2009 flu pandemic in Costa Rica
Encyclopedia
In March and April 2009, an outbreak of a new strain of flu (also known as influenza), popularly known as swine flu
was discovered to have infected several people in Mexico
and the states of California
and Texas
in the United States
. On April 28 Costa Rica
became the first Central America
n country to report the outbreak of the virus, with a confirmed infection. As of November 4 the Costa Rican Ministry of Health had 1,596 confirmed cases, 1,275 pending cases, 8,000 already discarded, and 38 deaths.
On July 31 local authorities announced that the country was selected among the sample countries that will be part of the test of the vaccine
developed by Swiss pharmaceutical Novartis
. The local sample will include 784 Costa Ricans ages 3 to 64. Besides Costa Rica, this vaccine prototype will be tested also in Mexico
and the United States
.
On August 11 was confirmed that Costa Rica's President, Óscar Arias Sánchez, was infected with the A(H1N1) virus, becoming the first head of state
sick with the A(H1N1) virus President Arias returned to his normal activities after one week of isolation at his home.
The Ministry of Health reported the existence of two new probable cases of swine flu in the country on the morning of May 2. These were a 53-year old man who had not traveled to Mexico, in a hospital in San Jose, and a 24-year old woman who is recovering at home. These new patients brought the total number of Costa Ricans affected by the virus to four. Three are listed as probable cases, while one was duly confirmed by the Centers for Disease Control and Prevention
in the United States. Four more cases were confirmed on May 4 by the Costa Rican "Centro Nacional de Referencia en Virología." All of these patients have recently traveled to Mexico. Since April 29 the Ministry of Health recommended to avoid travel to Mexico, Canada
, and the U.S. as the number of confirmed cases by local authorities reached eight.
On May 12 the Minister of Health announced that an alert was received from U.S. authorities informing that three members from a Boston
chorus, Canta Mundi, that traveled to several tourism places in Costa Rica during April, showed symptoms of AH1N1 flu after returning to the U.S. On May 13 Costa Rican health authorities announced four new probable cases, three of which had contact with the Boston chorus, and a follow-up is being done with those who had contact with the chorus. A couple of English language newspapers questioned whether the chorus members had infected locals, or rather the Boston youngsters picked up the disease in Costa Rica, as the chorus flew directly from the United States to Costa Rica.
Beginning May 20 probable cases are now confirmed locally by the aboratorio de Virología del Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud] (Inciensa), which now is in capacity to confirm the presence of the A (H1N1) virus in 24 hours. Previously, all samples had to be sent to the U.S Centers for Disease Control and Prevention
for confirmation. Among the 26 confirmed cases until May 21, six patients had contact with the Boston chorus and the Ministry of Health reported that all patients have a stable condition.
On July 21 the Ministry of Health, in agreement with the Catholic Church, and in order to prevent a massive contagion, prohibited the traditional pilgrimage
to the Basílica de Nuestra Señora de los Ángeles (Our Lady of the Angels Basilica), patroness of catholic Costa Ricans. This pilgrimage takes places every year on August 1 since 227 years ago, and this is the first time ever that is suspended. Health authorities estimate the risk of contagion in 20,000 people, as around two million pilgrims would have participated in this traditional religious event.
On July 31 local authorities announced that the country was selected among the sample countries that will be part of the test of the vaccine
developed by Swiss pharmaceutical Novartis
. The local sample will include 784 Costa Ricans ages 3 to 64. Besides Costa Rica, this vaccine prototype will be tested also in Mexico
and the United States
.
As of November 4 the Costa Rican Ministry of Health had 1,596 confirmed cases, 1,275 pending cases, 8,000 already discarded, and 38 deaths, with an infection rate of 35,32 per 100,000 people.
Out of the seven remaining cases confirmed by the US Center for Disease Control, three were children infected by the patient who died, and their condition never was critical. Costa Rica became the fourth country in the world, after Mexico, the United States and Canada to confirm fatalities related to the influenza virus A (H1N1).
The deceased man was suffering other chronic diseases. The Minister of Health informed he had diabetes and also was suffering from chronic obstructive pulmonary disease
(COPD). She also informed the man was infected inside Costa Rica because he had not traveled to Mexico, and that a total 51 persons were identified who had contact with the sick man, but only three turned out positive.
The second fatality was a 35-year old woman, and she died on June 23, less than 24 hours after arriving to the emergency room at a local hospital. The woman was suffering of hypertension
and morbid
obesity
. A third patient died on June 29, a 55-year old man who presented chronic obstructive pulmonary disease
due to smoking
. A 45-year old woman was the fourth fatality. She died on July 4.
The fifth death occurred on July 11. The patient was a 25-year old woman pregnant with twins. Both five-month old fetuses died hours before their mother did. The sixth fatality occurred on July 13, a 45-year old man. This was the first patient to died who was not suffering none of the risk factors previously identified in other deceased patients. The seventh confirmed fatality was a 24-year old man, who smoke and suffered obesity.
was also confirmed. The mortality rate
is 0.85 deaths by 100,000 people, and the fatality rate is 2.48%. From all deceased patients, 47.3% occurred among San José
residents, and only the Guanacaste Province
has not had any deaths related to the virus. The age of the deceased varies between 20 to 79 year-old, with an average age of 41 years.
Until early September, the most frequent risk factor
s presented by the deceased patients are obesity
(36.4%), diabetes
(18.2%), asthma
(18.2%), pregnancy
(9.1%) and chronic obstructive pulmonary disease
(6.1%).
Swine flu
Swine influenza, also called pig influenza, swine flu, hog flu and pig flu, is an infection by any one of several types of swine influenza virus. Swine influenza virus or S-OIV is any strain of the influenza family of viruses that is endemic in pigs...
was discovered to have infected several people in Mexico
Mexico
The United Mexican States , commonly known as Mexico , is a federal constitutional republic in North America. It is bordered on the north by the United States; on the south and west by the Pacific Ocean; on the southeast by Guatemala, Belize, and the Caribbean Sea; and on the east by the Gulf of...
and the states of California
California
California is a state located on the West Coast of the United States. It is by far the most populous U.S. state, and the third-largest by land area...
and Texas
Texas
Texas is the second largest U.S. state by both area and population, and the largest state by area in the contiguous United States.The name, based on the Caddo word "Tejas" meaning "friends" or "allies", was applied by the Spanish to the Caddo themselves and to the region of their settlement in...
in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
. On April 28 Costa Rica
Costa Rica
Costa Rica , officially the Republic of Costa Rica is a multilingual, multiethnic and multicultural country in Central America, bordered by Nicaragua to the north, Panama to the southeast, the Pacific Ocean to the west and the Caribbean Sea to the east....
became the first Central America
Central America
Central America is the central geographic region of the Americas. It is the southernmost, isthmian portion of the North American continent, which connects with South America on the southeast. When considered part of the unified continental model, it is considered a subcontinent...
n country to report the outbreak of the virus, with a confirmed infection. As of November 4 the Costa Rican Ministry of Health had 1,596 confirmed cases, 1,275 pending cases, 8,000 already discarded, and 38 deaths.
On July 31 local authorities announced that the country was selected among the sample countries that will be part of the test of the vaccine
Vaccine
A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe or its toxins...
developed by Swiss pharmaceutical Novartis
Novartis
Novartis International AG is a multinational pharmaceutical company based in Basel, Switzerland, ranking number three in sales among the world-wide industry...
. The local sample will include 784 Costa Ricans ages 3 to 64. Besides Costa Rica, this vaccine prototype will be tested also in Mexico
Mexico
The United Mexican States , commonly known as Mexico , is a federal constitutional republic in North America. It is bordered on the north by the United States; on the south and west by the Pacific Ocean; on the southeast by Guatemala, Belize, and the Caribbean Sea; and on the east by the Gulf of...
and the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
.
On August 11 was confirmed that Costa Rica's President, Óscar Arias Sánchez, was infected with the A(H1N1) virus, becoming the first head of state
Head of State
A head of state is the individual that serves as the chief public representative of a monarchy, republic, federation, commonwealth or other kind of state. His or her role generally includes legitimizing the state and exercising the political powers, functions, and duties granted to the head of...
sick with the A(H1N1) virus President Arias returned to his normal activities after one week of isolation at his home.
Initial outbreak
The first confirmed case of influenza A (H1N1) in Costa Rica was announced on April 28, and was that of a young woman hospitalized in San Jose. On April 28, Minister of Health of Costa Rica, Maria Luisa Avila confirmed the second case, a 29-year old man hospitalized at the Hospital San Vicente de Paul in Heredia. A National Health Emergency was announced.The Ministry of Health reported the existence of two new probable cases of swine flu in the country on the morning of May 2. These were a 53-year old man who had not traveled to Mexico, in a hospital in San Jose, and a 24-year old woman who is recovering at home. These new patients brought the total number of Costa Ricans affected by the virus to four. Three are listed as probable cases, while one was duly confirmed by the Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
in the United States. Four more cases were confirmed on May 4 by the Costa Rican "Centro Nacional de Referencia en Virología." All of these patients have recently traveled to Mexico. Since April 29 the Ministry of Health recommended to avoid travel to Mexico, Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
, and the U.S. as the number of confirmed cases by local authorities reached eight.
On May 12 the Minister of Health announced that an alert was received from U.S. authorities informing that three members from a Boston
Boston
Boston is the capital of and largest city in Massachusetts, and is one of the oldest cities in the United States. The largest city in New England, Boston is regarded as the unofficial "Capital of New England" for its economic and cultural impact on the entire New England region. The city proper had...
chorus, Canta Mundi, that traveled to several tourism places in Costa Rica during April, showed symptoms of AH1N1 flu after returning to the U.S. On May 13 Costa Rican health authorities announced four new probable cases, three of which had contact with the Boston chorus, and a follow-up is being done with those who had contact with the chorus. A couple of English language newspapers questioned whether the chorus members had infected locals, or rather the Boston youngsters picked up the disease in Costa Rica, as the chorus flew directly from the United States to Costa Rica.
Beginning May 20 probable cases are now confirmed locally by the aboratorio de Virología del Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud] (Inciensa), which now is in capacity to confirm the presence of the A (H1N1) virus in 24 hours. Previously, all samples had to be sent to the U.S Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
for confirmation. Among the 26 confirmed cases until May 21, six patients had contact with the Boston chorus and the Ministry of Health reported that all patients have a stable condition.
July and August contagion surge
As a result of a wave of new cases that occurred by early July, the Ministry of Health announced a new strategy to deal with this peak that resulted in increased deaths. Beginning July 11, 2009, testing for the virus will be conducted only on patients with risk factors and critical cases, including those with fever above 39 oC and patients with respiratory difficulties, as the main objective now is to reduce mortality rather than avoid contagion. This policy means that statistics regarding the number of cases will no longer reflect the total number of actual cases. Also, mid-year school vacations were extended one week in order to curb contagion.On July 21 the Ministry of Health, in agreement with the Catholic Church, and in order to prevent a massive contagion, prohibited the traditional pilgrimage
Pilgrimage
A pilgrimage is a journey or search of great moral or spiritual significance. Typically, it is a journey to a shrine or other location of importance to a person's beliefs and faith...
to the Basílica de Nuestra Señora de los Ángeles (Our Lady of the Angels Basilica), patroness of catholic Costa Ricans. This pilgrimage takes places every year on August 1 since 227 years ago, and this is the first time ever that is suspended. Health authorities estimate the risk of contagion in 20,000 people, as around two million pilgrims would have participated in this traditional religious event.
On July 31 local authorities announced that the country was selected among the sample countries that will be part of the test of the vaccine
Vaccine
A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe or its toxins...
developed by Swiss pharmaceutical Novartis
Novartis
Novartis International AG is a multinational pharmaceutical company based in Basel, Switzerland, ranking number three in sales among the world-wide industry...
. The local sample will include 784 Costa Ricans ages 3 to 64. Besides Costa Rica, this vaccine prototype will be tested also in Mexico
Mexico
The United Mexican States , commonly known as Mexico , is a federal constitutional republic in North America. It is bordered on the north by the United States; on the south and west by the Pacific Ocean; on the southeast by Guatemala, Belize, and the Caribbean Sea; and on the east by the Gulf of...
and the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
.
As of November 4 the Costa Rican Ministry of Health had 1,596 confirmed cases, 1,275 pending cases, 8,000 already discarded, and 38 deaths, with an infection rate of 35,32 per 100,000 people.
First deaths
The Ministry of Health received confirmation on May 8 from the Centers for Disease Control of seven cases of infection with influenza A/H1N1 virus. Health Minister Maria Luisa Avila announced that these were three men, aged 24, 30 and 53, two women, aged 20 and 25, two girls, aged 4 and 11, and a boy aged 3. "They are people who were in Mexico or had contact with travelers to that country", said the Ministry. The 53-year old man became the first fatality in Costa Rica, confirmed on May 9 by the Minister of Health.Out of the seven remaining cases confirmed by the US Center for Disease Control, three were children infected by the patient who died, and their condition never was critical. Costa Rica became the fourth country in the world, after Mexico, the United States and Canada to confirm fatalities related to the influenza virus A (H1N1).
The deceased man was suffering other chronic diseases. The Minister of Health informed he had diabetes and also was suffering from chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease , also known as chronic obstructive lung disease , chronic obstructive airway disease , chronic airflow limitation and chronic obstructive respiratory disease , is the co-occurrence of chronic bronchitis and emphysema, a pair of commonly co-existing diseases...
(COPD). She also informed the man was infected inside Costa Rica because he had not traveled to Mexico, and that a total 51 persons were identified who had contact with the sick man, but only three turned out positive.
The second fatality was a 35-year old woman, and she died on June 23, less than 24 hours after arriving to the emergency room at a local hospital. The woman was suffering of hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
and morbid
Obesity associated morbidity
Whether obesity should be considered a disease on its own, it is also an important risk factor for many chronic physical and mental illnesses.-Ischemic heart disease:Obesity is associated with cardiovascular diseases including angina and myocardial infarction...
obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
. A third patient died on June 29, a 55-year old man who presented chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease , also known as chronic obstructive lung disease , chronic obstructive airway disease , chronic airflow limitation and chronic obstructive respiratory disease , is the co-occurrence of chronic bronchitis and emphysema, a pair of commonly co-existing diseases...
due to smoking
Smoking
Smoking is a practice in which a substance, most commonly tobacco or cannabis, is burned and the smoke is tasted or inhaled. This is primarily practised as a route of administration for recreational drug use, as combustion releases the active substances in drugs such as nicotine and makes them...
. A 45-year old woman was the fourth fatality. She died on July 4.
The fifth death occurred on July 11. The patient was a 25-year old woman pregnant with twins. Both five-month old fetuses died hours before their mother did. The sixth fatality occurred on July 13, a 45-year old man. This was the first patient to died who was not suffering none of the risk factors previously identified in other deceased patients. The seventh confirmed fatality was a 24-year old man, who smoke and suffered obesity.
Current situation
As of October 15 health authorities had confirmed 38 fatalities, of which the last one took place on late September, and also the death of a Costa Rican woman in NicaraguaNicaragua
Nicaragua is the largest country in the Central American American isthmus, bordered by Honduras to the north and Costa Rica to the south. The country is situated between 11 and 14 degrees north of the Equator in the Northern Hemisphere, which places it entirely within the tropics. The Pacific Ocean...
was also confirmed. The mortality rate
Mortality rate
Mortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
is 0.85 deaths by 100,000 people, and the fatality rate is 2.48%. From all deceased patients, 47.3% occurred among San José
San José Province
San José is a province of Costa Rica. It is located in the central part of the country, and borders the provinces of Alajuela, Heredia, Cartago, Limón and Puntarenas. The provincial capital is San José. The province covers an area of 4,965.9 km²...
residents, and only the Guanacaste Province
Guanacaste Province
Guanacaste is a province of Costa Rica located in the northwestern part of the country, along the coast of the Pacific Ocean. To the north it borders Nicaragua. To the east is the Alajuela Province, and to the southeast is the Puntarenas Province. It is the most sparsely populated of all the...
has not had any deaths related to the virus. The age of the deceased varies between 20 to 79 year-old, with an average age of 41 years.
| total deaths by province and sex (April 23 to September 7, 2009) | |||||
|---|---|---|---|---|---|
| Provincia | Total | Femenino | Masculino | ||
| San José San José Province San José is a province of Costa Rica. It is located in the central part of the country, and borders the provinces of Alajuela, Heredia, Cartago, Limón and Puntarenas. The provincial capital is San José. The province covers an area of 4,965.9 km²... |
|||||
| Heredia Heredia Province Heredia is a province of Costa Rica. It is located in the north-central part of the country. As a result, the province covers areas as diverse as the agriculture rich Northern plains of San Carlos as well as the more metropolitan areas like the city of Heredia located in the Central Valley... |
|||||
| Alajuela Alajuela Province Alajuela is a province of Costa Rica. It is located in the north-central part of the country, bordering Nicaragua to the north, and clockwise the provinces Heredia, San José, Puntarenas and Guanacaste... |
|||||
| Limón Limón Province Limón is one of seven provinces in Costa Rica. The majority of its territory is situated in the country's Caribbean lowlands, though the southwestern portion houses part of an extensive mountain range known as the Cordillera de Talamanca... |
|||||
| Puntarenas Puntarenas Province Puntarenas is a province of Costa Rica. It is located in the western part of the country, covering most of Costa Rica's Pacific Ocean coast, and it is the largest province in Costa Rica. Clockwise from the northwest it borders on the provinces Guanacaste, Alajuela, San José and Limón, and the... |
|||||
| Cartago Cartago Province Cartago is a province of Costa Rica. It is located in the central part of the country. Bordering provinces are Limón to the east and San José to the west. The capital is Cartago and it was formerly the capital city of Costa Rica until 1823 when the capital was changed to San Jose... |
|||||
| Total | |||||
| Source: Dirección Vigilancia de la Salud. | |||||
Until early September, the most frequent risk factor
Risk factor
In epidemiology, a risk factor is a variable associated with an increased risk of disease or infection. Sometimes, determinant is also used, being a variable associated with either increased or decreased risk.-Correlation vs causation:...
s presented by the deceased patients are obesity
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...
(36.4%), diabetes
Diabetes mellitus
Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced...
(18.2%), asthma
Asthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
(18.2%), pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
(9.1%) and chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease , also known as chronic obstructive lung disease , chronic obstructive airway disease , chronic airflow limitation and chronic obstructive respiratory disease , is the co-occurrence of chronic bronchitis and emphysema, a pair of commonly co-existing diseases...
(6.1%).
External links
- Organización Mundial de la Salud (OMS): Gripe porcina The World Health OrganizationWorld Health OrganizationThe World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(Spanish site).