had spread across Mexico's borders to the USA. It was when the USA confirmed seven cases of influenza A (H1N1) on April 24 that international agencies started to respond quickly.
Although it is difficult to reconstruct the hazy timeline of events, the Mexican experience has exposed delays and apparent flaws in procedures to detect disease outbreaks as set out in the International Health Regulations in 2007, which aimed to strengthen WHO's response capacity after the epidemic of Severe Acute Respiratory Syndrome.
PAHO spokesperson, Daniel Epstein, confirms that PAHO received alerts from Veratect on April 16, but defends criticisms that the agency was slow to act. “There was no time delay”, he said, “a cluster of influenza cases in one country does not necessarily have international significance”. 8 days later, laboratory tests done in Canada confirmed that 18 of the 51 tests from Mexican specimens for suspected A (H1N1) came back positive. 12 of those were found to have the identical genetic pattern as the influenza A (H1N1) viruses from California, explains Epstein. “These were crucial links”, said Epstein. 2 days later, WHO raised its alert level from 3 to 4 (of 6).
People have been ready to point the finger of blame. Miguel Angel Lezana, director of the National Epidemiology Center in Mexico City, has said PAHO should have acted more quickly based on the alerts about unusual outbreaks of seasonal influenza sent to the international agency in mid-April. However, on May 1, Mexico's health minister, José Ángel Córdova, put these remarks down to a “confusion” and downplayed any tensions while emphasising there had been “no contradictions or difficulty” between WHO and the Mexican health ministry.
Mexico's response to the outbreak has also been criticised. Agenor Álvares da Silva, head of the Brazilian National Health Surveillance agency, has questioned the slow response of Mexican health authorities since, he says, alarm bells had been raised in March, but international health authorities were only informed about a potential epidemic in mid-April.
Experts think that the new H1N1 virus—a hybrid of avian, porcine, and human influenza—originated in Mexico. However, the Mexican Government, has been keen to stress that unusual cases of influenza had been detected around the same time in both the USA and Mexico from the end of March onwards.
People wait to be checked for flu-like symptoms at Mexico City's Naval Hospital
Mexico City has been the epicentre of the A (H1N1) outbreak, but across the country, as of 0600 h GMT on May 4, there were 590 confirmed cases of infection, including 25 deaths, according to WHO.
Once the Mexican authorities declared a health alert on April 23, a flurry of measures primarily aimed at preventing people congregating in crowded spaces in Mexico City, were introduced over several days. Thousands of free face masks were handed out to the public. Crèches, schools, and universities were told to close their doors until May 6. Public events were cancelled and football matches played before empty stands. The city's 25 000 eateries were banned from serving all food apart from takeaways, and cinemas, gyms, bars, conference centres, and tourist sites were closed, in an attempt to curb the spread of the virus. Information booths and call centres were set up and screening rooms installed at Mexico City's international airport.
Government public awareness campaigns on the radio and television advise people with flu-like symptoms to stay at home and wash their hands well. This seems to be paying off. A local opinion poll said that 87% of Mexicans knew about the preventive measures implemented by the government, and that 84% believed the government has provided clear and sufficient information about the epidemic. Mexico City's 20 million residents have been taking government measures seriously. “While people have been complaining, they've been obeying the government's instructions”, said Julio Sotelo, commissioner of the National Institute of Health in Mexico City. “I would say there's fear but not public panic.”
