Application of a seismic network to baleen whale call detection and localization in the Panama basin-a Bryde's whale example.

Baleen whales use sounds of various characteristics for different tasks and interactions. This study focuses on recordings from the Costa Rica Rift, in the Eastern Tropical Pacific Ocean, made by 25 ocean-bottom seismographs and a vertical array of 12 hydrophones between January and February 2015. The whale calls observed are of two kinds: more commonly, repetitive 4-5 s-long signals separated into two frequency bands centered at ∼20 and ∼36 Hz; less commonly, a series of ∼0.5 to 1.0 s-long, lower amplitude signals with frequencies between 80 and 160 Hz. These characteristics are similar to calls attributed to Bryde's whales which are occasionally sighted in this region. In this study, the repetitive calls are detected using both the short-term average/long-term average approach and a network empirical subspace detector. In total, 188 and 1891 calls are obtained for each method, demonstrating the value of the subspace detector for highly similar signals. These signals are first localized using a non-linear grid search algorithm and then further relocalized using the double-difference technique. The high-resolution localizations reveal the presence of at least seven whales during the recording period, often crossing the instrument network from southwest to northeast.

Entornos amigables con las personas mayores: evaluación de línea base en América Latina con referencia a Costa Rica

Consolidar entornos amigables para las personas mayores es un objetivo de la Década del Envejecimiento Saludable 2021-2030. El Programa de la Organización Mundial de la Salud (OMS) de Ciudades y Comunidades Amigables con las Personas Mayores establece que, para poder avanzar en este objetivo, se requiere como primer paso realizar una evaluación de referencia, con la participación activa de las personas mayores, que determine las áreas en las que las ciudades y las comunidades deben trabajar para remover las barreras que experimentan las personas mayores y crear entornos cada vez más amigables y adaptados a sus requerimientos. El programa de la OMS recomienda la utilización del Protocolo de Vancouver para realizar esta evaluación. Debido a las particularidades de su ejecución, muchos países de América Latina hicieron adaptaciones para favorecer la implementación local y subsanar las dificultades que se presentaron. Con el objetivo de perfilar el conocimiento actual disponible en América Latina y tomar en consideración las experiencias de las ciudades y comunidades de la subregión, el presente documento recopila algunos ejemplos y casos de estas adaptaciones, como el programa implementado en Costa Rica, que servirán para orientar las acciones de políticas hacia el desarrollo pleno de las personas a lo largo de todo el curso de vida. A fin de dar respuesta a los desafíos que plantea la transición demográfica, es fundamental crear instrumentos que permitan adaptar los entornos de modo de favorecer el envejecimiento saludable, para lo cual se debe contar con información certera, actualizada y eficaz. La Década del Envejecimiento Saludable establece un período para orientar la acción hacia la generación y el seguimiento de la información, estrategia en la que se enmarca este informe.

Pharmaceuticals, hazard and ecotoxicity in surface and wastewater in a tropical dairy production area in Latin America.

Pharmaceuticals comprise a complex group of emerging pollutants. Despite the significant number of pharmaceuticals used in veterinary medicine, the input of these compounds into the environment due to livestock activities has been scarcely described. This work assays for the first time in Central America the occurrence of pharmaceuticals in farm wastewater in an area devoted to dairy production, and in the surrounding surface waters. Among 69 monitored pharmaceuticals, a total of eight compounds were detected in wastewater samples collected from seven dairy farms after three sampling campaigns. Six pharmaceuticals were considered either of high (albendazole, lovastatin and caffeine) or intermediate estimated hazard (ciprofloxacin, acetaminophen and ketoprofen) based on the HQ approach, while 26% of the samples were considered of high estimated hazard according to the cumulative ∑HQ approach. Similarly, when ecotoxicological tests were applied, all the samples showed some level of toxicity towards Daphnia magna, and most samples towards Vibrio fischeri and Lactuca sativa. Fourteen pharmaceuticals were detected in surface water samples collected in the surroundings of the dairy production farms, including rural and urban areas. Seven out of these compounds showed high estimated risk (risperidone, diphenhydramine, trimethoprim, fluoxetine, ofloxacin, caffeine and ibuprofen), while three (gemfibrozil, ciprofloxacin and cephalexin) exhibited intermediate estimated risk. In a similar worrisome way, 27% of these samples were estimated to pose high environmental risk according to the pharmaceutical content. Despite being nontoxic for D. magna or V. fischeri, frequent inhibition (>20%) of GI in L. sativa was determined in 34% of surface water samples; such findings raise concern on the apparent inceptive environmental pollution and risk within the area. According to the pharmaceutical content patterns in both kinds of studied matrices, no clear evidence of significant contamination in surface water due to livestock activities could be retrieved, suggesting a main role of urban influence.

Prevalence of Children Aged 6 to 23 Months Who Did Not Consume Animal Milk, Formula, or Solid or Semisolid Food During the Last 24 Hours Across Low- and Middle-Income Countries.

Importance: The introduction of solid or semisolid foods alongside breast milk plays a vital role in meeting nutritional requirements during early childhood, which is crucial for child growth and development. Understanding the prevalence of zero-food children (defined for research purposes as children aged 6 to 23 months who did not consume animal milk, formula, or solid or semisolid food during the last 24 hours) is essential for targeted interventions to improve feeding practices. Objective: To estimate the percentage of zero-food children in 92 low- and middle-income countries. Design, Setting, and Participants: This cross-sectional study analyzed nationally representative cross-sectional household data of children aged 6 to 23 months from the Demographic and Health Surveys and the Multiple Indicator Cluster Surveys conducted between May 20, 2010, and January 27, 2022. Data were obtained from 92 low- and middle-income countries. Standardized procedures were followed to ensure data comparability and reliability. Both percentage and number of zero-food children were estimated. Main Outcomes and Measures: The outcome studied was defined as a binary variable indicating children aged 6 to 23 months who had not been fed any animal milk, formula, or solid or semisolid foods during the 24 hours before each survey, as reported by the mother or caretaker. Results: A sample of 276 379 children aged 6 to 23 months (mean age, 14.2 months [95% CI, 14.15-14.26 months]) in 92 low- and middle-income countries was obtained, of whom 51.4% (95% CI, 51.1%-51.8%) were boys. The estimated percentage of zero-food children was 10.4% (95% CI, 10.1%-10.7%) in the pooled sample, ranging from 0.1% (95% CI, 0%-0.6%) in Costa Rica to 21.8% (95% CI, 19.3%-24.4%) in Guinea. The prevalence of zero-food children was particularly high in West and Central Africa, where the overall prevalence was 10.5% (95% CI, 10.1%-11.0%), and in India, where the prevalence was 19.3% (95% CI, 18.9%-19.8%). India accounted for almost half of zero-food children in this study. Conclusions and Relevance: In this cross-sectional study of 276 379 children aged 6 to 23 months, substantial disparities in the estimates of food consumption across 92 low- and middle-income countries were found. The prevalence of zero-food children underscores the need for targeted interventions to improve infant and young child feeding practices and ensure optimal nutrition during this critical period of development. The issue is particularly urgent in West and Central Africa and India.

Exploration of photoprotective and antibiotic activity of wild Polypodiaceae ferns from Costa Rica.

Skin disorders affect millions of people all over the world. There are limited options to treat dermal illnesses such as vitiligo, psoriasis, and atopic dermatitis (eczema). Central American ferns are a potential source of bioactive metabolites against those diseases. Currently, Polypodium leucotomos Poir. is the only one being commercially utilized for this purpose. In this work, we evaluated the concentration of the skin bioactive compounds: quinic and chlorogenic acid, in the extract of 20 wild ferns from Costa Rica. We also evaluated the antimicrobial capabilities of the crude extracts of wild ferns and the sun protection factor (SPF) of the extracts. We found 19 out of 20 have either an important concentration of the compounds mentioned above or antimicrobial properties. Also, most samples result in higher SPF than P. aureum's rhizome. We also have studied the fern acclimatization, at different shading conditions, finding a significant influence of the culturing conditions on metabolite production. After acclimatization. So far, we demonstrate that various ferns included in this study are a potential source of treatments for skin conditions.

Neurological involvement in hospitalized children with SARS-CoV-2 infection: a multinational study.

BACKGROUND AND OBJECTIVES: Neurological involvement associated with SARS-CoV-2 infection is increasingly recognized. However, the specific characteristics and prevalence in pediatric patients remain unclear. The objective of this study was to describe the neurological involvement in a multinational cohort of hospitalized pediatric patients with SARS-CoV-2. METHODS: This was a multicenter observational study of children <18 years of age with confirmed SARS-CoV-2 infection or multisystemic inflammatory syndrome (MIS-C) and laboratory evidence of SARS-CoV-2 infection in children, admitted to 15 tertiary hospitals/healthcare centers in Canada, Costa Rica, and Iran February 2020-May 2021. Descriptive statistical analyses were performed and logistic regression was used to identify factors associated with neurological involvement. RESULTS: One-hundred forty-seven (21%) of 697 hospitalized children with SARS-CoV-2 infection had neurological signs/symptoms. Headache (n = 103), encephalopathy (n = 28), and seizures (n = 30) were the most reported. Neurological signs/symptoms were significantly associated with ICU admission (OR: 1.71, 95% CI: 1.15-2.55; p = 0.008), satisfaction of MIS-C criteria (OR: 3.71, 95% CI: 2.46-5.59; p < 0.001), fever during hospitalization (OR: 2.15, 95% CI: 1.46-3.15; p < 0.001), and gastrointestinal involvement (OR: 2.31, 95% CI: 1.58-3.40; p < 0.001). Non-headache neurological manifestations were significantly associated with ICU admission (OR: 1.92, 95% CI: 1.08-3.42; p = 0.026), underlying neurological disorders (OR: 2.98, 95% CI: 1.49-5.97, p = 0.002), and a history of fever prior to hospital admission (OR: 2.76, 95% CI: 1.58-4.82; p < 0.001). DISCUSSION: In this study, approximately 21% of hospitalized children with SARS-CoV-2 infection had neurological signs/symptoms. Future studies should focus on pathogenesis and long-term outcomes in these children.

Cohort profile: evaluation of immune response and household transmission of SARS-CoV-2 in Costa Rica: the RESPIRA study.

PURPOSE: The RESPIRA cohort aims to describe the nature, magnitude, time course and efficacy of the immune response to SARS-CoV-2 infection and vaccination, population prevalence, and household transmission of COVID-19. PARTICIPANTS: From November 2020, we selected age-stratified random samples of COVID-19 cases from Costa Rica confirmed by PCR. For each case, two population-based controls, matched on age, sex and census tract were recruited, supplemented with hospitalised cases and household contacts. Participants were interviewed and blood and saliva collected for antibodies and PCR tests. Participants will be followed for 2 years to assess antibody response and infection incidence. FINDINGS TO DATE: Recruitment included 3860 individuals: 1150 COVID-19 cases, 1999 population controls and 719 household contacts from 304 index cases. The age and regional distribution of cases was as planned, including four age strata, 30% rural and 70% urban. The control cohort had similar sex, age and regional distribution as the cases according to the study design. Among the 1999 controls recruited, 6.8% reported at enrolment having had COVID-19 and an additional 12.5% had antibodies against SARS-CoV-2. Compliance with visits and specimens has been close to 70% during the first 18 months of follow-up. During the study, national vaccination was implemented and nearly 90% of our cohort participants were vaccinated during follow-up. FUTURE PLANS: RESPIRA will enable multiple analyses, including population prevalence of infection, clinical, behavioural, immunological and genetic risk factors for SARS-CoV-2 acquisition and severity, and determinants of household transmission. We are conducting retrospective and prospective assessment of antibody levels, their determinants and their protective efficacy after infection and vaccination, the impact of long-COVID and a series of ancillary studies. Follow-up continues with bimonthly saliva collection for PCR testing and biannual blood collection for immune response analyses. Follow-up will be completed in early 2024. TRIAL REGISTRATION NUMBER: NCT04537338.

Prevalencia de enfermedades crónicas no transmisibles en las personas privadas de la libertad en Costa Rica / Prevalence of chronic noncommunicable diseases in persons deprived of liberty in Costa Rica

Mediante un estudio cuantitativo, descriptivo y de corte transversal se realiza una comparación entre la población penal de la Unidad de Atención Integral (UAI) 20 de diciembre y la población penal total costarricense. Hasta no hace mucho tiempo, en el ámbito penitenciario se ha experimentado un cambio importante en la morbimortalidad de las personas privadas de la libertad, pasando de un modelo casi unicausal de origen infeccioso, a procesos de etiología múltiple, con desarrollo poco predecible y alto porcentaje del gasto público sanitario. En el siguiente estudio se determina la similitud existente en prevalencia de enfermedades crónicas no trasmisibles tanto a nivel país, sistema penitenciario nacional y UAI 20 de diciembre.

Through a quantitative, descriptive and cross-sectional study, a comparison is made between the prison population of the Unidad de Atención Integral (UAI) 20 de diciembre and the total Costa Rican prison population. Until recently, there has been an important change in the morbimortality of persons deprived of liberty in the penitentiary environment, going from an almost unicausal model of infectious origin, to processes of multiple etiology, with little predictable development and a high percentage of public health expenditure. The following study determines the existing similarity in the prevalence of chronic non-communicable diseases at the country level, the national prison system and the UAI December 20.

Retrospective observational study on the impact of the Covid-19 pandemic on the prescription of medications for the treatment of Attention Deficit/Hyperactivity Disorder. Comparison of a European and an American cohort.

BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) is a neuropsychological disorder that affects the development of children and adolescents. The causes are not fully known although the origin of the disorder appears to depend on a combination of environmental, social, biochemical, and genetic factors. There is substantial evidence the Covid-19 pandemic caused an increase in mental disorders and therefore in spending related to the treatment of diseases. METHOD: We conducted a retrospective cohort study in two international centers of very different origins and cultures, one in Europe (Italy) and one in Central America (Costa Rica), to assess the impact of the Covid-19 pandemic on ADHD medication prescriptions and its costs. The analysis resulting from mining the databases in each individual nation allowed for the actual amounts of defined daily dose (DDD) prescribed and dispensed between the years 2019 and 2022 of methylphenidate and atomoxetine. RESULTS: The data show that the Italian ADHD medications DDDs and expenditure are aligned with the results in Costa Rica. It was found that from the year 2019 to the year 2022, both methylphenidate and atomoxetine prescriptions grew steadily, confirming a much higher incidence of the condition than in pre-pandemic periods. CONCLUSIONS: Our study shows that the global pandemic had an influence on the increase in the number of ADHD medication prescriptions. Individuals with ADHD are a population of individuals who may be particularly vulnerable to the distress caused by the pandemic, restrictions, and severe physical removal measures that have occurred in recent years.

Amphibian diversity across three adjacent ecosystems in Área de Conservación Guanacaste, Costa Rica.

Amphibians are the most threatened species-rich vertebrate group, with species extinctions and population declines occurring globally, even in protected and seemingly pristine habitats. These 'enigmatic declines' are generated by climate change and infectious diseases. However, the consequences of these declines are undocumented as no baseline ecological data exists for most affected areas. Like other neotropical countries, Costa Rica, including Área de Conservación Guanacaste (ACG) in north-western Costa Rica, experienced rapid amphibian population declines and apparent extinctions during the past three decades. To delineate amphibian diversity patterns within ACG, a large-scale comparison of multiple sites and habitats was conducted. Distance and time constrained visual encounter surveys characterised species richness at five sites-Murciélago (dry forest), Santa Rosa (dry forest), Maritza (mid-elevation dry-rain forest intersect), San Gerardo (rainforest) and Cacao (cloud forest). Furthermore, species-richness patterns for Cacao were compared with historic data from 1987-8, before amphibians declined in the area. Rainforests had the highest species richness, with triple the species of their dry forest counterparts. A decline of 45% (20 to 11 species) in amphibian species richness was encountered when comparing historic and contemporary data for Cacao. Conservation efforts sometimes focus on increasing the resilience of protected areas, by increasing their range of ecosystems. In this sense ACG is unique containing many tropical ecosystems compressed in a small geographic space, all protected and recognised as a UNESCO world heritage site. It thus provides an extraordinary platform to understand changes, past and present, and the resilience of tropical ecosystems and assemblages, or lack thereof, to climate change.

Development of High-Yielding Upland Cotton Genotypes with Reduced Regrowth after Defoliation Using a Combination of Molecular and Conventional Approaches.

Cotton is an economically important crop. However, the yield gain in cotton has stagnated over the years, probably due to its narrow genetic base. The introgression of beneficial variations through conventional and molecular approaches has helped broaden its genetic base to some extent. The growth habit of cotton is one of the crucial factors that determine crop maturation time, yield, and management. This study used 44 diverse upland cotton genotypes to develop high-yielding cotton germplasm with reduced regrowth after defoliation and early maturity by altering its growth habit from perennial to somewhat annual. We selected eight top-scoring genotypes based on the gene expression analysis of five floral induction and meristem identity genes (FT, SOC1, LFY, FUL, and AP1) and used them to make a total of 587 genetic crosses in 30 different combinations of these genotypes. High-performance progeny lines were selected based on the phenotypic data on plant height, flower and boll numbers per plant, boll opening date, floral clustering, and regrowth after defoliation as surrogates of annual growth habit, collected over four years (2019 to 2022). Of the selected lines, 8×5-B3, 8×5-B4, 9×5-C1, 8×9-E2, 8×9-E3, and 39×5-H1 showed early maturity, and 20×37-K1, 20×37-K2, and 20×37-D1 showed clustered flowering, reduced regrowth, high quality of fiber, and high lint yield. In 2022, 15 advanced lines (F8/F7) from seven cross combinations were selected and sent for an increase to a Costa Rica winter nursery to be used in advanced testing and for release as germplasm lines. In addition to these breeding lines, we developed molecular resources to breed for reduced regrowth after defoliation and improved yield by converting eight expression-trait-associated SNP markers we identified earlier into a user-friendly allele-specific PCR-based assay and tested them on eight parental genotypes and an F2 population.

An update on one-dose HPV vaccine studies, immunobridging and humoral immune responses - A meeting report.

The 12th HPV Prevention and Control meeting was held on June 2-3, 2022, in Antwerp, Belgium. This technical meeting focused on several topics. This report summarises the discussions and lessons learned on two topics: an update on one-dose HPV vaccination studies and humoral immune responses upon HPV vaccination. Long-term follow-up studies from Costa Rica (eleven years) and India (ten years) report stable levels of antibodies after a single HPV vaccination. High vaccine effectiveness against incident persistent HPV 16/18 infection was seen in India (95.4%, 85.0-99.9) ten years postvaccination and in Kenya (97.5%, 81.7-99.7) eighteen months postvaccination, an important observation in a setting with a higher HPV prevalence. The potential impact of HPV vaccination using a one-dose schedule in India was modelled and showed that implementation of one-dose schedule can contribute towards achieving WHO Cervical Cancer elimination goals. These data support the WHO SAGE recommendations for adopting a one-dose schedule for females aged 9-20 years. Immunobridging studies were discussed during the meeting. General agreement was reached that when thoughtfully applied, they can support and accelerate the expanded use of HPV vaccine with new vaccine schedules, age cohorts, or vaccine formulations. Internationally standardised measurements of HPV immune responses important for the progress of HPV vaccinology field. Humoral immune responses upon HPV vaccination plateau at 24 months regardless of number of doses, therefore, data should be analysed after at least 24 months of follow-up to bridge studies accurately.

Global patterns and trends in Kaposi sarcoma incidence: a population-based study.

BACKGROUND: Kaposi sarcoma is a rare, possibly angioproliferative, tumour. Kaposi sarcoma is one of the most common cancers in people living with HIV and poses a serious public health challenge in regions with high HIV burden. We aim to describe global patterns and population-wide trends in the burden of Kaposi sarcoma. METHODS: In this population-based study, the incidence and mortality estimates of Kaposi sarcoma from 185 countries and regions in 2020 were extracted from the GLOBOCAN 2020 database. The time trends in Kaposi sarcoma incidence were evaluated using the cancer registry data from Cancer Incidence in Five Continents plus from 1998 to 2012. We did not apply any inclusion or exclusion criteria to the data used in this study. Joinpoint regression was used to evaluate the average annual percentage change (AAPC) to quantify trends in the age-standardised incidence rate (ASIR) of Kaposi sarcoma. Correlation analysis was used to evaluate the relationship between the ASIR or age-standardised mortality rate (ASMR) and Human Development Index (HDI). FINDINGS: In 2020, the global estimated ASIR of Kaposi sarcoma was 0·39 (per 100 000 people), with an estimated 34 270 newly diagnosed cases (23 413 males and 10 857 females). An estimated 15 086 Kaposi sarcoma deaths were reported (9929 males and 5157 females), corresponding to an ASMR of 0·18 (per 100 000 people). In 2020, Africa accounted for 73·0% (25 010 of 34 270) of the incidence and 86·6% (13 066 of 15 086) of the deaths from Kaposi sarcoma worldwide. There was a significant correlation between the ASIR or ASMR and HDI. The incidence of Kaposi sarcoma increased in males in both Türkiye and the Netherlands. The AAPC was 11·5% (95% CI 3·2-20·4) for males in Türkiye and 2·5% (1·1-3·9) for males in the Netherlands from 1998 to 2012. The incidence of Kaposi sarcoma decreased in White Americans, Israel, Uganda, Costa Rica, Colombia, Canada, and Denmark, from 1998 to 2012. INTERPRETATION: Kaposi sarcoma is a relatively rare cancer worldwide but is endemic in some countries in southern and eastern Africa. Addressing disparities in health-care resource allocation and improving HIV/AIDS care across different HDI regions might contribute to the prevention of Kaposi sarcoma. FUNDING: The Natural Science Foundation of China Excellent Young Scientists Fund and the Natural Science Foundation of China International/Regional Research Collaboration Project. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

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

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

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

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

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

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 31 (11 August 2023)

[WEEKLY SUMMARY]. North America: Influenza activity has remained at low levels. During the last 4 epidemiological weeks (EW), the predominant influenza viruses have been influenza A(H1N1)pdm09, with concurrent circulation of influenza B/Victoria. Respiratory syncytial virus (RSV) activity has remained low. SARS-CoV-2 activity has shown an increase in the last 4 EWs and continues to circulate at moderate levels. Cases of influenza-like illness (ILI) and severe acute respiratory infection (SARI) have remained at low levels, with the majority of these associated with SARS-CoV-2 and to a lesser extent influenza. In Mexico, moderate levels of influenza circulation have been detected in the last EWs; however, the activity ILI and SARI remains low but above the epidemic threshold. Caribbean: After an increase in previous weeks, influenza activity has shown a decreasing trend in the last 4 EWs. During the last 4 EWs, the predominant influenza viruses have been B/Victoria, with lesser circulation of influenza A, mainly A(H1N1)pdm09. RSV activity has remained low. After showing an increase, the activity of SARS-CoV-2 has exhibited a fluctuating trend with intermediate levels of circulation. Cases of ILI and SARI, after an increase due to positive cases of influenza and SARS-CoV-2 in previous EWs, have shown a decreasing trend in the last 4 EWs. Central America: Influenza activity, after reaching a peak in previous weeks, continues decreasing in the last 4 EWs. During the last 4 EWs, the predominant influenza viruses have been influenza A, mainly A(H1N1)pdm09, with concurrent circulation of influenza B/Victoria and influenza A(H3N2) to a lesser extent. RSV activity has shown an increase in the last 4 EWs, reaching intermediate levels of circulation. SARS-CoV-2 activity has shown a slight increase. ILI activity has remained low, with the majority of cases associated with influenza. SARI activity is currently declining, with the majority of cases associated with influenza and RSV. In Costa Rica, extraordinary levels of influenza positivity have been observed, coinciding with concurrent circulation of SARS-CoV-2, with low ILI and SARI levels, with the majority of cases associated with influenza and to a lesser extent SARS-CoV-2. In El Salvador, extraordinary levels of influenza positivity have been reported in the last 4 EWs, although currently in decline, with epidemic levels in reported SARI cases. Additionally, an increase in RSV positivity levels has been observed with elevated activity. In Honduras, after reaching high percentages of influenza positivity, a decline has been observed in the last 4 EWs with levels below the epidemic threshold. SARI cases are currently declining, with almost all positives related to influenza. In Guatemala, RSV activity remains at moderate levels of circulation, showing moderate levels of ILI and SARI activity, with ILI cases mostly positive for influenza and SARI cases mostly positive for RSV. In Nicaragua and Panama, after moderate activity levels reached in previous EWs, influenza positivity in both countries is currently at epidemic levels.

[RESUMEN SEMANAL]. Andean region: Influenza activity remains stable at low levels. During the last 4 EWs, the predominant influenza viruses have been influenza A, mostly A(H1N1)pdm09, with lesser circulation of influenza B/Victoria. RSV activity remains at low levels. SARS-CoV-2 has presented a decreasing trend in the last 4 EWs, circulating at moderate levels, with elevated circulation in Bolivia. SARI activity continues to decline, with the majority of cases associated with influenza and to a lesser extent RSV and SARS-CoV-2. ILI activity has shown a decreasing trend, with the majority of cases associated with influenza. Brazil and Southern Cone: Influenza activity has decreased to low circulation levels. During the last 4 EWs, the predominant influenza viruses have been mainly A(H1N1)pdm09, with simultaneous circulation of influenza B/Victoria. RSV activity has shown a decline in the last 4 EWs, reaching low circulation levels. SARS-CoV-2 activity has remained low. After reaching a peak, both SARI and ILI activity have continued to decline in the last 4 EWs, with the majority of cases positive for RSV and influenza in the case of SARI and influenza in ILI cases. In Argentina, the epidemic levels of influenza activity persist, with the majority of detected cases testing positive for influenza A(H1N1)pdm09. After reaching moderate levels of ILI activity, it is currently on the decline. In Brazil, the activity of influenza and SARS-CoV-2 continues to decrease, with SARI activity remaining above the epidemic threshold and the majority of SARI cases are linked to RSV, with influenza playing a smaller role. In Chile ILI activity remains at moderate levels with the majority of cases related to RSV and influenza. Also, after reaching moderate activity levels for SARI, it is currently declining at epidemic levels, with RSV being the most common cause among positive cases. In Paraguay, the activity of SARI has shown a decrease, reaching moderate levels, with RSV being the primary cause among positive cases. In Uruguay, a slight increase in SARI activity has been observed in the last EWs, with the majority of cases being associated with RSV.

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 30 (4 August 2023)

[WEEKLY SUMMARY]. North America: Influenza activity has remained at low levels. During the last 4 epidemiological weeks (EW), the predominant influenza viruses have been influenza A(H1N1)pdm09, with concurrent circulation of influenza B/Victoria. Respiratory syncytial virus (RSV) activity has remained low. SARS-CoV-2 activity has shown an increase in the last 4 EWs and continues to circulate at moderate levels. Cases of influenza-like illness (ILI) and severe acute respiratory infection (SARI) have remained at low levels, with the majority of these associated with SARS-CoV-2 and to a lesser extent influenza. In Mexico, moderate levels of influenza circulation have been detected in the last EWs; however, the activity ILI and SARI remains low but above the epidemic threshold. Caribbean: After an increase in previous weeks, influenza activity has shown a decreasing trend in the last 4 EWs. During the last 4 EWs, the predominant influenza viruses have been B/Victoria, with lesser circulation of influenza A, mainly A(H1N1)pdm09. RSV activity has remained low. After showing an increase, the activity of SARS-CoV-2 has exhibited a decreasing trend over the past 4 epidemiological weeks and is currently at intermediate levels of circulation. Cases of ILI and SARI, after an increase due to positive cases of influenza and SARS-CoV-2 in previous EWs, have shown a decreasing trend in the last 4 EWs. Central America: Influenza activity, after reaching a peak in previous weeks, has shown a decline in the last 4 EWs. During the last 4 EWs, the predominant influenza viruses have been influenza A, mainly A(H1N1)pdm09, with concurrent circulation of influenza B/Victoria and influenza A(H3N2) to a lesser extent. RSV activity has shown an increase in the last 4 EWs, reaching intermediate levels of circulation. SARS-CoV-2 activity has shown a slight increase. ILI activity has remained low, with the majority of cases associated with influenza and SARS-CoV-2. SARI activity is currently declining, with the majority of cases associated with influenza and to a lesser extent RSV and SARS-CoV-2. In Costa Rica, extraordinary levels of influenza positivity have been observed, coinciding with concurrent circulation of SARS-CoV-2, with low ILI and SARI levels, with the majority of cases associated with influenza and to a lesser extent SARS-CoV-2. In El Salvador, extraordinary levels of influenza positivity have been reported in the last 4 EWs, although currently in decline, with epidemic levels in reported SARI cases. Additionally, an increase in RSV positivity levels has been observed with elevated activity. In Honduras, after reaching high percentages of influenza positivity, a decline has been observed in the last 4 EWs. SARI cases are currently declining, with almost all positives related to influenza. In Guatemala, after an increase in RSV activity, a decline has been observed in the last 4 EWs, with moderate levels of ILI and SARI activity, with ILI cases mostly positive for influenza and SARI cases mostly positive RSV. In Nicaragua and Panama, after moderate activity levels reached in previous EWs, influenza positivity in both countries is currently declining at epidemic levels. Andean region: Influenza activity remains stable at low levels. During the last 4 EWs, the predominant influenza viruses have been influenza A, mostly A(H1N1)pdm09, with lesser circulation of influenza B/Victoria. RSV activity, although showing a slight increase, remains at low levels. SARS-CoV-2 continues to circulate at moderate to high levels, with elevated circulation in Bolivia. SARI activity continues to decline, with the majority of cases associated with influenza and to a lesser extent RSV and SARS-CoV-2. ILI activity has shown a decreasing trend, with the majority of cases associated with influenza. Brazil and Southern Cone: Influenza activity has decreased to low circulation levels. During the last 4 EWs, the predominant influenza viruses have been mainly A(H1N1)pdm09, with simultaneous circulation of influenza B/Victoria. RSV activity has shown a decline in the last 4 EWs, reaching low circulation levels. SARS-CoV-2 activity has remained low. After reaching a peak, both SARI and ILI activity have continued to decline in the last 4 EWs, with the majority of cases positive for RSV and influenza in the case of SARI and influenza in ILI cases. In Argentina, the epidemic levels of influenza activity persist, with the majority of detected cases testing positive for influenza A(H1N1)pdm09. After reaching moderate levels of ILI activity, it is currently on the decline.. In Chile, after reaching extraordinary levels of ILI activity, with the majority of cases related to RSV and influenza, this activity has declined in the last 4 EWs, currently at epidemic levels. Also, after reaching moderate activity levels for SARI, it is currently declining at epidemic levels, with RSV being the most common cause among positive cases. The majority of deaths detected among SARI cases in the last EW have been positive for RSV. In Paraguay, the activity of SARI has shown a decrease, reaching moderate levels, with RSV being the primary cause among positive cases. In Uruguay, an increase in SARI activity has been observed in the EW, with the majority of cases being associated with RSV.

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

Challenges detecting SARS-CoV-2 in Costa Rican domestic wastewater and river water.

This study presents the development of a SARS-CoV-2 detection method for domestic wastewater and river water in Costa Rica, a middle-income country in Central America. Over a three-year period (November to December 2020, July to November 2021, and June to October 2022), 80 composite wastewater samples (43 influent and 37 effluent) were collected from a Wastewater Treatment Plant (SJ-WWTP) located in San José, Costa Rica. Additionally, 36 river water samples were collected from the Torres River near the SJ-WWTP discharge site. A total of three protocols for SARS-CoV-2 viral concentration and RNA detection and quantification were analyzed. Two protocols using adsorption-elution with PEG precipitation (Protocol A and B, differing in the RNA extraction kit; n = 82) were used on wastewater samples frozen prior to concentration, while wastewater (n = 34) collected in 2022 were immediately concentrated using PEG precipitation. The percent recovery of Bovine coronavirus (BCoV) was highest using the Zymo Environ Water RNA (ZEW) kit with PEG precipitation executed on the same day as collection (mean 6.06 % ± 1.37 %). It was lowest when samples were frozen and thawed, and viruses were concentrated using adsorption-elution and PEG concentration methods using the PureLink™ Viral RNA/DNA Mini (PLV) kit (protocol A; mean 0.48 % ± 0.23 %). Pepper mild mottle virus and Bovine coronavirus were used as process controls to understand the suitability and potential impact of viral recovery on the detection/quantification of SARS-CoV-2 RNA. Overall, SARS-CoV-2 RNA was detected in influent and effluent wastewater samples collected in 2022 but not in earlier years when the method was not optimized. The burden of SARS-CoV-2 at the SJ-WWTP decreased from week 36 to week 43 of 2022, coinciding with a decline in the national COVID-19 prevalence rate. Developing comprehensive nationwide surveillance programs for wastewater-based epidemiology in low-middle-income countries involves significant technical and logistical challenges.

An enigmatic new octocoral species (Anthozoa, Octocorallia, Malacalcyonacea) from Isla del Coco National Park.

Alienaparvagen. et sp. nov. is described from Cocos Island, Costa Rica. The species was found at various islets and rocky outcrops north and northwest of the island, 20-30 m in depth. The genus is characterised by polyps, retracting into calyces, that form thin encrusting mats extending on dead or live substrates. Sclerites are mostly asymmetrical spindles. Anthocodial rods are arranged in points, not forming a collaret. Colonies and coenenchymal sclerites are red, and polyps are transparent. Using an integrative taxonomic approach, we found the new genus to morphologically and genetically differ from all other described taxa. The molecular phylogenetic analyses provide strong support for the placement of this new genus in the family Pterogorgiidae. Morphologically it is unlike any of the other members of this family, necessitating an amendment to the diagnosis of Pterogorgiidae. Like several other known taxa of octocorals with encrusting growth forms, Alienagen. nov. appears to have evolved from a gorgonian ancestor by loss of an internal skeletal axis. It is the first member of Pterogorgiidae to be reported from the eastern Pacific, contributing further to the knowledge of marine biodiversity in the eastern tropical Pacific and to the octocoral biodiversity of Cocos Island in particular.

Regional Update, Influenza and Other Respiratory Viruses. Epidemiological Week 29 (28 July 2023)

[WEEKLY SUMMARY]. North America: Influenza activity has remained at low levels. During the last 4 epidemiological weeks (EW), the predominant influenza viruses have been influenza A(H1N1)pdm09, with concurrent circulation of influenza B/Victoria. Respiratory syncytial virus (RSV) activity has remained low. SARS-CoV-2 activity has shown an increase in the last 4 EWs and continues to circulate at moderate levels. Cases of influenza-like illness (ILI) and severe acute respiratory infection (SARI) have remained at low levels, with the majority of these associated with SARS-CoV-2 and to a lesser extent influenza. In Mexico, moderate levels of influenza circulation have been detected in the last EWs; however, the activity ILI and SARI remains low but above the epidemic threshold. Caribbean: After an increase in previous weeks, influenza activity has shown a decreasing trend in the last 4 EWs. During the last 4 EWs, the predominant influenza viruses have been B/Victoria, with lesser circulation of influenza A, mainly A(H1N1)pdm09. RSV activity has remained low. SARS-CoV-2 activity has shown an increase in the last 4 EWs and currently remains at intermediate levels of circulation. Cases of ILI and SARI, after an increase due to positive cases of influenza and SARS-CoV-2 in previous EWs, have shown a decreasing trend in the last 4 EWs. Central America: Influenza activity, after reaching a peak in previous weeks, has shown a decline in the last 4 EWs. During the last 4 EWs, the predominant influenza viruses have been influenza A, mainly A(H1N1)pdm09, with concurrent circulation of influenza B/Victoria and influenza A(H3N2) to a lesser extent. RSV activity has shown an increase in the last 4 EWs, reaching intermediate levels of circulation. SARS-CoV-2 activity has remained low. ILI activity has remained low, with the majority of cases associated with influenza and SARS-CoV-2. SARI activity is currently declining, with the majority of cases associated with influenza and to a lesser extent RSV and SARS-CoV-2. In Costa Rica, extraordinary levels of influenza positivity have been observed, coinciding with concurrent circulation of SARS-CoV-2, showing a decline for both in the last 2 EWs, with low ILI and SARI levels, with the majority of cases associated with influenza and to a lesser extent SARS-CoV-2. In El Salvador, extraordinary levels of influenza positivity have been reported in the last 4 EWs, although currently in decline, with epidemic levels in reported SARI cases. Additionally, an increase in RSV positivity levels has been observed with elevated activity. In Honduras, after reaching high percentages of influenza positivity, a decline has been observed in the last 4 EWs. SARI cases are currently declining, with all positives related to influenza. In Guatemala, after an increase in RSV activity, a decline has been observed in the last 4 EWs, with moderate levels of ILI and SARI activity, with cases mostly positive for influenza and RSV. In Nicaragua and Panama, after moderate activity levels reached in previous EWs, influenza positivity in both countries is currently declining at epidemic levels. Andean region: Influenza activity remains stable at low levels. During the last 4 EWs, the predominant influenza viruses have been influenza A, mostly A(H1N1)pdm09, with lesser circulation of influenza B/Victoria. RSV activity, although showing a slight increase, remains at low levels. SARS-CoV-2 continues to circulate at moderate to high levels, with elevated circulation in Bolivia. SARI activity continues to decline, with the majority of cases associated with influenza and to a lesser extent RSV and SARS-CoV-2. ILI activity has shown a decreasing trend, with the majority of cases associated with influenza. Brazil and Southern Cone: Influenza activity has decreased to low circulation levels. During the last 4 EWs, the predominant influenza viruses have been mainly A(H1N1)pdm09, with simultaneous circulation of influenza B/Victoria. RSV activity has shown a decline in the last 4 EWs, reaching low circulation levels. SARS-CoV-2 activity has remained low. After reaching a peak, both SARI and ILI activity have continued to decline in the last 4 EWs, with the majority of cases positive for RSV and influenza in the case of SARI and influenza in ILI cases. In Argentina, a pronounced increase in influenza activity has been observed in the last 4 EWs, reaching elevated levels, with the majority of cases detected as positive for influenza A(H1N1)pdm09, and after reaching moderate activity levels for ILI, it is currently declining. In Chile, after reaching extraordinary levels of ILI activity, with the majority of cases related to RSV and influenza, this activity has declined in the last 4 EWs, currently at epidemic levels. Also, after reaching moderate activity levels for SARI, it is currently declining at epidemic levels, with RSV being the most common cause among positive cases. The majority of deaths detected among SARI cases in the last EW have been positive for RSV and to a lesser extent for SARS-CoV-2. In Paraguay, extraordinary levels of SARI activity continue, with RSV being the main cause among positive cases. In Uruguay, an increase in SARI activity has been detected in the last 4 EWs, continuing at moderate levels, with the majority of cases associated with RSV and influenza

[RESUMEN SEMANAL]. Norteamérica: La actividad de influenza ha permanecido en niveles bajos. Durante las últimas 4 semanas epidemiológicas (SE) los virus influenza predominantes han sido influenza A(H1N1)pdm09, con circulación concurrente de influenza B/Victoria. La actividad del virus sincitial respiratorio (VSR) se ha mantenido en niveles bajos. La actividad del SARS-CoV-2 ha presentado un incremento en las últimas 4 SE y continúa circulando en niveles moderados. Los casos de enfermedad tipo influenza (ETI) e infección respiratoria aguda grave (IRAG) se han mantenido en niveles bajos, siendo la mayor parte de estos asociados a SARSCoV- 2 y en menor medida a influenza. En México se han detectado niveles moderados de circulación de influenza en las últimas SE, sin embrago la actividda de ETI e IRAG se mantiene baja, por encima del umbral epidémico. Caribe: Tras un incremento en semanas previas la actividad de la influenza ha mostrado una tendencia decreciente en las últimas 4 SE. Durante las últimas 4 SE, los virus predominantes de la influenza han sido B/Victoria, con menor circulación de la influenza A, principalmente A(H1N1)pdm09. La actividad del VSR ha permanecido baja. La actividad del SARS-CoV-2 ha mostrado un incremento en las últimas 4 SE y actualmente se encuentra en niveles intermedios de circulación. Los casos de ETI e IRAG tras mostrar un incremento debido a casos influenza y SARS-CoV-2 positivos en las SE previas, en las últimas 4 SE han mostrado una tendencia decreciente. Centroamérica: La actividad de influenza tras alcanzar un pico en semanas previas ha presentado un descenso en las últimas 4 SE. Durante las últimas 4 SE, los virus predominantes de influenza han sido del tipo A, principalmente A(H1N1)pdm09, con circulación concurrente en menor medida de influenza B/Victoria e influenza A(H3N2). La actividad de VSR ha mostrado un incremnto en las últimas 4 SE, situándose en niveles intermedios de circulación. La actividad de SARS-CoV-2 ha permanecido baja. La actividad de ETI se ha mantenido baja con la mayoría de los casos asociados a influenza y SARS-CoV-2. La actividad de IRAG se encuentra actualmente en descenso, con la mayoría de los casos asociados a influenza y en menor medida a VSR y SARS-CoV-2. En Costa Rica se han observado niveles de positividad de influenza extraordinarios coincidentes con circulación concurrente de SARS-CoV-2, mostrando un descenso para ambos en las 2 últimas SE, con niveles de ETI e IRAG bajos con la mayoría de los casos asociados a influenza y en menor medida SARS-CoV-2. En El Salvador se han notificado niveles extraordinarios de positividad de influenza en las últimas 4 SE aunque actualmente en descenso, con niveles epidémicos en los casos IRAG notificados. Adicionalmente, se ha observado un incremento en los niveles de positividad de VSR con una actividad elevada. En Honduras tras alcanzar niveles elevados en los porcentajes de positividad de influenza, en las 4 últimas SE se ha observado un descenso. Los casos de IRAG actualmente se encuentran en descenso siendo la totalidad de los positivos relacionado con influenza. En Guatemala tras un incremento en la actividad de VSR, se ha observado un descenso en las últimas 4 SE con niveles de actividad de ETI e IRAG moderados, siendo los casos positivos en su mayoría para influenza y VSR. En Nicaragua y Panamá tras los niveles de actividad moderados alcanzados en SE previas, la positividad de influenza en ambos países se encuentra actualmente en descenso en niveles epidémicos. Andina: La actividad de la influenza se mantiene estable a niveles bajos. Durante las 4 últimas SE los virus influenza predominantes han sido influenza A, mayoritariamente A(H1N1)pdm09, con circulación en menor medida de influenza B/Victoria. La actividad del VSR aunque mostrando un ligero incremento, se mantiene en niveles bajos. El SARS-CoV-2 continúa circulando en niveles moderado-altos, con circulación elevada en Bolivia. La actividad de IRAG continúa en descenso con la mayoría de los casos asociados a influenza y en menor medida VSR y SARS-CoV-2. La actividad de ETI ha mostrado una tendencia decreciente con la mayoría de los casos asociados a influenza. Brasil y Cono Sur: La actividad de la influenza ha disminuido a niveles bajos de circulación. Durante las últimas 4 SE, los virus predominantes de la influenza han sido principalmente A(H1N1)pdm09, con circulación simultánea de influenza B/Victoria. La actividad del VSR ha presentado un descenso en las 4 últimas SE situándose en niveles bajos de circulación. La actividad del SARS-CoV-2 ha permanecido baja. Después de alcanzar un pico, tanto la actividad de IRAG como la de ETI han continuado en descenso en las últimas 4 SE, siendo la mayoría de los casos positivos a VSR e influenza en el caso de IRAG e influenza en los casos de ETI. En Argentina se ha observado un pronunciado incremento en la actividad de influenza en las últimas 4 SE , alcanzando niveles elevados siendo la mayoría de los casos detectados positivos a influenza A(H1N1)pdm09 y tras alcanzar niveles moderados de actividad de ETI, actualmente se encuentra en descenso. En Chile, tras alcanzar niveles extraordinarios de actividad de ETI, con la mayoría de los casos relacionados con VSR e influenza, esta actividad ha presentado un descenso en las últimas 4 SE situándose actualmente en niveles epidémicos. También tras alcanzar niveles moderados de actividad de IRAG, actualmente se encuentra en descenso en niveles epidémicos, siendo el VSR la causa más común entre los casos positivos. La mayoría de las defunciones detectadas entre los casos de IRAG en las últimas SE han sido en casos positivos para VSR y en menor medida para SARS-CoV-2. En Paraguay, continúan observándose niveles extraordinarios de actividad de IRAG, siendo el VSR la causa principal entre los casos positivos. En Uruguay se ha detectado un incremento en la actividad de IRAG en las últimas 4 SE continuando en niveles moderados, siendo la mayoría de los casos asociados a VSR e influenza.