WHO Region of the Americas (AMR) 2014-2015

As of fiscal year 2014, there are four bilateral influenza cooperative agreements in the WHO Region of the Americas. These agreements with ministries of health (MOH) or institutions designated by the MOHs work with the Pan American Health Organization (PAHO)/the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) to build capacity to routinely identify and respond to seasonal and novel influenza strains across the Americas.

Direct country support through non-research cooperative agreements is established in the following four countries:

In addition, CDC supports PAHO through a cooperative agreement. CDC also supports activities at the Center for Central America and Panama’s (CDC-CAP), Global Disease Detection (GDD) site in Guatemala. These activities support programs in eight Central American/Caribbean countries: Belize, Guatemala, El Salvador, Honduras, Nicaragua, Costa Rica, Panama, and the Dominican Republic.

The core activities of the bilateral agreements and technical assistance are:

To build sustainable national capacity to identify and respond to seasonal influenza, pandemic influenza and other emerging diseases in accordance with the International Health Regulations 2005 (IHR).
To make routine contributions of surveillance and virology data to WHO’s Global Influenza Surveillance and Response System (GISRS).
To increase the geographic reach of WHO GISRS.
To provide earlier access to critical virus isolates from humans and birds for WHO GISRS.
To increase the numbers of shipments and influenza isolates provided by local influenza laboratories for analysis by WHO Collaborating Centers (CC).
To develop sustainable epidemiologic and virologic surveillance systems for severe influenza in order to gain an understanding of the disease and economic burden caused by influenza and other respiratory viruses.
To develop and sustain interagency national preparedness plans.
To develop and train local rapid response and containment teams.
To sustain and leverage quality sentinel surveillance and study cohorts to explore the potential cost-effectiveness of expanding vaccination and incorporating new delivery mechanisms, formulations, and novel influenza vaccines in the PAHO Region.

In addition to our bilateral work, we also partner with the U.S. Naval Medical Research Unit No. 6 (NAMRU-6) in Lima, Peru to jointly support South American countries that are starting influenza surveillance.

Sara Mirza, PhD, MPH (until October 2015)
Epidemiologist
Extramural Program
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Atlanta, GA
Email: smirza@cdc.gov

Eduardo Azziz-Baumgartner, MD, MPH
Medical Officer/Epidemiologist
International Epidemiology and Research Team
Influenza Division, NCIRD
U.S. Centers for Disease Control and Prevention
Atlanta, GA
Email: eha9@cdc.gov

Susan Kaydos-Daniels, PhD, MSPH
Director, Influenza Program
U.S. Centers for Disease Control and Prevention – Central American Region
Guatemala City, Guatemala
Email: sqk3@cdc.gov

WHO Region of the Americas (AMR) Map

A map of the WHO Region of the Americas (AMR) shows all 35 AMR member states/countries. The member countries, include Antigua and Barbuda, Argentina, Bahamas, Barbados, Belize, Bolivia, Brazil, Canada, Chile, Columbia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago, United States of America, Uruguay, and Venezuela.

Countries with shading indicate that the Influenza Division provides project funding and technical assistance through cooperative agreements. Brazil, Mexico, Paraguay and Peru are shaded green to indicate Sustainability Cooperative Agreements. Belize, Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua and Panama are shaded pink to indicate that they receive indirect funding from the Division.

CDC Influenza Division Field Staff, indicated by a yellow dot, are located in the following cities: Washington, DC and Guatemala City, Guatemala.

The Global Disease Detection [GDD] Site, indicated by the red “X”, is located in Guatemala.

WHO National Influenza Centers (NICs), indicated by a purple dot, are located in Argentina (Buenos Aires, Córdoba, and Mar Del Plata), Brazil (Ananindeua, Sao Paulo, and Rio de Janeiro), Canada (Winnipeg), Chile (Santiago), Columbia (Bogota), Costa Rica (Cartago), Cuba (Havana), Ecuador (Guayaquil), El Salvador (San Salvador), France-French Guiana (Cayenne), Guatemala (Barcenus), Honduras (Tegucigalpa), Jamaica (Kingston), Mexico (Mexico City), Nicaragua (Managua), Panama (Panama City), Paraguay (Asunción), Peru (Lima), Trinidad and Tobago (Port of Spain), United States of America (Atlanta, Georgia), Uruguay (Montevideo), and Venezuela (Caracas).

The Pan American Health Organization (PAHO) Headquarters, indicated by a blue star, is located in Washington, DC (USA).

Launched SARInet (http://www.sarinet.org/), the regional influenza network, in May 2014.
Conducted the second annual SARInet Meeting in April 2015.
Established regional estimates of influenza disease burden, in depth analyses of seasonality, and improved data sharing and dissemination through SARInet collaborations.
Conducted SARInet technical webinars and disseminated quarterly newsletters.
Continued to implement the PAHO SARI Surveillance Protocol in more than 90 hospitals in 20 countries.
Developed an information system, PAHOFlu that generates automated outputs of case-based, integrated laboratory and epidemiologic data. Two Member States are using PAHOFlu and several others are using their own systems.
Conducted site visits to improve surveillance capacity in Colombia and Nicaragua. Future visits are planned for Chile, Costa Rica, Ecuador, Honduras, Paraguay, and Suriname.
Provided technical assistance on strengthening laboratory diagnostic capacity in Colombia, Ecuador, and Nicaragua.
Purchased laboratory equipment, reagents and supplies for many countries in the region.

The current five-year cooperative agreement, Surveillance and Response to Seasonal and Pandemic Influenza by Regional Offices of the World Health Organization (WHO), began in September 2011 and is now in its fourth year. The Pan American Health Organization (PAHO) is the WHO Regional Office for the Americas and is located in Washington, DC, USA. The Office serves 35 Member States, four Associate Members, and three Participating States.

In 2014–2015, technical cooperation activities centered on influenza and pandemic influenza preparedness through strengthening three pillars; epidemiology, laboratory, and analyses to estimate influenza disease burden.

In 2015–2016, PAHO will focus on supporting epidemiologic and laboratory capacity in the countries and developing influenza burden of disease estimates. Technical cooperation in strengthening epidemiologic capacity will include training in severe acute respiratory infections (SARI) surveillance and developing data-sharing bridges.

Laboratory activities will include support for immunofluorescence and real-time RT-PCR, including the detection of other respiratory viruses and building the laboratory networks, including the National Influenza Center (NIC) network and participation in WHO External Quality Assessment Project (EQAP) and CDC proficiency panel.

During the 2009 influenza pandemic, surveillance for severe respiratory disease became increasingly important. This was because cases in a hospital setting are easier to capture, are smaller in number than the milder ambulatory cases, and during a pandemic, information about severe cases is of paramount importance for making decisions about response. SARInet, a network of PAHO/AMR Member States that conduct SARI surveillance, was created in 2014. Since then, countries in the Americas have been eager to improve their SARI surveillance, and today 15 (43%) countries in PAHO are reporting data through WHO’s FluID platform.

Surveillance Activities

Shared weekly epidemiologic and laboratory data through SARInet (20 countries).
Conducted an updated training course on event surveillance for unusual respiratory illness and the development surveillance guidance for influenza-like illness (ILI).
Trained more than 20 healthcare workers (HCW) in Colombia and Nicaragua, with plans to train HCWs in Costa Rica, Honduras, Paraguay and Suriname.
Published an analysis of influenza-associated mortality in the region in a peer-reviewed journal.

Considering the challenges faced during the pandemic, technical cooperation was directed to increase the capacity in the laboratory to process specimens for real-time RT-PCR, through the purchase of automated extractors and vacuum extractors. PAHO has continued to support the strengthening of laboratory capacity for the diagnosis of influenza and other respiratory viruses, including through the limited decentralization of real-time RT-PCR for influenza, through refresher courses for real-time RT-PCR and immunofluorescence, and through participation in WHO’s EQAP. Through these activities, PAHO continued to strengthen the regional laboratory network, which now consists of 27 NICs in Latin America and the Caribbean.

Laboratory Activities

Worked with regional laboratories to strengthen the diagnostic capabilities for influenza and other respiratory viruses, through the provision of supplies, equipment purchases, and training.
Submitted over 700 samples from Latin America and the Caribbean to the WHO CC in Atlanta for characterization.
Participated in the 2014 WHO EQAP (32 NICs and laboratories from the Region).
Shared virologic data for influenza and other respiratory viruses with PAHO (20 countries).
Conducted laboratory evaluations using the CDC/APHL laboratory tool.

During the response to the Ebola virus disease (EVD) outbreak in West Africa, PAHO activated the emergency operation center (EOC) in Washington D.C. to coordinate preparedness activities in the region and provide support in the deployment of rapid response teams (RRT) to West Africa. The EOC serves as the point of contact for communication between technical areas and MOHs. PAHO continues to support all countries in creating situation rooms and EOCs to centralize data and coordinate preparedness activities. In the context of the EVD response, PAHO had the opportunity to evaluate preparedness for the spread of Emerging Infectious Diseases (EIDs) and the status of Member States’ core capacities under the International Health Regulations (IHR).

Preparedness Activities

Visited 25 countries for EVD preparedness assessments (November 2014 to January 2015). Country missions helped to detect gaps and provided an opportunity to prioritize essential public health functions.
Enhanced a regional stockpile of personal protective equipment (PPE) for potential use in emergencies in the region at the PAHO warehouse in Panama.

Conducted national, sub regional, and regional trainings on risk communication, clinical management and laboratory biosafety in the context of the EVD preparedness activities.

Dr. Sylvain Aldighieri
Unit Chief
IHR, Epidemic Alert & Response, and Water Borne Diseases
Pan American Health Organization
Washington, DC
Email: aldighsy@paho.org

Dr. Rakhee Palekar
Coordinator, Flu and Other Viruses (CDC Secondment)
IHR, Epidemic Alert & Response, and Water Borne Diseases
Pan American Health Organization
Washington, DC
Email: palekarr@paho.org

Dr. Jairo Mendez Rico
Advisor, Viral Diseases
IHR, Epidemic Alert & Response, and Water Borne Diseases
Pan American Health Organization
Washington, DC
Email: ricoj@paho.org

Dr. Mauricio Cerpa
Specialist, Influenza Surveillance
IHR, Epidemic Alert & Response, and Water Borne Diseases
Pan American Health Organization
Washington, DC
Email: cerpamau@paho.org

Dr. Angel Rodriguez
Specialist, Influenza Surveillance
IHR, Epidemic Alert & Response, and Water Borne Diseases
Pan American Health Organization
Washington, DC
Email: rodrigueza@paho.org

Dr. Robert Lee
Advisor, Policy Analysis and Program Planning
IHR, Epidemic Alert & Response, and Water Borne Diseases
Pan American Health Organization
Washington, DC
Email: leerober@paho.org

Mr. Travis High
Program Officer
IHR, Epidemic Alert & Response, and Water Borne Diseases
Pan American Health Organization
Washington, DC
Email: hight@paho.org

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