Strategy for accelerating maternal mortality reduction in the Region of the Americas based on Primary Health Care

In Latin America and the Caribbean (LAC), one maternal death was registered every hour in 2020. That same year, the trend in the maternal mortality ratio (MMR) for the Region of the Americas regressed alarmingly and unprecedentedly to the levels seen two decades ago. In addition to indicating a worsening of health outcomes, these figures also signal a deepening of inequalities, representing thousands of individual, unacceptable tragedies that in most cases could have been preventable. Maternal death is the result of a multifactorial process in which structural elements such as the economic system, environmental conditions, and culture interact. Other factors related to social inequality are also present, such as racism, poverty, gender inequality, and lack of access to the education system. The current situation calls for urgent mobilization of the health systems of LAC countries in order to strengthen efforts to combat maternal mortality, especially in countries that are still far from achieving the SHAA2030 regional target. For this reason, a preventive, health-promoting, life-course-based approach is needed, with models of care centered on women, families, and the community Scientific evidence shows that health systems with a solid foundation in primary health care (PHC) achieve better outcomes, greater equity, and reduced health expenditures. To address this, PAHO proposes a strategy, aimed primarily at women who are in the most vulnerable situation, who are the ones who represent the greatest burden of maternal mortality, to accelerate the reduction of maternal mortality in the Region of the Americas, based on the expansion and strengthening of PHC.

Plan de acción para fortalecer la vigilancia y el control de las leishmaniasis en las Américas 2023-2030

Con el fin de actualizar, sistematizar y monitorear las acciones relacionadas con la leishmaniasis en el nivel operativo, la Organización Panamericana de la Salud ha elaborado esta nueva versión del Plan para el período 2023-2030, que contiene las principales líneas de acción para la vigilancia, la asistencia y el control de las leishmaniasis en la Región. En estas páginas se abordan la evidencia, el costo, la costo-efectividad de las intervenciones disponibles, el acceso y los análisis de los datos epidemiológicos y de procesos, entre otras cuestiones esenciales, así como la organización de los servicios de salud en los países de las Américas. Para preparar las metas y los indicadores del Plan se consideraron discusiones técnicas, puntos de consenso, orientaciones y sugerencias provenientes de expertos, investigadores y profesionales responsables de las acciones de lucha contra la enfermedad en los países endémicos. Las acciones propuestas se formularon a partir del diagnóstico de la situación en la Región, lo cual implicó definir los indicadores de procesos, epidemiológicos y operativos, a fin de valorar los avances y hacer un seguimiento de la enfermedad con miras a alcanzar mejoras palpables. Estas acciones se enfocan en el diagnóstico temprano, el tratamiento y el seguimiento adecuados de las personas afectadas, y toman en cuenta la vigilancia, la prevención y el control de los casos humanos, de los vectores y de los reservorios, cuando se requiera, todo lo cual debe sumarse a las labores de educación y comunicación. Las metas para el control de las leishmaniasis en la Región son ambiciosas y exigirán que los países y los socios interesados en proporcionar su apoyo trabajen con mucho empeño para alcanzarlas.

Developing respiratory pathogen pandemic preparedness plans

Planning for public health emergencies should ensure that capabilities developed during previous emergencies are maintained, incorporated, and put into practice when a new event of public health concern arises. Investments in pandemic preparedness lead to more rapid detection and a stronger response to public health threats, thereby shielding communities from the debilitating social and economic effects of epidemics and pandemics. The Pan American Health Organization (PAHO) recognizes the efforts of countries in the Region of the Americas to develop and/or strengthen their respiratory pathogen pandemic plans. PAHO supports planning activities with tools and expertise, aligning these efforts with the Preparedness and Resilience for Emerging Threats (PRET) initiative. The PRET initiative is an innovative approach to improving disease pandemic preparedness. It recognizes that the same systems, capacities, knowledge, and tools can be leveraged and applied for groups of pathogens based on their mode of transmission (respiratory, vector-borne, foodborne etc.). The PRET initiative incorporates the latest tools and approaches for shared learning and collective action established during the COVID-19 pandemic and other recent public health emergencies. It places the principles of equity, inclusivity, and coherence at the forefront. This document outlines four steps for respiratory pathogen pandemic planning (PRET Module1). Step 1: Prepare, analyze the situation and engage stakeholders, Step 2: Draft the plan, Step 3: Evaluate, finalize and disseminate the plan and Step 4: Implement, monitor and continuously evaluate the plan. The scope of this document is guide the process of updating and developing preparedness and response plans for pandemics caused by respiratory pathogens, in order to strengthen their basic capacities and encourage the countries of the Region of the Americas to have operational, proven plans, and with a regular monitoring and updating plan to address epidemics and pandemics in the face of this type of threat.

Virtual Campus for Public Health (VCPH): Bringing knowledge to practice. Updated version

The Virtual Campus of Public Health (VCPH) is the educational platform of the Pan American Health Organization (PAHO) that seeks to contribute to the development of the capabilities and competencies of health workers by supporting the transformation of public health services and practices in the Region of the Americas. It functions as a decentralized network of people, institutions and organizations that share open educational courses and resources on public health topics relevant to the countries of the Region, through the use of information and communication technologies.

Strengthening care for noncommunicable diseases in the Americas

Noncommunicable diseases (NCDs), such as cardiovascular diseases, cancer, respiratory diseases and diabetes, account for 81% of lives lost in the Americas. An estimated 240 million adults in the Region live with at least one NCD, requiring access to continuous support, delivered through Primary Health Care. Successful implementation of NCD policies and interventions can result in significant cost savings, alleviating the economic burden on healthcare systems, individuals, and society, while effective NCD management at the Primary Health Care level reduces premature deaths and disabilities. Strengthening integration of NCDs into Primary Health Care represents a key milestone in a country’s health system response to the Sustainable Development Agenda, with the aim of leaving no-one behind.

Toward zero maternal deaths

Since 2015, maternal mortality has been steadily increasing in the Americas, highlighting the need for urgent action. The maternal mortality ratio (MMR) in 2020 returned to the same level observed in the early 2000s, marking a setback of 20 years. Between 2015 and 2020, the MMR increased by 17% in the Americas, leading to 25 maternal deaths per day in 2020. Compared with other WHO Regions, the Americas has registered the highest increase in the MMR globally. Despite the fact that 98% of births were attended by skilled health personnel in 2020, the MMR in the Americas for that year was 68 deaths per 100 000 live births. It is estimated that since 2020 the MMR has remained at the same high level for the Region. Tackling this negative trend, in March 2023 the Regional Task Force for the Reduction of Maternal Mortality, led by the Pan American Health Organization (PAHO), launched the campaign Zero Maternal Deaths: Prevent the Preventable to accelerate progress toward the regional goal of fewer than 30 maternal deaths per 100 000 live births, as outlined in PAHO’s Sustainable Health Agenda for the Americas.

Protecting and promoting mental health in the Americas

Mental disorders, such as anxiety and depression, and psychoactive substance use-related disorders, such as alcohol or tobacco abuse, affect people all over the world and contribute to an important burden of disease. The Americas is no exception. The Region has high prevalence rates of anxiety and depressive disorders, and has experienced a considerable increase in recent years of people living with dementia, the third leading cause of death in the Region in 2019. The COVID-19 pandemic exacerbated mental health issues and brought them into the spotlight. Latin America and the Caribbean saw a deterioration in mental health at the population level with prevalences of major depressive and anxiety disorders rising by 35% and 32%, respectively, in 2020. Some groups were disproportionately affected, such as health and frontline workers, women, young people, individuals with preexisting mental health conditions, ethnic minorities, and those living in situations of vulnerability. There is a lack of access to quality services for mental health conditions in many countries. Furthermore, these services are underfinanced; public spending on mental health is only about 3% of the health budget. The Pan American Health Organization (PAHO) has urged all Member States to promote increased investment in mental health services.

PAHO's Regional Revolving Funds: A health cooperation success story

The Pan American Health Organization (PAHO)’s Regional Revolving Funds (RRFs) are technical cooperation mechanisms that enable the Americas to equitably and timely access quality vaccines, essential medicines, and public health supplies. When countries work together, they achieve benefits for all: through pooled procurement and planning their demand together, Member States obtain affordable prices, securing around 50% in savings for vaccines and public health supplies; benefitting around 180 million people in the past two years alone. PAHO’s RRFs comprise the Revolving Fund for Access to Vaccines and the Strategic Fund for Public Health Supplies. The RRFs are key to the Americas’ impressive record of addressing public health demands by responding rapidly, implementing critical interventions for access to health technologies, and supporting disease elimination. The Funds’ product portfolio includes medicines for communicable and noncommunicable diseases as well as neglected diseases; diagnostic kits and medical equipment such as rapid tests for HIV, malaria, leishmaniasis and more; vector control supplies such as insecticides and long-lasting insecticidal nets; and vaccines and related supplies such as safety boxes, immunoglobulins, and cold chain equipment. The RRFs have also contributed to the introduction of new health supplies in countries, as well as the response to recent health emergencies such as COVID-19 and mpox. Moreover, the Funds are central to achieving the renewed Disease Elimination Initiative’s targets.

Health financing and access to medicines in the Caribbean

For millions of people, including those in the Caribbean region, accessing affordable and high-quality medicines poses significant challenges. These include affordability issues, concerns over the quality and safety of medicines, and inadequate financing for health care, as well as the inappropriate use of essential medicines, weak or limited regulatory systems, and complex procurement and supply chain management processes. The Caribbean region also faces a unique set of challenges, including high levels of public debt and significant informal economies. These factors constrain the capacity of governments to invest in social programs and agendas, including the provision of universal health coverage. At present, public spending on health care in the region is only 3.9% of gross domestic product, well below the 6% target. Consequently, many people must rely on out-of-pocket payments for health care, including medicines. This financial burden creates barriers to accessing health care and can lead to the irrational use of prescription drugs and other medicines. This report offers an initial and concise evaluation of certain health financing aspects that are crucial for accessing medicines in the Caribbean. It also provides a preliminary set of recommendations to guide national and regional efforts to improve the region’s current organization, financing, and provision of medicines. These recommendations aim to tackle the significant challenges highlighted in the report, including those related to system financing, barriers to access, and the financial burden of out-of-pocket costs. Envisioned as an integral part of a broader series of initiatives, this study aims to promote equitable, affordable, and sustainable access to medicines and health technologies by strengthening regulatory frameworks and production capacities, as well as by promoting the rational use of medicines. The publication also aims to be a useful resource for policymakers, health professionals, and other stakeholders in the region and beyond, as they work toward ensuring that everyone in the Caribbean has access to the medicines they need to lead healthy and productive lives, and that the region can achieve sustainable and equitable health financing.

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 24 (21 June 2024)

[WEEKLY SUMMARY]. During the last four epidemiological weeks (EWs), low levels of Influenza-Like Illness (ILI) activity have been reported across the Americas. However, there has been epidemic activity in the Southern Cone and an increase in activity in the Caribbean and Central America subregions. This activity is associated with the circulation of influenza in the Southern Cone and Central America and SARS-CoV-2 in the Caribbean. Additionally, moderate levels of Severe Acute Respiratory Infection (SARI) have been observed, particularly in the Southern Cone, followed by the Andean subregion. In both cases the activity is related to positive cases of influenza and RSV. Regarding the circulation of respiratory viruses, SARS-CoV-2 activity has remained at low levels compared to previous epidemic waves, although showing an increase associated with circulation in North America and the Caribbean. Additionally, there has been rising epidemic-level influenza activity, marked by circulation in Central America, the Southern Cone, and some Caribbean countries. RSV activity has remained low except in the Andean region, where moderate levels have been observed. North America: ILI cases and hospitalizations associated with respiratory viruses have continued to decline over the past four EWs, remaining at low levels. Influenza activity has also continued to decrease, staying below the epidemic threshold. During this period, the predominant influenza viruses have been type A(H3N2), followed by type A(H1N1)pdm09 and type B/Victoria. RSV activity has shown a decline, remaining at low levels. SARS-CoV-2 activity has remained low compared to previous waves, although it has been on the rise. By country: In Canada, SARS-CoV-2 activity has continued to increase, although it remains at low levels. Influenza activity has dropped below the epidemic threshold, and RSV activity has remained low. In Mexico, influenza circulation has fallen below the epidemic threshold, and SARS-CoV-2 activity has shown a slight increase, remaining at low levels. In the United States, both ILI cases and hospitalization rates for influenza, RSV, and SARS-CoV-2 remain low. While influenza and RSV activity is low, the SARS-CoV-2 positivity rate has shown an increase. Caribbean: ILI cases have increased, associated with a higher proportion of positive cases of SARS-CoV-2 and influenza. On the other hand, although SARI cases have remained at low levels, there has been an increase in the proportion of positive cases of SARS-CoV-2. Influenza activity has remained at intermediate levels during the last four EWs. During this period, the predominant viruses have been type A(H3N2), with concurrent circulation of influenza A(H1N1)pdm09. RSV activity has remained low. SARS-CoV-2 activity has shown a marked increase in the last two weeks, reaching elevated levels compared to previous waves. By country: Influenza activity has been observed over the last four EWs in the Dominican Republic, Jamaica, Guyana, and the Cayman Islands. SARS-CoV-2 activity has been noted in Jamaica, Saint Lucia, Suriname, Barbados, Guyana, the Cayman Islands, and Saint Vincent and the Grenadines. Central America: Both ILI and SARI activity have increased over the last four EWs, with most positive cases attributable to influenza. Influenza activity has risen during this period, reaching epidemic levels in several countries in the subregion. In the last four EWs, the predominant influenza viruses have been type A(H3N2), with concurrent circulation of A(H1N1)pdm09. RSV and SARS-CoV-2 activity have remained at low levels. By country: In El Salvador, influenza circulation has risen to high activity levels, and SARS-CoV-2 has shown an increase, although it remains low compared to previous waves. In Guatemala, during the last four EWs, ILI and SARI activity have fluctuated around the epidemic threshold. Most positive cases are attributed to influenza, which is at epidemic levels and declining, and RSV, whose activity is increasing. In Honduras, during the last four EWs, SARI activity has been fluctuating and remains at epidemic levels. This is mainly associated with positive influenza cases, currently at moderate levels, and to a lesser extent, SARS-CoV-2, which is increasing. In Nicaragua, a moderate increase above the epidemic threshold for influenza activity has been observed, while RSV and SARS-CoV-2 circulation remains low. In Panama, ILI and SARI cases have shown an increase over the last four EWs, coinciding with influenza activity rising to extraordinary levels. Andean: ILI and SARI activity have remained stable at low levels over the past four EWs, although an increase in the proportion of positive RSV and influenza cases has been observed. Influenza activity has remained low over the last four EWs with a fluctuating trend. During this period, the predominant influenza viruses have been type A(H3N2), with concurrent circulation of A(H1N1)pdm09. RSV activity has remained at moderate levels, with a growing trend. SARS-CoV-2 activity has remained low, showing a slight increase. By country: In Bolivia, SARI cases are in decline, with levels below the epidemic threshold. Almost all positive cases are attributable to influenza, whose activity has decreased to below the epidemic threshold after having reached moderate levels. In Colombia, SARI activity has remained at epidemic levels during the last four weeks, with most positive cases attributable to RSV (whose activity is at intermediate levels compared to previous seasons) and, to a lesser extent, influenza (whose activity is below the epidemic threshold). Acute Respiratory Infection (ARI) cases have reached extraordinary levels. In Ecuador, SARI activity remains at epidemic levels and shows an increase, while pneumonia levels have risen to moderate levels. Positive SARI cases are primarily attributable to influenza, whose increasing activity has surpassed the epidemic threshold. To a lesser extent, they are attributable to RSV, which is declining, and SARS-CoV-2, which is increasing. In Peru, influenza activity remains below the epidemic threshold, while RSV and SARS-CoV-2 activity also remain low. In Venezuela, during the last four EWs, fluctuating influenza activity around the epidemic threshold has been observed. Brazil and the Southern Cone: After the increase observed in previous weeks, SARI activity has declined over the last four EWs, with most positive cases attributable to influenza and RSV. ILI activity continues to rise, with most positive cases attributed to influenza. Influenza activity has increased over the last four EWs, reaching epidemic levels in most countries. During this period, the predominant influenza viruses have been type A(H3N2), with lesser circulation of A(H1N1)pdm09. RSV activity has remained low but has shown a slight increase. SARS-CoV-2 activity has continued to decline, staying at low levels. By country: In Argentina, ILI activity, after reaching moderate levels, has shown a slight decrease, while SARI activity continues to rise, around the epidemic threshold. Influenza activity has shown an increase, reaching extraordinary levels. There has also been an increase in the RSV positivity rate. In Brazil, after moderate SARI activity in previous weeks, it has now declined below the epidemic threshold. The highest proportion of positive cases is attributable to RSV, followed by influenza. Meanwhile, ILI cases, which had previously reached high levels, have begun to decline, with influenza responsible for the majority of positive results. In Chile, both ILI and SARI cases have reached extraordinary and epidemic levels respectively and are currently in decline; most positive cases are attributable to influenza, which, after reaching extraordinary levels, has decreased to epidemic levels. In Paraguay, SARI activity is at moderate levels, while ILI activity is around the epidemic threshold. Most positive cases are attributable to influenza, circulating at moderate levels, and to a lesser extent, RSV, which is circulating at levels below those observed in previous seasons. In Uruguay, SARI activity, after reaching high levels, has decreased to intermediate levels, with most positive cases attributable to influenza. After reaching moderate levels, influenza has decreased to epidemic levels. To a lesser extent, cases are also attributable to RSV, which is currently circulating at levels below those observed in previous seasons.

[RESUMEN SEMANAL]. Situación regional: Durante las últimas cuatro semanas epidemiológicas (SE), se han registrado niveles bajos de actividad de la Enfermedad Tipo Influenza (ETI) en la región de las Américas. Sin embargo, ha habido actividad epidémica en el Cono Sur, y un aumento en la actividad en las subregiones del Caribe y Centroamérica. Esta actividad está asociada con la circulación de influenza en el Cono Sur y Centroamérica, y de SARS-CoV-2 en el Caribe. Además, se ha observado una actividad moderada de Infección Respiratoria Aguda Grave (IRAG), particularmente en el Cono Sur, seguida por la subregión Andina. En ambos casos, esta actividad está relacionada con casos positivos de influenza y VRS. En cuanto a la circulación de virus respiratorios, a nivel regional la actividad de SARS-CoV-2 ha se ha mantenido en niveles bajos en comparación con olas epidémicas previas, aunque mostrando un incremento asociado a la circulación en Norte América y Caribe. Asimismo, se ha observado una actividad epidémica de influenza en ascenso, marcada por la circulación en Centro América, el Cono Sur y algunos países del Caribe. La actividad del Virus Respiratorio Sincitial (VRS) se ha mantenido en niveles bajos excepto en la región Andina donde se han observado niveles moderados. América del Norte: Los casos de ETI y las hospitalizaciones asociadas a virus respiratorios, se han mantenido en descenso durante las cuatro últimas SE, presentando niveles bajos. La actividad de influenza se ha mantenido en descenso situándose por debajo del umbral epidémico. Durante este periodo, los virus de influenza predominantes han sido del tipo A (H3N2) seguido de influenza tipo A(H1N1)pdm09 y tipo B/Victoria. La actividad del VRS ha mostrado un descenso, manteniéndose en niveles bajos. La actividad del SARS-CoV-2 se ha mantenido en ascenso, aunque manteniéndose en niveles bajos en comparación con olas previas. Por países: En Canadá, la actividad del SARS-CoV-2 se ha mantenido en ascenso, aunque manteniendo niveles bajos. La actividad de influenza ha descendido por debajo del umbral epidémico y la actividad del VRS ha permanecido en niveles bajos. En México, la circulación de influenza ha descendido por debajo del umbral epidémico y la actividad del SARS-CoV-2 ha mostrado un ligero incremento, manteniéndose en niveles bajos. En Estados Unidos, tanto los casos de ETI como las tasas de hospitalización por influenza, VRS y SARS-CoV-2 se mantienen en niveles bajos. Tanto la actividad de influenza, VRS como se encuentran en niveles bajos, mientras el porcentaje de positividad del SARS-CoV-2 ha mostrado un incremento. Caribe: Los casos de ETI han incrementado, asociados a una mayor proporción de casos positivos de SARS-CoV-2 e influenza. Por otro lado, aunque los casos de IRAG han permanecido en niveles bajos, se ha observado un aumento en la proporción de casos positivos de SARS-CoV-2. La actividad de influenza se ha mantenido con niveles intermedios durante las últimas cuatro SE. Durante este periodo, los virus predominantes han sido de tipo A(H3N2), con circulación concurrente de influenza A(H1N1)pdm09. La actividad del VRS se ha mantenido en niveles bajos. La actividad del SARS-CoV-2 ha presentado un marcado incremento en las dos últimas semanas situándose en niveles elevados en comparación con olas previas. Por países: Se ha observado actividad de influenza las últimas cuatro SE en República Dominicana, Jamaica, Guyana y las Islas Caimán. Se ha observado actividad de SARS-CoV-2 en Jamaica, Santa Lucía, Surinam, Barbados, Guyana, las Islas Caimán y San Vicente y Granadinas. América Central: Durante las cuatro últimas SE la actividad tanto de ETI como de IRAG ha presentado un incremento, con la mayoría de los casos positivos atribuibles a influenza. La actividad de influenza ha presentado un ascenso durante este periodo situándose en niveles epidémicos en varios países de la subregión. En las cuatro últimas SE, los virus influenza predominantes han sido de tipo A(H3N2) con circulación concurrente de influenza A(H1N1)pdm09. La actividad del VRS y del SARS-CoV-2 ha permanecido en niveles bajos. Por países: En El Salvador, la circulación de influenza ha ascendido hasta niveles de actividad elevada y el SARS.CoV-2 ha mostrado un ascenso, aunque se mantiene en niveles bajos en comparación con ola previas. En Guatemala, durante las últimas cuatro SE, la actividad de ETI e IRAG ha oscilado alrededor del umbral epidémico. La mayoría de los casos positivos se atribuyen a influenza, cuya circulación está en niveles epidémicos y en descenso, y a VRS, cuya actividad está en ascenso. En Honduras, en las últimas cuatro SE, la actividad de IRAG ha sido fluctuante y se mantiene en niveles epidémicos. Esto se asocia principalmente a casos positivos de influenza, actualmente en niveles moderados, y en menor medida a SARS-CoV-2, que está en ascenso. En Nicaragua, se ha observado un incremento sobre el umbral moderado de la actividad de influenza, la circulación del VRS y SARSCoV- 2 se encuentra en niveles bajos. En Panamá, los casos de ETI e IRAG han mostrado un incremento en las últimas cuatro semanas epidemiológicas, coincidiendo con una actividad de influenza que ha ascendido a niveles extraordinarios. Andina: La actividad de ETI e IRAG se ha mantenido estable en niveles bajos durante las cuatro últimas SE, sin embrago se ha observado un ascenso en la proporción de casos positivos a VRS e influenza. La actividad de influenza ha permanecido en niveles bajos en las cuatro últimas SE con una tendencia fluctuante. Durante este periodo, los virus de influenza predominantes han sido de tipo A(H3N2) con circulación concurrente de A(H1N1)pdm09. La actividad del VRS se ha mantenido en niveles moderados, con una tendencia creciente. La actividad de SARS-CoV-2 se ha mantenido en niveles bajos mostrando un ligero ascenso. Por países: En Bolivia, los casos de IRAG se encuentran en descenso, con niveles por debajo del umbral epidémico. Prácticamente la totalidad de los positivos son atribuibles a influenza, cuya actividad ha disminuido hasta niveles por debajo del umbral epidémico tras haber alcanzado niveles moderados. En Colombia, la actividad de IRAG se ha mantenido en niveles epidémicos durante las últimas cuatro semanas, con la mayoría de los casos positivos atribuibles a VRS (cuya actividad se encuentra en niveles intermedios en comparación con temporadas previas) y, en menor medida, a influenza (cuya actividad se encuentra por debajo del umbral epidémico). Los casos de IRA (Infección Respiratoria Aguda) han alcanzado niveles extraordinarios. En Ecuador, la actividad de IRAG se mantiene en niveles epidémicos y muestra un incremento, mientras que los niveles de neumonía han ascendido a niveles moderados. Los casos positivos de IRAG son principalmente atribuibles a influenza, cuya actividad está en ascenso y ha superado el umbral epidémico. En menor medida, se atribuyen a VRS, que está en descenso, y a SARS-CoV-2, que se encuentra en ascenso. En Perú, la actividad de influenza se mantiene por debajo del umbral epidémico, mientras que la actividad de VRS y SARS-CoV-2 también se mantiene baja. En Venezuela, durante las últimas cuatro semanas epidemiológicas, se ha observado una actividad fluctuante de influenza en torno al umbral epidémico. Brasil y el Cono Sur: Tras el incremento observado en semanas previas la actividad de IRAG ha presentado un descenso en las cuatro últimas SE, con la mayoría de los casos positivos atribuibles a influenza y VRS. La actividad de ETI se mantiene en ascenso con la mayoría de los casos positivos a influenza. La actividad de influenza ha presentado un incremento en las últimas cuatro SE con niveles epidémicos en la mayoría de los países. En este periodo, los virus de influenza predominantes han sido de tipo A(H3N2) y en menor medida A(H1N1)pdm09. La actividad del VRS, aunque en ascenso, se ha mantenido en niveles bajos en comparación con temporadas previas. La actividad del SARS-CoV-2 se ha mantenido en niveles bajos de actividad. Por países: En Argentina, la actividad de ETI tras alcanzar niveles moderados ha presentado un ligero descenso, la actividad de IRAG continúa en ascenso en niveles en torno al umbral epidémico. La actividad de influenza ha mostrado un aumento, alcanzando niveles extraordinarios. Paralelamente, se ha observado un incremento en el porcentaje de positividad de VRS. En Brasil, tras observarse una actividad moderada de IRAG en semanas anteriores, esta ha descendido a niveles por debajo del umbral epidémico. La mayor proporción de casos positivos se atribuye a VRS, seguido de influenza. Por otro lado, los casos de ETI, que previamente alcanzaron niveles elevados, han comenzado a descender, siendo en este caso la influenza la responsable de la mayor proporción de resultados positivos. En Chile, los casos de ETI e IRAG han presentado niveles extraordinarios y epidémicos respectivamente y se encuentran actualmente en descenso; la mayoría de los casos positivos son atribuibles a influenza que tras alcanzar niveles extraordinarios ha presentado un descenso hasta niveles epidémicos. En Paraguay, la actividad de IRAG se encuentra en niveles moderados y la actividad de ETI en torno al umbral epidémico. La mayoría de los casos positivos son atribuibles a influenza que se encuentra circulando en niveles moderados y en menor medida a VRS que circula en niveles por debajo de los observados en temporadas previas. En Uruguay, la actividad de IRAG, tras alcanzar niveles elevados, ha descendido a niveles intermedios, con la mayoría de los casos positivos atribuibles a influenza. Esta última, después de alcanzar niveles moderados, ha descendido a niveles epidémicos. En menor medida, los casos se atribuyen a su vez a VRS, que actualmente circula en niveles por debajo de los observados entemporadas previas.

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 23 (14 June 2024)

[WEEKLY SUMMARY]. Regional Situation: During the last four epidemiological weeks (EWs), low levels of Influenza-Like Illness (ILI) activity have been observed across the Americas. At the same time, moderate levels of Severe Acute Respiratory Infection (SARI) have been reported, particularly in Brazil and the Southern Cone, followed by the Andean subregion. Both have been linked to positive cases of influenza and RSV. Regarding the circulation of respiratory viruses, SARS-CoV-2 activity has remained at low levels compared to previous epidemic waves, although showing a slight increase associated with circulation in North America and the Caribbean. Additionally, there has been increasing epidemic-level influenza activity, marked by circulation in Central America, Brazil, the Southern Cone, and some Caribbean countries. RSV activity has remained low except in the Andean region, where moderate levels have been observed. North America: ILI cases and hospitalizations associated with respiratory viruses have continued to decline over the past four EWs, remaining at low levels. Influenza activity has also continued to decrease, staying below the epidemic threshold. During this period, the predominant influenza viruses have been of type A(H3N2), followed by type B/Victoria, and type A(H1N1)pdm09. RSV activity has shown a decline, remaining at low levels. SARS-CoV-2 activity has remained low, with a slight increase. By country: In Canada, SARS-CoV-2 activity has remained low, with a slight increase. Influenza activity has dropped below the epidemic threshold, and RSV activity has remained low. In Mexico, influenza circulation has fallen below the epidemic threshold, and SARS-CoV-2 activity has shown a slight increase. In the United States, both ILI cases and hospitalization rates for influenza, RSV, and SARS-CoV-2 remain low. While influenza and RSV activity is low, the SARS-CoV-2 positivity rate has shown a slight increase. Caribbean: ILI and SARI cases have been declining over the past four weeks, with most positive cases attributable to influenza and SARS-CoV-2. Influenza activity has shown an increase to intermediate levels during the last four EWs. During this period, the predominant viruses have been of type A(H3N2), with concurrent circulation of influenza A(H1N1)pdm09 and, to a lesser extent, B/Victoria. RSV activity has remained low. SARS-CoV-2 activity has shown a marked increase in the last two weeks, reaching elevated levels compared to previous waves. By country: Influenza activity has been observed over the last four EWs in the Dominican Republic, Jamaica, Guyana, and the Cayman Islands. SARS-CoV-2 activity has been noted in Jamaica, Barbados, Guyana, and the Cayman Islands. Central America: Both ILI and SARI activity have increased over the last four EWs, with most positive cases attributable to influenza. Influenza activity has risen during this period, reaching epidemic levels in several countries in the subregion. In the last four EWs, the predominant influenza viruses have been of type A(H3N2), with concurrent circulation of A(H1N1)pdm09. RSV and SARS-CoV-2 activity have remained at low levels. By country: In El Salvador, influenza circulation has risen to moderate activity levels. In Guatemala, during the last four EWs, ILI and SARI activity have fluctuated around the epidemic threshold, with most positive cases attributable to influenza, which is at epidemic levels, and RSV, whose activity is increasing. In Honduras, fluctuating SARI activity at epidemic levels has been noted over the past four EWs, associated with positive influenza cases at moderate levels. In Nicaragua, a slight increase above the epidemic threshold for influenza activity has been observed, while RSV and SARS-CoV-2 circulation remains at low levels. In Panama, ILI and SARI cases have shown an increase over the last four EWs, coinciding with influenza activity rising to extraordinary levels. Andean: ILI and SARI activity have remained stable at low levels over the past four EWs, although an increase in the proportion of positive RSV and influenza cases has been observed. Influenza activity has remained low over the last four EWs with a fluctuating trend. During this period, the predominant influenza viruses have been of type A(H3N2), with concurrent circulation of A(H1N1)pdm09. RSV activity has remained at moderate levels, with a growing trend. SARS-CoV-2 activity has remained low. By country: In Bolivia, SARI cases are in decline, with levels below the epidemic threshold. Almost all positive cases are attributable to influenza, whose activity has decreased to below the epidemic threshold after having reached moderate levels. In Colombia, SARI activity has remained at epidemic levels during the last four weeks, with most positive cases attributable to RSV (which is increasing) and, to a lesser extent, influenza (which is below the epidemic threshold). ILI cases have risen to extraordinary levels. In Ecuador, SARI activity remains at epidemic levels, showing an increase, while pneumonia levels have risen to moderate levels. Positive SARI cases are attributable to influenza, whose increasing activity has surpassed the epidemic threshold, and to a lesser extent, RSV, which is in decline. In Peru, influenza activity remains below the epidemic threshold, while RSV and SARS-CoV-2 activity also remain low. In Venezuela, during the last four EWs, fluctuating influenza activity around the epidemic threshold has been observed. Brazil and the Southern Cone: After the increase observed in previous weeks, SARI activity has declined over the last four EWs, particularly in Brazil, with most positive cases attributable to influenza and RSV. However, ILI activity continues to rise, with most positive cases attributed to influenza. Influenza activity has increased over the last four EWs, reaching epidemic levels in most countries. During this period, the predominant influenza viruses have been of type A(H3N2), with lesser circulation of A(H1N1)pdm09. RSV activity has remained low but has shown a slight increase. SARS-CoV-2 activity has continued to decline, staying at low levels. By country: In Argentina, ILI activity is on the rise with moderate levels, while SARI activity remains below the epidemic threshold. Influenza activity has shown an increase, reaching extraordinary levels. There has also been an increase in the RSV positivity rate. In Brazil, after moderate SARI activity in previous weeks, it has now declined below the epidemic threshold. The highest proportion of positive cases is attributable to RSV, followed by influenza. Meanwhile, ILI cases, which had previously reached high levels, have begun to decline, with influenza responsible for the majority of positive results. In Chile, both ILI and SARI cases have reached extraordinary and epidemic levels respectively and are currently in decline; most positive cases are attributable to influenza, which circulates at moderate levels and has shown a decrease. In Paraguay, SARI activity is at moderate levels, while ILI activity is around the epidemic threshold. Most positive cases are attributable to influenza, circulating at moderate levels, and to a lesser extent, RSV, which is circulating at levels below those observed in previous seasons. In Uruguay, SARI activity is at high and increasing levels, with most positive cases attributable to influenza, which has reached moderate levels, and to a lesser extent, RSV, which is circulating at levels below those observed in previous seasons.

[RESUMEN SEMANAL]. Situación regional: Durante las últimas cuatro semanas epidemiológicas (SE) se han observado niveles bajos en la actividad de la Enfermedad Tipo Influenza (ETI) en la región de las Américas. A su vez se ha observado una actividad de Infección Respiratoria Aguda Grave (IRAG), moderada, especialmente relacionada con la actividad observada en Brasil y Cono Sur, seguido por la subregión Andina. En ambos casos esta actividad se ha asociado a casos positivos de influenza y VRS. En cuanto a la circulación de virus respiratorios, a nivel regional la actividad de SARS-CoV-2 ha se ha mantenido en niveles bajos en comparación con olas epidémicas previas, aunque mostrando un ligero incremento asociado a la circulación en Norte América y Caribe. Asimismo, se ha observado una actividad epidémica de influenza en ascenso, marcada por la circulación en Centro América, Brasil y el Cono Sur y algunos países del Caribe. La actividad del Virus Respiratorio Sincitial (VRS) se ha mantenido en niveles bajos excepto en la región Andina donde se han observado niveles moderados. América del Norte: Los casos de ETI y las hospitalizaciones asociadas a virus respiratorios, se han mantenido en descenso durante las cuatro últimas SE, presentando niveles bajos. La actividad de influenza se ha mantenido en descenso situándose por debajo del umbral epidémico. Durante este periodo, los virus de influenza predominantes han sido del tipo A (H3N2) seguido de tipo B/Victoria e influenza A(H1N1)pdm09. La actividad del VRS ha mostrado un descenso, manteniéndose en niveles bajos. La actividad del SARS-CoV-2 se ha mantenido en niveles bajos, aunque con un ligero incremento. Por países: En Canadá, la actividad del SARS-CoV-2 se ha mantenido en niveles bajos, aunque con un ligero incremento. La actividad de influenza ha descendido por debajo del umbral epidémico y la actividad del VRS ha permanecido en niveles bajos. En México, la circulación de influenza ha descendido por debajo del umbral epidémico y la actividad del SARS-CoV-2 ha mostrado un ligero incremento. En Estados Unidos, tanto los casos de ETI como las tasas de hospitalización por influenza, VRS y SARS-CoV-2 se mantienen en niveles bajos. Tanto la actividad de influenza, VRS como se encuentran en niveles bajos, mientras el porcentaje de positividad del SARS-CoV-2 ha mostrado un ligero incremento. Caribe: Los casos de ETI y de IRAG han permanecido en descenso durante las cuatro últimas semanas, siendo la mayoría de los casos positivos atribuibles a influenza y SARS-CoV-2. La actividad de influenza se ha presentado un incremento con niveles intermedios durante las últimas cuatro SE. Durante este periodo, los virus predominantes han sido de tipo A(H3N2), con circulación concurrente de influenza A(H1N1)pdm09 y en menor medida B/Victoria. La actividad del VRS se ha mantenido en niveles bajos. La actividad del SARS-CoV-2 ha presentado un marcado incremento en las dos últimas semanas situándose en niveles elevados en comparación con olas previas. Por países: Se ha observado actividad de influenza las últimas cuatro SE en República Dominicana, Jamaica, Guyana y las Islas Caimán. Se ha observado actividad de SARS-CoV-2 en Jamaica, Barbados, Guyana y las Islas Caimán. América Central: Durante las cuatro últimas SE la actividad tanto de ETI como de IRAG ha presentado un incremento, con la mayoría de los casos positivos atribuibles a influenza. La actividad de influenza ha presentado un ascenso durante este periodo situándose en niveles epidémicos en varios países de la subregión. En las cuatro últimas SE, los virus influenza predominantes han sido de tipo A(H3N2) con circulación concurrente de influenza A(H1N1)pdm09. La actividad del VRS y del SARS-CoV-2 ha permanecido en niveles bajos. Por países: En El Salvador, la circulación de influenza ha ascendido hasta niveles de actividad moderada. En Guatemala, durante las últimas cuatro SE, se ha observado una actividad de ETI e IRAG oscilante en torno al umbral epidémico, con la mayoría de los casos positivos atribuibles a influenza, cuya circulación se encuentra en niveles epidémicos, y a VRS, cuya actividad se encuentra en ascenso. En Honduras, en las cuatro últimas SE, se ha observado una actividad fluctuante de IRAG en niveles epidémicos, asociada a casos positivos de influenza, cuya actividad se encuentra en niveles moderados. En Nicaragua, se ha observado un incremento sobre el umbral epidémico de la actividad de influenza, la circulación del VRS y SARS-CoV-2 se encuentra en niveles bajos. En Panamá, los casos de ETI e IRAG han mostrado un incremento en las últimas cuatro semanas epidemiológicas, coincidiendo con una actividad de influenza que ha ascendido a niveles extraordinarios. Andina: La actividad de ETI e IRAG se ha mantenido estable en niveles bajos durante las cuatro últimas SE, sin embrago se ha observado un ascenso en la proporción de casos positivos a VRS e influenza. La actividad de influenza ha permanecido en niveles bajos en las cuatro últimas SE con una tendencia fluctuante. Durante este periodo, los virus de influenza predominantes han sido de tipo A(H3N2) con circulación concurrente de A(H1N1)pdm09. La actividad del VRS se ha mantenido en niveles moderados, con una tendencia creciente. La actividad de SARS-CoV-2 se ha mantenido en niveles bajos. Por países: En Bolivia, los casos de IRAG se encuentran en descenso, con niveles por debajo del umbral epidémico. Prácticamente la totalidad de los positivos son atribuibles a influenza, cuya actividad ha disminuido hasta niveles por debajo del umbral epidémico tras haber alcanzado niveles moderados. En Colombia, la actividad de IRAG se ha mantenido en niveles epidémicos durante las últimas cuatro semanas, con la mayoría de los casos positivos atribuibles a VRS (cuya actividad está en ascenso) y, en menor medida, a influenza (cuya actividad se encuentra por debajo del umbral epidémico). Los casos de IRA han ascendido a niveles extraordinarios. En Ecuador, la actividad de IRAG se mantiene en niveles epidémicos, mostrando un incremento, mientras que los niveles de neumonía han ascendido a niveles moderados. Los casos positivos de IRAG son atribuibles a influenza, cuya actividad en ascenso ha superado el umbral epidémico, y en menor medida a VRS, que se encuentra en descenso. En Perú, la actividad de influenza se mantiene por debajo del umbral epidémico, mientras que la actividad de VRS y SARS-CoV-2 también se mantiene baja. En Venezuela, durante las últimas cuatro semanas epidemiológicas, se ha observado una actividad fluctuante de influenza en torno al umbral epidémico. Brasil y el Cono Sur: Tras el incremento observado en semanas previas la actividad de IRAG ha presentado un descenso en las cuatro últimas SE, marcado por la actividad en Brasil con la mayoría de los casos positivos atribuibles a influenza y VRS. La actividad de ETI se mantiene en ascenso con la mayoría de los casos positivos a influenza. La actividad de influenza ha presentado un incremento en las últimas cuatro SE con niveles epidémicos en la mayoría de los países. En este periodo, los virus de influenza predominantes han sido de tipo A(H3N2) y en menor medida A(H1N1)pdm09. La actividad del VRS se ha mantenido en niveles bajos, aunque con un ligero incremento. La actividad del SARS-CoV-2 se ha mantenido en descenso con niveles bajos de actividad. Por países: En Argentina, la actividad de ETI se encuentra en ascenso con niveles moderados, mientras que la actividad de IRAG se mantiene por debajo del umbral epidémico. La actividad de influenza ha mostrado un aumento, alcanzando niveles extraordinarios. Paralelamente, se ha observado un incremento en el porcentaje de positividad de VRS. En Brasil, tras observarse una actividad moderada de IRAG en semanas anteriores, esta ha descendido a niveles por debajo del umbral epidémico. La mayor proporción de casos positivos se atribuye a VRS, seguido de influenza. Por otro lado, los casos de ETI, que previamente alcanzaron niveles elevados, han comenzado a descender, siendo en este caso la influenza la responsable de la mayor proporción de resultados positivos. En Chile, los casos de ETI como de IRAG han presentado niveles extraordinarios y epidémicos respectivamente y se encuentran actualmente en descenso; la mayoría de los casos positivos son atribuibles a influenza que circula con niveles moderados y ha presentado un descenso. En Paraguay, la actividad de IRAG se encuentra en niveles moderados y la actividad de ETI en torno al umbral epidémico. La mayoría de los casos positivos son atribuibles a influenza que se encuentra circulando en niveles moderados y en menor medida a VRS que circula en niveles por debajo de los observados en temporadas previas. En Uruguay, la actividad de IRAG se encuentra en niveles elevados y en ascenso, con la mayoría de los casos positivos atribuibles a influenza, cuya actividad ha alcanzado niveles moderados; y en menor medida a VRS que circula en niveles por debajo de los observados en temporadas previas.

15th Meeting of the Regional Certification Commission for the Polio Endgame in the Region of the Americas. Meeting Report. Atlanta, 25-27 October 2022

The 15th Meeting of the Regional Certification Commission for the Eradication of Poliomyelitis in the Region of the Americas (RCC) was held in Atlanta, Georgia, United States of America from 25-27 October 2022. All members of the RCC discussed and approved the validation results and the final report of the meeting. The objectives of the meeting were: meet with the National Poliovirus Containment Coordinators (NPCCs) of the countries that had not received validation of the survey/inventory process of facilities with poliovirus material; review the updated containment reports that were submitted by the countries; meet with representatives of the United States’ domestic polio program and the National Certification Committee (NCC) to discuss the current cVDPV2 outbreak situation in New York, United States of America; review annual reports from countries that did not submit the 2021 Annual Report on time for review during the 14th Meeting; and update the annual report format and review the validation questions. The Regional Certification Commission greatly appreciates the hard work of the NCCs and countries in preparing their reports to be reviewed by the Regional Certification Commission. The Regional Certification Commission would like to thank the Task Force for Global Health, which serves as the United States’ NCC Secretariat, for its kind support in preparing for and convening the meeting and for lending its facilities to the Regional Certification Commission for this meeting. The Regional Certification Commission also recognizes and values the work of PAHO in its ongoing support to the RCC.

Guidance on messages about home care for dengue patients

This document is for communicators at the Ministries of Health of PAHO Member States. Together with their national teams, they can adapt the information presented so that it is appropriate to the needs in each country and each target audience. This information covers general aspects of home care for dengue patients.

Guidance on messages about how to care for children with dengue fever at home

This document is addressed to communicators from the ministries of health of PAHO Member States so that, together with their national teams, they adapt the information according to the specific needs of each country and the public to which it will be addressed. The information presented concerns general aspects of home care for children with dengue.

The digital transformation in nursing education and practice

Digital health refers to “the cost-effective and secure use of information and communications technologies in support of health and health-related fields, including healthcare services, health surveillance, health literature, and health education, knowledge and research.” The adoption of digital health solutions has been accelerated by the COVID-19 pandemic, proving they are key for the delivery of care at all levels of the public health system: the patient, the community, the care team, the healthcare institution, and the political and economic environment. Digital health is an integral part of health priorities and can be beneficial when used in an ethical, equitable, and sustainable way. The comprehensive benefits of digital health include facilitating the assessment, diagnosis, and management of health problems in a safe and effective manner, thereby fostering greater equity in access to timely medical care; addressing unmet health needs; and strengthening the capacity of the whole sector to access the information needed to understand complex scenarios and make decisions, among others. This publication presents the possibilities of incorporating and using technologies in the education and practices of nurses in their various contexts of activity and proposes a digital transformation of nursing as part of the increased technological advance in health care. It also contemplates regulatory and normative aspects in digital health. This digital transformation depends on a range of aspects, such as investment, infrastructure, professional recognition, cultural change, educational update, new skills, and competencies. It positions the nurse as a health agent capable of transforming nursing processes for a future setting where patients will be more digitally empowered and more knowledgeable on their own health status.

Healthy Municipalities, Cities, and Communities Movement of the Americas. Local Governance for Health and Well-being

This brochure presents the Movement of Healthy Municipalities, Cities and Communities (MCCS) of the Americas, a regional platform of local governments in the Region, committed to local governance for health and well-being. Aimed at mayors and women mayors, it shows how the MCCS Movement is organized, how to join, and what opportunities it offers.

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 22 (7 June 2024)

[WEEKLY SUMMARY]. Regional Situation: Over the past four epidemiological weeks (EWs), intermediate levels of Influenza-Like Illness (ILI) activity have been observed in the Americas region. Additionally, a decrease in Severe Acute Respiratory Infection (SARI) activity has been noted, 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 primarily linked to moderate activity observed in North America and elevated activity observed in the Caribbean, while SARI activity has been particularly influenced by detected activity in North America. Regarding the circulation of respiratory viruses, a regional rise in SARS-CoV-2 activity has been observed, remaining moderate compared to previous epidemic waves. Likewise, epidemic influenza activity has been observed for this time of year, with moderate Respiratory Syncytial Virus (RSV) activity showing a decrease over the last four EWs. North America: ILI cases, following a slight decrease in previous EWs, have remained at medium-high levels, with most cases attributable to influenza. SARI cases have continued to decline. Influenza activity has remained at epidemic circulation levels, showing a slight decrease over the last four EWs. During this period, predominant influenza viruses have been A(H1N1)pdm09 and influenza A(H3N2), with lesser circulation of influenza B/Victoria. RSV activity has shown a decrease over the last four EWs, remaining at moderate levels. SARS-CoV-2 activity has decreased over the last four EWs to low levels compared to previous waves. By countries: In Canada, SARS-CoV-2 activity has markedly decreased over the last four EWs to medium-low levels. Influenza activity has remained at epidemic levels with a gradual decrease, and RSV activity has also decreased to moderate levels. In Mexico, influenza circulation has fluctuated at epidemic levels over the last four EWs, while SARS-CoV-2 circulation has remained at intermediate levels compared to previous waves. In the United States, influenza activity has remained consistently above the epidemic threshold, while RSV and SARS-CoV-2 activity have decreased to low levels over the last four EWs. ILI cases have remained stable at medium levels. Hospitalization rates for influenza, RSV, and SARS-CoV-2, after reaching similar elevated levels as the previous season, have shown a downward trend over the last four EWs. Caribbean: Following the increase observed in previous EWs, ILI cases have shown a decrease in the last four weeks, with positive cases for influenza. SARI cases have remained on the decline, with the majority of positive cases attributable to influenza. Influenza activity has shown a decrease in the last four EWs, reaching low circulation levels. Over the last four EWs, predominant viruses have been 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 low levels. By countries: Increased influenza activity has been observed in Suriname. Elevated SARS-CoV-2 activity has been observed in Dominica, Haiti, Saint Lucia, Barbados, and Guyana. Central America: ILI activity has shown a slight decrease in the last four weeks, reaching low activity levels, with most positive cases attributable to influenza. SARI cases have also shown a decrease, reaching low levels, with the majority of positive cases attributable to influenza and, to a lesser extent, SARS-CoV-2. Influenza activity has increased over the last four EWs, although remaining at low levels. During this period, predominant viruses have been 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 last four EWs to low levels. In Guatemala, an increase in ILI cases associated with influenza and, to a lesser extent, SARS-CoV-2 has been observed, reaching moderate activity levels, while SARI cases have remained at epidemic levels. In Honduras, after an increase in ILI and SARI cases associated with positive influenza cases observed in previous weeks, a decrease has been detected in the last four EWs, reaching levels below the epidemic threshold, while influenza activity has remained above this threshold. In Nicaragua, RSV, influenza, and SARS-CoV-2 activity have remained at low levels. In Panama, influenza activity has shown a pronounced increase to moderate levels, while ILI and SARI cases have remained low over the last four EWs. Andean Region: ILI activity has remained stable at low levels, with the majority of positive cases attributable to influenza. SARI cases 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 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 shown 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 has remained on a decreasing trend and 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, predominant influenza viruses have been 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 positivity rate for SARS-CoV-2, while remaining at elevated levels, has shown a marked decline in the last four EWs. In Brazil, SARS-CoV-2 activity has remained at elevated levels, and influenza activity has shown an increase during the last four EWs, fluctuating around the epidemic threshold. In Chile, an increase in SARS-CoV-2 activity has been observed in the last four EWs at moderate levels, and there has been a rise in influenza activity, which remains around the epidemic threshold. ILI cases have remained at epidemic levels, and SARI cases below this threshold, with the majority attributable to SARS-CoV-2 and to a lesser extent to influenza. In Paraguay, SARS-CoV-2 circulation has shown a decline in the last four EWs, being at low levels, and influenza and RSV activity have remained low. SARI and ILI activity have stayed below the epidemic threshold. In Uruguay, SARI activity has continued at levels below the epidemic threshold, though 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. 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 la actividad elevada observada en el 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 se ha observado un ascenso en la actividad de SARS-CoV-2 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 moderada del Virus Respiratorio Sincitial (VRS) que ha mostrado un descenso en las cuatro últimas SE. 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 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(H1N1)pdm09 e influenza A(H3N2), 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 descenso en las cuatro últimas semanas, siendo los casos positivos a influenza. 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 aumentada de influenza en Surinam. Se ha observado una actividad elevada de SARS-CoV-2 en Dominica, Haití, Santa Lucia, Barbados y Guyana. América Central: La actividad de ETI ha mostrado un ligero descenso en las cuatro últimas semanas, encontrándose en niveles bajos de actividad y siendo la mayoría de los casos positivos atribuibles a influenza. Los casos de IRAG han mostrado a su vez un descenso situándose en niveles bajos, con la mayoría de los casos positivos atribuibles a influenza y en menor medida SARS-CoV-2. La actividad de influenza ha presentado un incremento en las cuatro últimas SE, aunque se mantiene en niveles bajos. Durante este periodo, los virus predominantes han sido de tipo A(H1N1)pdm09, con circulación concurrente de A(H3N2) y en menor medida B/Victoria. La actividad del VRS se ha mantenido en niveles bajos. La actividad del SARS-CoV-2 se ha mantenido a su vez en niveles bajos. Por países: En El Salvador, la actividad de SARS-CoV-2 has descendido durante las cuatro últimas SE hasta niveles bajos. En Guatemala, se ha observado un incremento en los casos de ETI asociados a influenza y en menor medida SARS-CoV-2, encontrándose en niveles de actividad moderados, en cuanto a los casos de IRAG se mantienen en niveles epidémicos. En Honduras, tras el incremento en casos de ETI e IRAG asociados a casos positivos a influenza observado en semanas previas, se ha detectado un descenso en las cuatro últimas SE, alcanzando niveles por debajo del umbral epidémico, mientras que la actividad de influenza se ha mantenido por encima de este umbral. En Nicaragua, la actividad tanto del VRS, influenza y SARS-CoV-2 se han mantenido en niveles bajos. En Panamá, la actividad de influenza ha mostrado un pronunciado incremento hasta niveles moderados, 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 y en menor medida 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 con niveles en torno al umbral epidémico asociados a casos positivos a influenza. 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 situado 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 con tendencia decreciente 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 elevados, ha mostrado un marcado descenso en las cuatro últimas SE. En Brasil, la actividad del SARS-CoV-2 se ha mantenido en niveles elevados y la actividad de influenza ha mostrado un ascenso durante la cuatro últimas SE fluctuando en torno al umbral epidémico. En Chile, se ha observado un incremento en la actividad del SARS.CoV-2 en las cuatro últimas SE con niveles moderados, a su vez se ha observado un ascenso en la actividad de influenza que se mantiene en torno al umbral epidémico. Los casos de ETI se han mantenido en niveles epidémicos y los casos de IRAG por debajo de este umbral, siendo en su mayoría 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.

Initiative on Urban Governance for Health and Well-being in Bogota

Rapid, unplanned urbanization is one of the significant ecological and human challenges of the 21st century. UN-Habitat predicts that, by 2050, nearly 70% of the world’s population will be living in cities, with disproportionate urban growth in low- and middle-income countries. The Region of the Americas is one of the most urbanized and unequal regions in the world. The World Health Organization (WHO) Urban Governance for Health and Wellbeing initiative seeks to support local-level actions to promote good urban governance for health and well-being, emphasizing community participation. Urban governance for health and well-being refers to focused processes of interaction and subsequent decision-making to generate collective solutions to enhance health and well-being through co-creation practices, social change, and institutional engagement as part of whole-of-government and whole-of-society approaches. The World Health Organization is working with five cities: Bogota (Colombia), Douala (Cameroon), Mexico City (Mexico), Khulna (Bangladesh), and Tunis (Tunisia) in the first phase. This brief aims to share the progress achieved until in Bogotá, Colombia in implementing the World Health Organization (WHO) Initiative on Urban Governance for Health and Well-being throughout the first phase. Bogotá is the capital of Colombia, and it constitutes 16.4% of the country's total urban population. It presents the context and principles of the global initiative, achievements in Bogotá, and the next steps. The target audience of this publication is city officials, national governments, and donors.

Initiative on Urban Governance for Health and Well-being in Mexico City

Rapid, unplanned urbanization is one of the significant ecological and human challenges of the 21st century. UN-Habitat predicts that, by 2050, nearly 70% of the world’s population will be living in cities, with disproportionate urban growth in low- and middle-income countries. The Region of the Americas is one of the most urbanized regions in the world. The World Health Organization (WHO) Urban Governance for Health and Wellbeing initiative seeks to support local-level actions to promote good urban governance for health and well-being, emphasizing community participation. Urban governance for health and well-being refers to focused processes of interaction and subsequent decision-making to generate collective solutions to enhance health and well-being through co-creation practices, social change, and institutional engagement as part of whole-of-government and whole-of-society approaches. WHO is working with five cities: Bogota (Colombia), Douala (Cameroon), Mexico City (Mexico), Khulna (Bangladesh), and Tunis (Tunisia). Mexico City (Ciudad de México) is the capital and largest city of Mexico, with the population of Mexico City alone representing 7.52% of the total urban population of Mexico. This brief aims to share the progress achieved in Mexico City in implementing the World Health Organization (WHO) Initiative on Urban Governance for Health and Well-being throughout the first phase. It presents the context and principles of the global initiative, achievements in Mexico City, and the next steps. The target audience of this publication is city officials, national governments, and donors.

Operational guidelines for the elimination of human fascioliasis as a public health problem in the Americas

Fascioliasis is a parasitic disease that affects both people and a wide variety of animals, primarily herbivores. In Latin America and the Caribbean, it is caused by the trematode Fasciola hepatica. Fascioliasis is classified by the World Health Organization (WHO) as one of the neglected tropical diseases. The Pan American Health Organization (PAHO), as part of its commitment to achieving the goals of the 2030 Agenda for Sustainable Development and the Sustainable Health Agenda for the Americas 2018-2030, has launched an initiative to eliminate communicable diseases in the Region of the Americas, which includes among its objectives the elimination of fascioliasis as a public health problem in the Americas by 2030. These operational guidelines have been developed to provide information and guidance to support endemic countries in advancing towards and achieving that goal. They have been prepared with the support of technicians from the countries as well as expert professionals from the Region and the WHO Collaborating Centre on fascioliasis and its vector snails, attempting to incorporate current practices and considering the challenges and particularities of endemic areas. While fasciolosis in animals is a problem in many countries of the Region, leading to economic losses, human fascioliasis is limited to environments where the ethnographic characteristics and socio-economic determinants necessary for human infection are present. These operational guidelines focus on such areas, typically associated with small-scale farmers and rural communities, and are framed within the "One Health" approach, integrating different sectors involved, working together and synergistically to make interventions more effective and sustainable.