H1N1: ARGENTINA DECLINES TO DECLARE H1N1 EMERGENCY--FOR

UNCLAS BUENOS AIRES 000778 SIPDIS DEPT FOR OES/IHB - P. MURPHY AND D. WILUSZ E.O. 12958: N/A TAGS: TBIO SOCI PGOV PREL AMED ELAB AR SUBJECT: H1N1: ARGENTINA DECLINES TO DECLARE H1N1 EMERGENCY--FOR NOW REF: BUENOS AIRES 0752 ¶1. SUMMARY: The death toll in Argentina attributed to H1N1 influenza has reached 55. In the midst of this crisis, the Government of Argentina (GOA) has appointed a new Minister with extensive public health experience (reftel). Although the new Minister declined to declare a national health emergency, numerous provinces have done so, and local governments are looking for local solutions. The GOA has liberalized its policy on influenza treatment and offered their stock of oseltamivir to public and private health care providers. Both the Centers for Disease Control and the Pan American Health Organization are working with the Ministry of Health (MOH) to develop a methodology to provide more reliable information. Indications are that the MOH will take additional measures next week. END SUMMARY. -------------- OFFICIAL NUMBERS -------------- ¶2. As of June 28, Argentina's Ministry of Health (MOH) reported 1804 confirmed cases of H1N1 out of 3632 samples tested from suspect cases (49.7% positive); they reported an additional 967 suspected cases with testing still pending, and 55 confirmed deaths. There are 46 additional deaths under investigation. Of note, of the confirmed deaths where information is available, 27 out of 32 had underlying high risk conditions. The median age of the deaths was 28 years. The median age of cases was younger. There have been cases reported in most areas of the country, but up until now, most of the cases (over 1300) have been concentrated in Buenos Aires province and in the Capital District. -------------- HEALTH MINISTRY CHANGES HANDS -------------- ¶3. Minister of Health Graciela Ocana resigned the day after the legislative elections. Her resignation came as no surprise. It was in the works for a long time, and can be attributed to exhaustion fighting dengue, influenza, and labor leader Moyano (see Buenos Aires 0752). Ocana had been under fire for the government's handling of the current influenza pandemic and the outbreak earlier this year of mosquito-borne dengue fever. Argentine media had reported that Ocana had recommended postponing midterm elections, but was overruled. (Note: The elections took place Sunday, and many poll workers donned surgical masks). ¶4. The national H1N1 Crisis Committee met after Ocana's resignation. President Cristina Fernandez de Kirchner, government officials and epidemiology experts decided not to declare a national health emergency. In a press conference, the Chief of Cabinet Sergio Massa mentioned that no measures would be taken at that time "out of respect" to the incoming Minister of Health, Juan Luis Manzur, who was officially appointed on July 1. (Note: The minister was sworn in at the Casa Rosada, seat of the executive branch, in a room where some 500 government officials and guests had convened, ironically ignoring prior city and provincial proclamations recommending that people avoid public gatherings.) Juan Luis Manzur began his medical career as a surgeon, and has a Master's degree in Public Health. Prior to his appointment, he had served as the Secretary of Health in the municipality of La Matanza and Deputy Minister of Health in the province of San Luis. As Minister of Health in the Province of Tucuman, he was credited with reducing infant mortality, refurbishing provincial hospitals, and creating primary care centers around the province. He was until recently the Lieutenant Governor of Tucuman, and has summoned six trusted colleagues from Tucuman to assist him. -------------- Health Emergency Declarations -------------- ¶5. The Province of Buenos Aires declared an official health emergency on June 30, giving health authorities special powers to cut through red tape to buy medical supplies and pay for additional personnel. The provincial Minister of Health, Claudio Zin, approved a measure July 2 to summon retired doctors and students of medicine in order to increase the number of health care providers. The province also announced both an extension and an advanced start of the austral winter school recess. It will start two weeks early on July 6, doubling from two to four weeks. ¶6. The City of Buenos Aires also declared an official health emergency on the same day and similarly changed school vacation dates. Both the province and the city allowed public gathering places such as restaurants, shopping centers, public transportation and movie theaters to remain open, but advised against large gatherings to avoid contagion, particularly in the case of children during the extended winter holidays. ¶7. The new national Minister of Health, Juan Luis Manzur, in his first official statement on July 1, announced plans to boost public health spending by US$263 million. He declined to declare a national health emergency, but announced that pregnant women and other at risk groups would be permitted to stay at home without losing pay for 15 days to avoid contracting influenza. He recommended that schools around the country be closed for the next four weeks as the city and province of Buenos Aires has done. Seventeen provinces had already declared such measures. (Note: In the absence of a declaration of national emergency, the Minister can only recommend the closing of schools, as they mostly fall under provincial governments.) Manzur promised that if beds were lacking in public hospitals, the government would pay for hospitalization in private hospitals for those without insurance. Although the national government has no current plans to shut down public buildings or transportation, he added that "we will continue monitoring day by day". As of July 2, each of Argentina's 23 provinces has moved their school holidays forward, and 12 of the provinces have declared a health emergency. -------------- New Emphasis on Oseltamivir Treatment -------------- ¶8. Chief of Cabinet Massa said that the national government would provide the public and private health care system antivirals such as oseltamivir (Tamiflu). The medicine will also be provided to prophylax health care workers in contact with influenza patients. In addition, all patients suspected of being infected with H1N1 will be treated with oseltamivir. Previously, oseltamivir was not administered until a patient exhibited serious symptoms. According to the government, two million treatments of oseltamivir are available. Critics claim that this would be insufficient if the situation worsens, and that distribution has been a serious problem. The drug is still unavailable in local pharmacies. Critics have suggested that Argentina has restricted prescribing oseltamivir because there was not enough available. (Note: Chile has been administering oseltamivir in all suspected cases to contain the virus. This might help to explain why their mortality rate is less.) -------------- Additional Measures by Local Governments -------------- ¶9. In addition to the limited prevention measures taken by the national government, reports are starting to trickle in of various local governments and institutions shutting down their administrative offices. The province of Santa Fe has even delayed until August 9 local primary elections that had been scheduled for July 5. Some public and private universities have extended their winter holidays, the Supreme Court has moved their winter break forward, and some theatres have decided to shut down temporarily and reschedule their planned shows for the month of August. President Kirchner will present a special program "Learn at Home" for children to study during the winter holidays. Employees from the Province of Buenos Aires with children of 14 or less can request special leave to take care of their children. Changes have been implemented in local religious services; priests will now put communion in a person's hand instead of in the mouth. The Rugby Association has suspended all matches, and the casino in Mar del Plata that boasts never to close has finally done so. -------------- Determining the True Extent of H1N1 -------------- ¶10. Experts from the Centers for Disease Control (CDC) are assisting the Pan American Health Organization (PAHO) and the MOH in developing a surveillance program to develop reliable figures for the H1N1 virus. Efforts are underway to enhance surveillance throughout the country, and in particular to do additional work in three provinces to monitor clinical (to follow the presentation of symptoms of patients and/or severity changes),virologic (to monitor for changes in the virus and/or its susceptibility to antiviral medication),and epidemiologic characteristics (age and gender of those affected, risk factors for severe disease, rate of infection in the population, etc.) of the outbreak. -------------- Comment -------------- ¶11. The influenza season in Argentina is expected to peak over the next two to three weeks. All levels of government and private organizations are starting to take measures to minimize the further spread of H1N1. We expect the announcement of additional measures that will be driven by new statistical information currently being developed. KELLY