels, continuing to show a decreasing trend. By countries: Elevated influenza activity has been observed in Suriname. Central America: ILI and SARI cases have decreased in the last four weeks, with the majority of positive cases attributable to SARSCoV- 2 and, to a lesser extent, influenza. Influenza activity has decreased in the last four EWs, with an increase noted in the most recent EW, however remaining at low levels. During this period, the predominant viruses have been type A(H1 N1)pdm09, followed by A(H3N2) and B/Victoria. RSV activity has decreased to low levels. SARS-CoV-2 activity further declined and remained at low levels. By countries: ln EI Salvador, SARS-CoV-2 activity continued to decline over the past four EWs. ln Guatemala, ILI cases were sustained at high levels and SARI cases while declining to moderate levels showed increasing positivity for SARS-Co-V-2 and influenza. ln Honduras, both ILI and SARI cases increased slightly in the past four EWs, however both remain below epidemie levels. Influenza activity continued at epidemie leveis. ln Nicaragua, RSV activity has continued to decline; both influenza and SARS-CoV-2 levels have remained low. After reaching high levels in early January 2024 in Panama, SARS-CoV-2 activity has decreased. However, after fluctuating around the epidemie threshold in the last four EWs, influenza activity levels have increased to epidemie levels. ILI and SARI cases, have declined in the last four EWs. Andean: ILI activity has remained stable at iow levels, and SARI casesremaineda t high levels, with the highest proportion of positive cases attributable to SARS-CoV-2. Influenza activity has remained at low leveis in the last four EWs. During this period, the predominant influenza viruses have been type A(H1 N1)pdm09, with circulation of A(H3N2) and B/Victoria to a lesser extent. RSV activity has remained at low levels. SARS-CoV-2 activity has declined over the past four EWs. By countries: ln Bolivia, influenza circulation has increased in recent EWs with influenza A(H3N2) dominating. SARI and ILI numbers have, however, remained low. ln Colombia, SARS-CoV-2 activity have declined after an initial increase in mid-January 2024. ln Ecuador, SARS-CoV-2 has shown an increase in activity in the past EW; influenza activity has continued to decline and has remained beneath epidemie thresholds for the past four EWs, and RSV activity has declined. SARI cases have also decreased. ln Peru, SARSCoV- 2 activity has steadily declined over the past four EWs. Influenza activity in Venezuela has increased over the past four EWs with A(H1N1)pdm09 dominating followed by influenza A(H3N2), and influenza B/Victoria. Brazil and the Southem Cone: SARI and ILI activity has remained low in the last four EWs, with most positive cases attributable to SARS-CoV-2. Influenza activity has remained at low circuiation levels during the last four EWs, with a slight increase in the last two EWs. During this period, the predominant influenza viruses have been type A(H3N2) and A(H1N1)pdm09, followed by B/Victoria. RSV activity has remained at low levels. SARS-CoV-2 positivity has remained at high levels, however the number of positives has declined. By countries: ln Argentina, ILI and SARI levels have remained below the epidemie threshold. After an initial inerease in the positivity rate of SARS-CoV-2 in late January, a decline has been observed, remaining at high ievels. ln Brazil, SARS-CoV-2 activity has increased in the past four EWs, remaining at high levels. ln Chile, after a marked deerease, SARS-CoV-2 activity has reeently increased again in the last four EWs, with ILI cases remaining above epidemie levels, however, SARI cases remained just below the epidemie threshold, mostly attributable to SARS-CoV-2. ln Paraguay, SARS-CoV-2 cireulation has shown a decrease in the last three EWs, reaching moderate leveis, and influenza aetivity has increased above the epidemie threshold, while SARI activity has been below epidemie leveis, with most positive cases attributable to SARS-CoV-2. ln Uruguay, SARI activity has continued at levels below the epidemie threshold, with most of the few positive cases attributable to SARS-CoV-2.

[RESUMEN SEMANAL]. Situación regional: Durante las últimas cuatro Semanas Epidemiológicas (SE), ha habido una disminución en la actividad de Enfermedad Tipo Influenza (ETI) en la región de las Américas, estabilizándose en niveles medios. De igual forma, se ha observado una disminución en la actividad de la lnfección Respiratoria Aguda Grave (IRAG), actualmente en niveles bajos. En ambos casos, la actividad observada se ha asociado con casos positivos de influenza y SARS-CoV-2. La actividad de ETI se ha relacionado principalmente con la actividad moderada observada en América dei Norte, que mostrá una leve disminución en las últimas cuatro semanas. En cuanto a la circulación de virus respiratorios, la actividad dei SARS-CoV-2 se ha mantenido moderada a nivel regional en comparación con oleadas epidémicas anteriores. La actividad de la influenza ha disminuido durante el período; La actividad dei virus respiratorio sincicial (VRS), aunque sigue siendo moderada, también ha disminuido. América dei Norte: los casos de ETI se han mantenido en niveles medio-altos, y la mayoría de los casos son atribuibles a la influenza, aunque muestran una disminución en esta proporción. Los casos de IRAG han disminuido, y la mayoría de los casos son atribuibles a la influenza y, en menor medida, ai SARS-CoV-2. La actividad de la influenza se ha mantenido en niveles epidémicos después de una ligera disminudón en las SE redentes. Durante este período, los virus de influenza predominantes han sido el tipo A(H1 N1)pdm09, con circulación concurrente de influenza A(H3N2) y, en menor medida, influenza BNictoria. La actividad dei VRS ha disminuido en las últimas cuatro SE, manteniéndose en niveles moderados. La positividad dei SARS-CoV-2 ha disminuido en las últimas cuatro SE y se mantiene por debajo de los niveles de finales de 2023. Por países: En Canadá, la actividad dei SARS-CoV-2 ha disminuido notablemente en las últimas cuatro SE hasta niveles medias. La actividad de la influenza se mantiene en niveles epidémicos y la actividad dei VRS ha disminuido durante este período. En México, la circulación de influenza se ha mantenido fluctuando a niveles epidémicos en las últimas cuatro SE, mientras que se observa un aumento en la circuladón de SARS-CoV-2. En los Estados Unidos, la actividad de la influenza disminuyó en los últimos cuatro SE y se mantuvo por encima dei umbral epidémico, la actividad dei VRS disminuyó a niveles moderados y, aunque el SARS-CoV-2 se mantuvo en niveles altos, mostrá una tendenda decreciente. Las tasas de hospitalización por influenza, VRS y SARS-CoV-2, luego de alcanzar niveles similares a los de la temporada anterior, han mostrado una tendencia a la baja en las últimas cuatro SE. Caribe: Los casos de ETI han disminuido desde niveles altos en las semanas anteriores a niveles moderados en la SE más redente asodado con disminuciones en los casos positivos de influenza y SARS-Co-V-2; Los casos de IRAG han seguido disminuyendo. La actividad de influenza ha aumentado en las últimas cuatro SE, alcanzando niveles bajos de drculación. Durante las últimas cuatro SE, los virus predominantes han sido el tipo A(H1N1)pdm09, seguido dei A(H3N2) y, en menor medida, el BNictoria. La actividad dei VRS se ha mantenido en niveles bajos. La actividad dei SARS-CoV-2 ha disminuido a niveles moderados y continúa mostrando una tendencia decreciente. Por países: Se ha observado una elevada actividad de influenza en Surinam. Centroamérica: Los casos de ETI e IRAG han disminuido en las últimas cuatro semanas, siendo la mayoría de los casos positivos atribuibles ai SARS-CoV-2 y, en menor medida, a la influenza. La actividad de influenza ha disminuido en las últimas cuatro SE, observándose un aumento en la SE más redente, aunque se mantiene en niveles bajos. Durante este período los virus predominantes han sido el tipo A(H1N1)pdm09, seguido dei A(H3N2) y BNictoria. La actividad dei VRS ha disminuido a niveles bajos. La actividad dei SARS-CoV-2 siguió disminuyendo y se mantuvo en niveles bajos. Por países: En EI Salvador, la actividad dei SARS-CoV-2 continuá disminuyendo durante las últimas cuatro SE. En Guatemala, los casos de ETI se mantuvieron en niveles altos y los casos de IRAG, aunque disminuyeron a niveles moderados, mostraron una positividad creciente para el SARS-Co-V-2 y la influenza. En Honduras, tanto los casos de ETI como de IRAG aumentaron ligeramente en las últimas cuatro SE, sin embargo, ambos permanecen por debajo de los niveles epidémicos. La actividad gripal continuá a niveles epidémicos. En Nicaragua, la actividad dei VRS ha seguido disminuyendo; Tanto los niveles de influenza como de SARS-CoV- 2 se han mantenido bajos. Después de alcanzar niveles elevados a principies de enero de 2024 en Panamá, la actividad dei SARSCoV- 2 ha disminuido. Sin embargo, después de fluctuar alrededor dei umbral epidémico en las últimas cuatro SE, los niveles de actividad de la influenza han aumentado a niveles epidémicos. Los casos de ETI e IRAG han disminuido en las últimas cuatro SE. Andino: La actividad de ETI se ha mantenido estable en niveles bajos y los casos de IRAG se mantuvieron en niveles altos, siendo la mayor proporción de casos positivos atribuibles ai SARS-CoV-2. La actividad de influenza se ha mantenido en niveles bajos en las últimas cuatro SE. Durante este período, los virus de influenza predominantes han sido el tipo A(H1 N1)pdm09, con circulación de A(H3N2) y BNictoria en menor medida. La actividad dei VRS se ha mantenido en niveles bajos. La actividad dei SARS-CoV-2 ha disminuido en las últimas cuatro SE. Por países: En Bolivia la circulación de influenza ha aumentado en las últimas SE, predominando la influenza A(H3N2). Sin embargo, las cifras de IRAG y ETI se han mantenido bajas. En Colombia, la actividad dei SARS-CoV-2 ha disminuido luego de un aumento inicial a mediados de enero de 2024. En Ecuador, el SARS-CoV-2 ha mostrado un aumento en la actividad en la pasada SE; la actividad de la influenza ha seguido disminuyendo y se ha mantenido por debajo de los umbrales epidémicos durante las últimas cuatro SE, y la actividad dei VRS ha disminuido. Los casos de IRAG también han disminuido. En Perú, la actividad dei SARS-CoV-2 ha disminuido constantemente durante las últimas cuatro SE. La actividad de influenza en Venezuela ha aumentado en las últimas cuatro SE, con A(H1N1)pdm09 dominando seguido de influenza A(H3N2) e influenza BNictoria. Brasil y Cono Sur: La actividad de IRAG y ETI se ha mantenido baja en las últimas cuatro SE, siendo la mayoría de los casos positivos atribuibles ai SARS-CoV-2. La actividad de influenza se ha mantenido en niveles de circulación bajos durante las últimas cuatro SE, con un ligero aumento en las últimas dos SE. Durante este período, los vírus de influenza predominantes han sido el tipo A(H3N2) y A(H1N1)pdm09, seguidos por el BNictoria. La actividad dei VRS se ha mantenido en niveles bajos. La positividad dei SARS-CoV-2 se ha mantenido en niveles elevados, sin embargo, el número de positivos ha disminuido. Por países: En Argentina los niveles de ETI e IRAG se han mantenido por debajo dei umbral epidémico. Tras un aumento inicial de la tasa de positividad dei SARS-CoV-2 a finales de enero, se ha observado un descenso, manteniéndose en niveles elevados. En Brasil, la actividad dei SARS-CoV-2 ha aumentado en las últimas cuatro SE y se mantiene en niveles elevados. En Chile, después de una marcada disminución, la actividad dei SARS-CoV-2 recientemente aumentá nuevamente en las últimas cuatro SE, y los casos de ETI se mantuvieron por encima de los niveles epidémicos; sin embargo, los casos de IRAG se mantuvieronjusto por debajo dei umbral epidémico, en su mayoría atribuibles ai SARS-CoV-2. En Paraguay, la circulación de SARS-CoV-2 ha mostrado una disminución en las últimas tres SE, alcanzando niveles moderados, y la actividad de influenza ha aumentado por encima dei umbral epidémico, mientras que la actividad de IRAG ha estado por debajo de los niveles epidémicos, siendo la mayoría de los casos positivos atribuibles ai SARS-CoV-2. En Uruguay, la actividad de IRAG ha continuado en niveles por debajo dei umbral epidémico, y la mayoría de los pocos casos positivos son atribuibles ai SARS-CoV-2.

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 9 (8 March 2024)

[WEEKLY SUMMARY]. Regional Situation: Over the past tour Epidemiological Weeks (EWs), there has been a decline in lnfluenza-Like lllness (ILI) activity in the Americas region, stabilizing at medium levels. Similarly, a decrease has been observed in the activity of Severe Acute Respiratory lnfection (SARI), currently at low levels. In both cases, the observed activity has been associated with positive cases of influenza and SARS-CoV-2. ILI activity has been mainly linked to moderate activity observed in North America, which showed a mild decrease in the past tour weeks. Regarding the circulation of respiratory viruses, SARS-CoV-2 activity has remained moderate at the regional level compared to previous epidemic waves. Influenza activity has decreased over the period; respiratory syncytial virus (RSV) activity, while remaining moderate, has also declined. North America: ILI cases have remained at medium-high levels, with most cases attributable to influenza, although showing a decline in this proportion. SARI cases have decreased, with most cases attributable to influenza and, to a lesser extent, SARS-CoV-2. Influenza activity has remained at epidemic levels after a slight decrease in recent EWs. During this period, the predominant influenza viruses have been type A(H 1 N 1 )pdm09, with concurrent circulation of influenza A(H3N2) and, to a lesser extent, influenza B/Victoria. RSV activity has declined in the last tour EWs, remaining at moderate levels. SARS-CoV-2 positivity has decreased in the last tour EWs and remains below late 2023 levels. By countries: In Canada, SARS-CoV-2 activity has markedly decreased in the last tour EWs to medium levels. Influenza activity remains at epidemic levels, and RSV activity has declined during this period. In Mexico, influenza circulation has remained fluctuating at epidemic levels in the last tour EWs, while an increase in SARS-CoV-2 circulation has been observed. In the United States, influenza activity has decreased in the past tour EWS and remained above the epidemic threshold, RSV activity has decreased to moderate levels, and although SARS-CoV-2 has remained at high levels, it has shown a decreasing trend. Hospitalization rates tor influenza, RSV, and SARS-CoV-2, after reaching similar high levels to the previous season, have shown a downward trend in the last tour EWs. Caribbean: ILI cases have declined from high levels in preceding weeks to moderate levels in the most recent EW associated with decreases in positive influenza and SARS-Co-V-2 cases; SARI cases have remained on the decline. Influenza activity has increased in the last tour EWs, reaching low circulation levels. During the last tour EWs, the predominant viruses have been type A(H1 N1)pdm09, tollowed by A(H3N2) and, to a lesser extent, B/Victoria. RSV activity has remained at low levels. SARS-CoV-2 activity has declined to moderate levels, continuing to show a decreasing trend. By countries: Elevated influenza activity has been observed in Suriname. Central America: ILI and SARI cases have decreased in the last tour weeks, with the majority of positive cases attributable to SARSCoV- 2 and, to a lesser extent, influenza. Influenza activity has decreased in the last tour EWs, with an increase noted in the most recent EW, however remaining at low levels. During this period, the predominant viruses have been type A(H 1 N 1 )pdm09, tollowed by A(H3N2) and B/Victoria. RSV activity has decreased to low levels. SARS-CoV-2 activity further declined and remained at low levels. By countries: In El Salvador, SARS-CoV-2 activity continued to decline over the past tour EWs. In Guatemala, ILI cases were sustained at high levels and SARI cases while declining to moderate levels showed increasing positivity tor SARS-Co-V-2 and influenza. In Honduras, both ILI and SARI cases increased slightly in the past tour EWs, however both remain below epidemic levels. Influenza activity continued at epidemic levels. In Nicaragua, RSV activity has continued to decline; both influenza and SARS-CoV-2 levels have remained low. After reaching high levels in early January 2024 in Panama, SARS-CoV-2 activity has decreased. However, after fluctuating around the epidemic threshold in the last tour EWs, influenza activity levels have increased to epidemic levels. ILI and SARI cases, have declined in the last tour EWs. Andean: ILI activity has remained stable at low levels, and SARI casesremaineda t high levels, with the highest proportion of positive cases attributable to SARS-CoV-2. Influenza activity has remained at low levels in the last four EWs. During this period, the predominant influenza viruses have been type A(H 1 N 1 )pdm09, with circulation of A(H3N2) and B/Victoria to a lesser extent. RSV activity has remained at low levels. SARS-CoV-2 activity has declined over the past four EWs. By countries: In Bolivia, influenza circulation has increased in recent EWs with influenza A(H3N2) dominating. SARI and ILI numbers have, however, remained low. In Colombia, SARS-CoV-2 activity have declined after an initial increase in mid-January 2024. In Ecuador, SARS-CoV-2 has shown an increase in activity in the past EW; influenza activity has continued to decline and has remained beneath epidemic thresholds far the past four EWs, and RSV activity has declined. SARI cases have also decreased. In Peru, SARSCoV- 2 activity has steadily declined over the past four EWs. Influenza activity in Venezuela has increased over the past four EWs with A(H1 N1)pdm09 dominating followed by influenza A(H3N2), and influenza B/Victoria. Brazil and the Southern Cone: SARI and ILI activity has remained low in the last four EWs, with most positive cases attributable to SARS-CoV-2. Influenza activity has remained at low circulation levels during the last four EWs, with a slight increase in the last two EWs. During this period, the predominant influenza viruses have been type A(H3N2) and A(H1 N1)pdm09, followed by B/Victoria. RSV activity has remained at low levels. SARS-CoV-2 positivity has remained at high levels, however the number of positives has declined. By countries: In Argentina, ILI and SARI levels have remained below the epidemic threshold. After an initial increase in the positivity rate of SARS-CoV-2 in late January, a decline has been observed, remaining at high levels. In Brazil, SARS-CoV-2 activity has increased in the past four EWs, remaining at high levels. In Chile, after a marked decrease, SARS-CoV-2 activity has recently increased again in the last four EWs, with ILI cases remaining above epidemic levels, however, SARI cases remained just below the epidemic threshold, mostly attributable to SARS-CoV-2. In Paraguay, SARS-CoV-2 circulation has shown a decrease in the last three EWs, reaching moderate levels, and influenza activity has increased above the epidemic threshold, while SARI activity has been below epidemic levels, with most positive cases attributable to SARS-CoV-2. In Uruguay, SARI activity has continued at levels below the epidemic threshold, with most of the few positive cases attributable to SARS-CoV-2.

[RESUMEN SEMANAL]. Situación regional: Durante las últimas cuatro Semanas Epidemiológicas (SE), ha habido una disminución en la actividad de Enfermedad Tipo Influenza (ETI) en la región de las Américas, estabilizándose en niveles medios. De igual forma, se ha observado una disminución en la actividad de la Infección Respiratoria Aguda Grave (IRAG), actualmente en niveles bajos. En ambos casos, la actividad observada se ha asociado con casos positivos de influenza y SARS-CoV-2. La actividad de ETI se ha relacionado principalmente con la actividad moderada observada en América del Norte, que mostró una leve disminución en las últimas cuatro semanas. En cuanto a la circulación de virus respiratorios, la actividad del SARS-CoV-2 se ha mantenido moderada a nivel regional en comparación con oleadas epidémicas anteriores. La actividad de la influenza ha disminuido durante el período; La actividad del virus respiratorio sincicial (VRS), aunque sigue siendo moderada, también ha disminuido. América del Norte: los casos de ETI se han mantenido en niveles medio-altos, y la mayoría de los casos son atribuibles a la influenza, aunque muestran una disminución en esta proporción. Los casos de IRAG han disminuido, y la mayoría de los casos son atribuibles a la influenza y, en menor medida, al SARS-CoV-2. La actividad de la influenza se ha mantenido en niveles epidémicos después de una ligera disminución en las SE recientes. Durante este período, los virus de influenza predominantes han sido el tipo A(H1 N1)pdm09, con circulación concurrente de influenza A(H3N2) y, en menor medida, influenza B/Victoria. La actividad del VRS ha disminuido en las últimas cuatro SE, manteniéndose en niveles moderados. La positividad del SARS-CoV-2 ha disminuido en las últimas cuatro SE y se mantiene por debajo de los niveles de finales de 2023. Por países: En Canadá, la actividad del SARS-CoV-2 ha disminuido notablemente en las últimas cuatro SE hasta niveles medios. La actividad de la influenza se mantiene en niveles epidémicos y la actividad del VRS ha disminuido durante este período. En México, la circulación de influenza se ha mantenido fluctuando a niveles epidémicos en las últimas cuatro SE, mientras que se observa un aumento en la circulación de SARS-CoV-2. En los Estados Unidos, la actividad de la influenza disminuyó en los últimos cuatro SE y se mantuvo por encima del umbral epidémico, la actividad del VRS disminuyó a niveles moderados y, aunque el SARS-CoV-2 se mantuvo en niveles altos, mostró una tendencia decreciente. Las tasas de hospitalización por influenza, VRS y SARS-CoV-2, luego de alcanzar niveles similares a los de la temporada anterior, han mostrado una tendencia a la baja en las últimas cuatro SE. Caribe: Los casos de ETI han disminuido desde niveles altos en las semanas anteriores a niveles moderados en la SE más reciente asociado con disminuciones en los casos positivos de influenza y SARS-Co-V-2; Los casos de IRAG han seguido disminuyendo. La actividad de influenza ha aumentado en las últimas cuatro SE, alcanzando niveles bajos de circulación. Durante las últimas cuatro SE, los virus predominantes han sido el tipo A(H1 N1)pdm09, seguido del A(H3N2) y, en menor medida, el B/Victoria. La actividad del VRS se ha mantenido en niveles bajos. La actividad del SARS-CoV-2 ha disminuido a niveles moderados y continúa mostrando una tendencia decreciente. Por países: Se ha observado una elevada actividad de influenza en Surinam. Centroamérica: Los casos de ETI e IRAG han disminuido en las últimas cuatro semanas, siendo la mayoría de los casos positivos atribuibles al SARS-CoV-2 y, en menor medida, a la influenza. La actividad de influenza ha disminuido en las últimas cuatro SE, observándose un aumento en la SE más reciente, aunque se mantiene en niveles bajos. Durante este periodo los virus predominantes han sido el tipo A(H 1 N 1 )pdm09, seguido del A(H3N2) y B/Victoria. La actividad del VRS ha disminuido a niveles bajos. La actividad del SARS-CoV-2 siguió disminuyendo y se mantuvo en niveles bajos. Por países: En El Salvador, la actividad del SARS-CoV-2 continuó disminuyendo durante las últimas cuatro SE. En Guatemala, los casos de ETI se mantuvieron en niveles altos y los casos de IRAG, aunque disminuyeron a niveles moderados, mostraron una positividad creciente para el SARS-Co-V-2 y la influenza. En Honduras, tanto los casos de ETI como de IRAG aumentaron ligeramente en las últimas cuatro SE, sin embargo, ambos permanecen por debajo de los niveles epidémicos. La actividad gripal continuó a niveles epidémicos. En Nicaragua, la actividad del VRS ha seguido disminuyendo; Tanto los niveles de influenza como de SARS-CoV- 2 se han mantenido bajos. Después de alcanzar niveles elevados a principios de enero de 2024 en Panamá, la actividad del SARSCoV- 2 ha disminuido. Sin embargo, después de fluctuar alrededor del umbral epidémico en las últimas cuatro SE, los niveles de actividad de la influenza han aumentado a niveles epidémicos. Los casos de ETI e IRAG han disminuido en las últimas cuatro SE. Andino: La actividad de ETI se ha mantenido estable en niveles bajos y los casos de IRAG se mantuvieron en niveles altos, siendo la mayor proporción de casos positivos atribuibles al SARS-CoV-2. La actividad de influenza se ha mantenido en niveles bajos en las últimas cuatro SE. Durante este período, los virus de influenza predominantes han sido el tipo A(H1 N1)pdm09, con circulación de A(H3N2) y B/Victoria en menor medida. La actividad del VRS se ha mantenido en niveles bajos. La actividad del SARS-CoV-2 ha disminuido en las últimas cuatro SE. Por países: En Bolivia la circulación de influenza ha aumentado en las últimas SE, predominando la influenza A(H3N2). Sin embargo, las cifras de IRAG y ETI se han mantenido bajas. En Colombia, la actividad del SARS-CoV-2 ha disminuido luego de un aumento inicial a mediados de enero de 2024. En Ecuador, el SARS-CoV-2 ha mostrado un aumento en la actividad en la pasada SE; la actividad de la influenza ha seguido disminuyendo y se ha mantenido por debajo de los umbrales epidémicos durante las últimas cuatro SE, y la actividad del VRS ha disminuido. Los casos de IRAG también han disminuido. En Perú, la actividad del SARS-CoV-2 ha disminuido constantemente durante las últimas cuatro SE. La actividad de influenza en Venezuela ha aumentado en las últimas cuatro SE, con A(H1N1)pdm09 dominando seguido de influenza A(H3N2) e influenza B/Victoria. Brasil y Cono Sur: La actividad de IRAG y ETI se ha mantenido baja en las últimas cuatro SE, siendo la mayoría de los casos positivos atribuibles al SARS-CoV-2. La actividad de influenza se ha mantenido en niveles de circulación bajos durante las últimas cuatro SE, con un ligero aumento en las últimas dos SE. Durante este período, los virus de influenza predominantes han sido el tipo A(H3N2) y A(H1 N1)pdm09, seguidos por el B/Victoria. La actividad del VRS se ha mantenido en niveles bajos. La positividad del SARS-CoV-2 se ha mantenido en niveles elevados, sin embargo, el número de positivos ha disminuido. Por países: En Argentina los niveles de ETI e IRAG se han mantenido por debajo del umbral epidémico. Tras un aumento inicial de la tasa de positividad del SARS-CoV-2 a finales de enero, se ha observado un descenso, manteniéndose en niveles elevados. En Brasil, la actividad del SARS-CoV-2 ha aumentado en las últimas cuatro SE y se mantiene en niveles elevados. En Chile, después de una marcada disminución, la actividad del SARS-CoV-2 recientemente aumentó nuevamente en las últimas cuatro SE, y los casos de ETI se mantuvieron por encima de los niveles epidémicos; sin embargo, los casos de IRAG se mantuvieron justo por debajo del umbral epidémico, en su mayoría atribuibles al SARS-CoV-2. En Paraguay, la circulación de SARS-CoV-2 ha mostrado una disminución en las últimas tres SE, alcanzando niveles moderados, y la actividad de influenza ha aumentado por encima del umbral epidémico, mientras que la actividad de IRAG ha estado por debajo de los niveles epidémicos, siendo la mayoría de los casos positivos atribuibles al SARS-CoV-2. En Uruguay, la actividad de IRAG ha continuado en niveles por debajo del umbral epidémico, y la mayoría de los pocos casos positivos son atribuibles al SARS-CoV-2.

Establishing priorities to strengthen National Immunization Technical Advisory Groups in Latin America and the Caribbean.

Following the COVID-19 pandemic, the Americas faced a significant decline in vaccination coverage as well as increased vaccine hesitancy. The objective of this paper is to summarize the challenges and opportunities outlined by the National Immunization Technical Advisory Groups (NITAGs) in Latin America and the Caribbean (LAC) and prioritize targeted interventions. The exploratory survey included open-ended questions on two primary components: challenges, and opportunities. Free-text comments presented by each NITAG were collated and classified using indicators and sub-indicators of the NITAG Maturity Assessment Tool (NMAT). Opportunities were classified thematically, and priority actions were generated from the responses. All 21 NITAGs in LAC, representing 40 countries, 76 % of which have been active for over a decade, responded to the survey. The most common challenges were establishment and composition (62 %), integration into policymaking (62 %), resources and secretariat (52 %), and stakeholder recognition (48 %). The distribution of responses was seen across the whole sample and did not suggest a more pronounced need in relation to year of establishment. Opportunities included maximizing the Regional NITAG Network of the Americas (RNA) to facilitate collaboration, information sharing, visibility, and communication; existing global, regional, and systemic analyses; the World Health Organization/Pan American Health Organization (WHO/PAHO) templates for standard operating procedures; twinning programs with mature NITAGs; and NITAGs in governance structures. Action plans were outlined to formalize the establishment of NITAGs and broaden their composition; strengthen decision-making and access to data resources; and enhance the credibility of evidence-based recommendations and their uptake by policymakers and the public. NITAG challenges are not unique to LAC. NITAGs have outlined a short-term prioritized action plan which is critical to enhancing NITAG value and importance in countries.

Phylosymbiosis and metabolomics resolve phenotypically plastic and cryptic sponge species in the genus Agelas across the Caribbean basin.

Fundamental to holobiont biology is recognising how variation in microbial composition and function relates to host phenotypic variation. Sponges often exhibit considerable phenotypic plasticity and also harbour dense microbial communities that function to protect and nourish hosts. One of the most prominent sponge genera on Caribbean coral reefs is Agelas. Using a comprehensive set of morphological (growth form, spicule), chemical and molecular data on 13 recognised species of Agelas in the Caribbean basin, we were able to define only five species (=clades) and found that many morphospecies designations were incongruent with phylogenomic and population genetic analyses. Microbial communities were also strongly differentiated between phylogenetic species, showing little evidence of cryptic divergence and relatively low correlation with morphospecies assignment. Metagenomic analyses also showed strong correspondence to phylogenetic species, and to a lesser extent, geographical and morphological characters. Surprisingly, the variation in secondary metabolites produced by sponge holobionts was explained by geography and morphospecies assignment, in addition to phylogenetic species, and covaried significantly with a subset of microbial symbionts. Spicule characteristics were highly plastic, under greater impact from geographical location than phylogeny. Our results suggest that while phenotypic plasticity is rampant in Agelas, morphological differences within phylogenetic species affect functionally important ecological traits, including the composition of the symbiotic microbial communities and metabolomic profiles.

Temporal fluctuation of metallic trace elements concentrations in three morphotypes of floating holopelagic Sargassum from the Caribbean coast (Guadeloupe, French West Indies).

Since 2011, the Caribbean coasts have unprecedented stranding of a pelagic brown macroalgae Sargassum inducing damages for coastal ecosystems and economy. This study evaluated the temporal fluctuations of metallic trace elements (MTE) in Sargassum freshly arrived on the Caribbean coast. From May 2020 to September 2021, 12 floating samples of three morphotypes (S. fluitans III and S. natans I and VIII) were regularly collected in the Petit Cul-de-Sac Marin (Guadeloupe, French West Indies). Measured concentrations of 28 metal(loid)s trace elements reveal i) an absence of seasonal patterns in MTE concentrations except for metals Fe and Al during 2020 summer ii) a regular and high As content during the entire survey iii) a similar trend of contamination for each morphotype. The constant and high amount of As implies that stranding management policy and valorization processes of Sargassum must consider As contamination and that this vigilance must be constantly along the year.

Impacts of hurricanes and disease on Diadema antillarum in shallow water reef and mangrove locations in St John, USVI.

The 1983-1984 mortality event of the long-spined sea urchin Diadema antillarum reduced their population by up to 99% and was accompanied by a phase shift from coral dominated to algal dominated reefs in the Caribbean. Modest rebounds of D. antillarum populations in the Caribbean have been noted, and here we document the impacts of two major hurricanes (2017, Irma and Maria) and the 2022 disease outbreak on populations of D. antillarum found by targeted surveys in the urchin zone at nine fringing reef and three mangrove sites on St. John, USVI. D. antillarum populations at the reef sites had declined by 66% five months after the hurricanes but showed significant recovery just one year later. The impact of recent disease on these populations was much more profound, with all reef populations exhibiting a significant decline (96.4% overall). Fifteen months after the disease was first noted, D. antillarum at reef sites exhibited a modest yet significant recovery (15% pre-disease density). D. antillarum populations in mangrove sites were impacted by the hurricanes but exhibited much higher density than reef sites after the disease outbreak, suggesting that at D. antillarum in some locations may be less vulnerable to disease.

Evaluating vector competence for Yellow fever in the Caribbean.

The mosquito-borne disease, Yellow fever (YF), has been largely controlled via mass delivery of an effective vaccine and mosquito control interventions. However, there are warning signs that YF is re-emerging in both Sub-Saharan Africa and South America. Imported from Africa in slave ships, YF was responsible for devastating outbreaks in the Caribbean. In Martinique, the last YF outbreak was reported in 1908 and the mosquito Aedes aegypti was incriminated as the main vector. We evaluated the vector competence of fifteen Ae. aegypti populations for five YFV genotypes (Bolivia, Ghana, Nigeria, Sudan, and Uganda). Here we show that mosquito populations from the Caribbean and the Americas were able to transmit the five YFV genotypes, with YFV strains for Uganda and Bolivia having higher transmission success. We also observed that Ae. aegypti populations from Martinique were more susceptible to YFV infection than other populations from neighboring Caribbean islands, as well as North and South America. Our vector competence data suggest that the threat of re-emergence of YF in Martinique and the subsequent spread to Caribbean nations and beyond is plausible.

A 14-Year-Old Girl with Shortness of Breath and Chest Pain.

A 14-Year-Old Girl with Dyspnea and Chest PainA 14-year-old girl presented for evaluation of shortness of breath and chest pain after recent travel to the Caribbean. How do you approach the evaluation, and what is the diagnosis?

Microbial communities present in Sargassum spp. leachates from the Mexican Caribbean which are involved in their degradation in the environment, a tool to tackle the problem.

The Sargassum phenomenon is currently affecting the Caribbean in several ways; one of them is the increase of greenhouse gases due to the decomposition process of this macroalgae; these processes also produce large amounts of pollutant leachates, in which several microbial communities are involved. To understand these processes, we conducted a 150-day study on the Sargassum spp environmental degradation under outdoor conditions, during which leachates were collected at 0, 30, 90, and 150 days. Subsequently, a metagenomic study of the microorganisms found in the leachates was carried out, in which changes in the microbial community were observed over time. The results showed that anaerobic bacterial genera such as Thermofilum and Methanopyrus were predominant at the beginning of this study (0 and 30 days), degrading sugars of sulfur polymers such as fucoidan, but throughout the experiment, the microbial communities were changed also, with the genera Fischerella and Dolichospermum being the most predominant at days 90 and 150, respectively. A principal component analysis (PCA) indicated, with 94% variance, that genera were positively correlated at 30 and 90 days, but not with initial populations, indicating changes in community structure due to sargassum degradation were present. Finally, at 150 days, the leachate volume decreased by almost 50% and there was a higher abundance of the genera Desulfobacter and Dolichospemum. This is the first work carried out to understand the degradation of Sargassum spp, which will serve, together with other works, to understand and provide a solution to this serious environmental problem in the Caribbean.