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 Mexico (Spanish language, Spanish: México), officially the United Mexican States, is a List of sovereign states, country in the southern portion of North America. It is borders of Mexico, bordered to the north by the United States; to the so ...

and the states of

California California is a state in the Western United States, located along the Pacific Coast. With nearly 39.2million residents across a total area of approximately , it is the most populous U.S. state and the 3rd largest by area. It is also the m ...

and

Texas Texas (, ; Spanish: ''Texas'', ''Tejas'') is a state in the South Central region of the United States. At 268,596 square miles (695,662 km2), and with more than 29.1 million residents in 2020, it is the second-largest U.S. state by ...

in the

United States The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country Continental United States, primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., ...

. On April 28

Costa Rica Costa Rica (, ; ; literally "Rich Coast"), officially the Republic of Costa Rica ( es, República de Costa Rica), is a country in the Central American region of North America, bordered by Nicaragua to the north, the Caribbean Sea to the no ...

became the first

Central America Central America ( es, América Central or ) is a subregion of the Americas. Its boundaries are defined as bordering the United States to the north, Colombia to the south, the Caribbean Sea to the east, and the Pacific Ocean to the west. ...

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 A vaccine is a biological preparation that provides active acquired immunity to a particular infectious or malignant disease. The safety and effectiveness of vaccines has been widely studied and verified.

developed by Swiss pharmaceutical

Novartis Novartis AG is a Swiss-American multinational pharmaceutical corporation based in Basel, Switzerland and Cambridge, Massachusetts, United States (global research).name="novartis.com">https://www.novartis.com/research-development/research-lo ...

. The local sample will include 784 Costa Ricans ages 3 to 64. Besides Costa Rica, this vaccine prototype will be tested also in

and the

. On August 11, it was confirmed that Costa Rica's president, Óscar Arias Sánchez, was infected with the A(H1N1) virus, becoming the first

head of state A head of state (or chief of state) is the public persona who officially embodies a state Foakes, pp. 110–11 " he head of statebeing an embodiment of the State itself or representatitve of its international persona." in its unity and ...

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 The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georg ...

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 is a country in North America. Its ten provinces and three territories extend from the Atlantic Ocean to the Pacific Ocean and northward into the Arctic Ocean, covering over , making it the world's second-largest country by to ...

, 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 (), officially the City of Boston, is the state capital and most populous city of the Commonwealth of Massachusetts, as well as the cultural and financial center of the New England region of the United States. It is the 24th- mo ...

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

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

°C The degree Celsius is the unit of temperature on the Celsius scale (originally known as the centigrade scale outside Sweden), one of two temperature scales used in the International System of Units (SI), the other being the Kelvin scale. The d ...

and patients with respiratory difficulties, as the main objective now is to reduce mortality rather than avoid contagion. ''As a result of new health policies, statistics regarding the number of cases will no longer reflect the total number of actual cases as the Ministry of Health decided to concentrate testing only on patients with risk factors and critical cases, beginning July 11, 2009.'' 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 The Catholic Church, also known as the Roman Catholic Church, is the List of Christian denominations by number of members, largest Christian church, with 1.3 billion baptized Catholics Catholic Church by country, worldwide . It is am ...

, and in order to prevent a massive contagion, prohibited the traditional

pilgrimage A pilgrimage is a journey, often into an unknown or foreign place, where a person goes in search of new or expanded meaning about their self, others, nature, or a higher good, through the experience. It can lead to a personal transformation, aft ...

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

developed by Swiss pharmaceutical

. The local sample will include 784 Costa Ricans ages 3 to 64. Besides Costa Rica, this vaccine prototype will be tested also in

and the

. 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 The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...

, 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 had other chronic diseases. The Minister of Health informed he had

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

and also had

chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...

(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 had

hypertension Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high b ...

and was morbidly

obese Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...

. A third patient died on June 29, a 55-year-old man who presented

due to

smoking Smoking is a practice in which a substance is burned and the resulting smoke is typically breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have b ...

. 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 die who did not have any of the risk factors previously identified in other deceased patients. The seventh confirmed fatality was a 24-year-old man, who smoked and was obese.

Later fatalities

As of October 15, 2009 health authorities had confirmed 38 fatalities, the last one having taken place in late September, and also the death of a Costa Rican woman in

Nicaragua Nicaragua (; ), officially the Republic of Nicaragua (), is the largest country in Central America, bordered by Honduras to the north, the Caribbean to the east, Costa Rica to the south, and the Pacific Ocean to the west. Managua is the coun ...

was also confirmed. The

mortality rate Mortality rate, or death rate, is a measure of the number of deaths (in general, or due to a specific cause) in a particular population, scaled to the size of that population, per unit of time. Mortality rate is typically expressed in units of d ...

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 Guanacaste () is a province of Costa Rica located in the northwestern region of the country, along the coast of the Pacific Ocean. It is bordered by Nicaragua to the north, Alajuela Province to the east, and Puntarenas Province to the southeast. I ...

has not had any deaths related to the virus. The age of the deceased varies between 20 and 79 years, with an average age of 41 years. Until early September, the most frequent

risk factor In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection. Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often u ...

s presented by the deceased patients are

obesity Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's ...

(36.4%),

(18.2%),

asthma Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, co ...

(18.2%),

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ...

(9.1%) and

(6.1%).

References

External links

Organización Mundial de la Salud (OMS): Gripe porcina
The

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...

(Spanish site). {{DEFAULTSORT:2009 Flu Pandemic In Costa Rica Costa Rica Disease outbreaks in Costa Rica 2009 in Costa Rica