Notes on H1N1 in Brazil

In Brazil I had dinner with two former fellows and their colleagues, where I gained new insights into the H1N1 situation in Latin America. Here there has been an upsurge of reported cases. This increase appears to correlate with vacationers returning from Argentina and Chile with the virus.

The Brazilian government is managing the outbreak in a way unlike any other country I have examined. Patients with influenza-like illness (ILI) (i.e. fever with either cough or sore throat) in São Paulo, a mega-city of approximately 15 million, can be screened—by law—at only seven hospital emergency rooms.

Here, patients are screened using an immunoblot procedure with a sensitivity of 70 percent. The Oseltamivir drug is administered if (and only if) a patient with a positive screen also has some defined high-risk factors. A confirmation polymerase chain reaction (PCR) test is then done and sent to a single lab, responsible for the entire city’s PCR evaluation. It takes more than ten days for the PCR results to become available.

To me, the most troubling issue is that infectious disease specialists here cannot write a prescription for Oseltamivir or screen for flu. The government grants this authority only to the physicians at the seven designated emergency departments.