zoom RSS 豚インフルエンザ患者0 エドガー・ヘルナンデス/メキシコ医療事情

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画像 エドガー・ヘルナンデスÉdgar Hernández 5才は、3月9日に始まったブタインフルエンザ感染のLa Gloriaでの数百人の一人であるが、メキシコ政府はメキシコでの最初の患者と確認した。
 地域住民は発症当時に公衆衛生当局が重大なものではないと安心させていたことを非難している。Édgar Hernándezが発症してから1週間たって他の地域に拡大して初めて問題だと認識したことを当局は認めている。
 La Gloria からは多くの移民が米国へ行っている。メキシコの疫学者には、米国からこの地域にウイルスが持ち込まれたという理論もあると言うものもいる。メキシコ政府の主任疫学者Dr. Miguel Ángel Lezana は、Édgarが病気になる前に、サンディエゴの別の人が感染していた可能性があると言った。
 火曜日、世界中でブタインフルエンザの新たな感染者数の増加が報告された。米国では月曜日に50人だったのが64人となり、そのうちニューヨーク州で45人となった。死者は出ていないが、5人が入院している。メキシコ健康省は、2,498人の疑い例、死者は159人となった。大きな養豚場のある La Gloria では3月と4月始めに2人の子どもが死亡したが、Édgar の感染したウイルスと同じ株によるものか特定できていないため、住民は困惑したままである。
画像 月曜日、地域の医師はMrs. Hernández に対して息子はインフルエンザにはかかったが、ブタインフルエンザではなかったと言ったという。しかし、数時間前にÉdgarをチェックするために 知事Gov. Fidel Herrera Beltrán がやってきた。週末には公然と、Édgar がブタインフルエンザ陽性と判明したと言い、保健局長は La Gloria の少年が陽性と判明し、回復したと月曜日に確認したと言った。
 実際には、保健当局に緊急事態を報告したのはÉdgarのケースではなく、オアハカOaxaca の病院に入院した39歳の女性María Gutiérrezのケースだった。4月13日に死亡し、1週間後アトランタのCDCがブタインフルエンザ患者が南カリフォルニアで現れたことをメキシコ当局に通知し、テストするために、Gutiérrezさん、Édgar、およびメキシコシティの患者のサンプルをカナダの検査施設に送った。先週木曜(4/23)午後に結果が出て両者が新型ウイルス陽性と判明した。フェリペカルデロン大統領のオフィスで緊急会合が開かれ、夕方までに首都周辺での学校閉鎖を発表した。
 政府がブタインフルエンザの流行を確認する1ヶ月以上前に、小学校で先生である Verónica Ramosはすでに、La Gloria での異常事態に気づいていた。最初に、4学年の女子が病気になり、それから、そのクラスの半分以上に症状が出た。女の子の姉妹は熱、咳、痛みによって倒れ、その後すぐ、学校の300人の生徒の3分の1が病気となった。こんなに多くの生徒が急に病気になることは今までなかったと言う。

From Édgar, 5, Coughs Heard Round the World
Adriana Zehbrauskas for The New York Times

Édgar Hernández, second from right with his family, was one of hundreds of people in La Gloria who came down with flulike symptoms in an outbreak that federal officials say began March 9.

Published: April 28, 2009

LA GLORIA, Mexico ― Édgar Hernández can rattle off the fierce flu symptoms he suffered a few weeks back, like a boy far beyond his five years: His head was hot. He coughed until his belly and his throat were sore. He did not want to eat, which was strange for him, someone who gobbles up everything he can.

Édgar Hernández of La Gloria, Mexico, may have had the first case of swine flu this year.

“I was very bad,” he said Tuesday, with his worried parents looking on.

“I feel good now,” he said later, flashing a smile.

The government has identified Édgar as the first person in Mexico to have become infected with a virulent strain of swine flu, a notoriety that could raise questions about how Mexican officials reacted ― or failed to react ― to the early stages of what might become a global epidemic.

Édgar was one of hundreds of people in La Gloria who came down with flulike symptoms in an outbreak that federal officials say began March 9.

Local residents accuse public health officials of discounting the outbreak at the time, reassuring them that it was nothing grave.

Federal officials said they did respond quickly, though they acknowledged that they took the matter more seriously after the virus infected people in another part of the country, which was at least a week after Édgar developed symptoms.

Among the many unknowns about the flu that struck Édgar are whether it could have set off more alarms early on, and whether it could have been contained if it had.

La Gloria may not, in the end, be found to be the source of anything. The village has many immigrants in the United States. Mexican epidemiologists say one theory is that someone who had been in the United States brought the virus back to the community.

Before Édgar fell ill, another person in San Diego may have been affected, said Dr. Miguel Ángel Lezana, Mexico’s chief government epidemiologist.

Even now, Édgar’s mother, María del Carmen Hernández, said she received conflicting accounts of the exact illness that kept her son in bed for three days. No one has explained what she should be doing to keep him and the rest of the family healthy, she said, signs that Mexico’s response effort may be spotty, especially in rural areas.

“Some people are saying my boy is to blame for everyone else in the country getting sick,” said Mrs. Hernández, 34, a blank stare on her face as she recounted the family’s ordeal. “I don’t believe that. I don’t know what to think.”

There was a modest increase on Tuesday in new cases of swine flu reported around the world.

In the United States, the number of confirmed cases rose to 64, from Monday’s count of 50, according to a news briefing by Dr. Richard E. Besser, acting director of the Centers for Disease Control and Prevention. The total includes 45 cases in New York State. There have been no deaths from the disease in the United States, but five people have been hospitalized for treatment.

Mexico remains the hardest hit. Late Tuesday, the Health Ministry put the number of suspected cases at 2,498, and the suspected number of deaths at 159.

In La Gloria, a town that has a major pig farming industry, two children died of the flu in March and early April, though the authorities said they had yet to determine whether it was the same strain that infected Édgar and spread widely to other locales. That and other questions have left residents here unnerved and confused.

Each knock on the door brings a surprise to the Hernándezes: fumigators who sprayed her home but did not tell her for what; scientists who asked to take a swab of Édgar’s throat; even the governor of Veracruz, who arrived by helicopter on Monday with an entourage in tow and left Édgar with a soccer ball and a baseball cap.

On Monday, the local physician who treated Mrs. Hernández told her that her son had influenza, but that it was not the swine flu virus, she said. But a few hours before, Gov. Fidel Herrera Beltrán walked right into her home to check on Édgar. He had said publicly over the weekend that Édgar had tested positive for swine flu, and Health Secretary José Ángel Córdova had confirmed on Monday that a boy from La Gloria, whom he refused to identify, had tested positive and then recovered.

“Shouldn’t they tell the mother first?” Mrs. Hernández asked as her younger son, Jonathan, 3, let out a cough of his own.

In fact, it was not Édgar’s case that tipped off health officials to the emergency. It was the case of a 39-year-old woman, who went into a hospital in Oaxaca with an unusual viral infection, that prompted Mexico’s epidemiologists to act.

The woman, María Gutiérrez, had gone to the hospital after initially falling ill days before and visiting several doctors without getting help. After tests revealed an unusual illness, medical personnel isolated her and notified state and federal officials.

She died April 13. A week later, the Centers for Disease Control in Atlanta notified Mexican officials that swine flu cases had turned up in Southern California, and they sent samples from Ms. Gutiérrez, Édgar and a patient in Mexico City to a Canadian lab for testing.

La Gloria sends many immigrants to the United States.

The results came back last Thursday afternoon, and both Ms. Gutiérrez and Édgar were found to have tested positive for a new strain of virus.

“The situation changed dramatically,” Dr. Lezana said.

A crisis meeting was called at the office of President Felipe Calderón. By that evening, officials announced the closing of schools in and around the capital, where the bulk of the cases were seen. Now, as the cases continue to come in, all of Mexico’s schools are closed.

“My impression ― as an external observer, and that’s what I am now ― is that the response has been quite competent,” said Dr. Julio Frenk, a former Mexican health minister who is now dean of Harvard’s School of Public Health. “Not perfect,” he continued, “but quite competent.”

Mexico has acted swiftly since the new flu strain was confirmed.

But officials acknowledge that the country lacks enough health workers to do as much outreach as they would like, and that the country has been unable to even test for the new strain of virus.

It was only this week that two laboratories, one in Mexico City and one in Veracruz, obtained the reagents to do their own checks on the new virus, rather than having to rely solely on epidemiologists in the United States and Canada.

“We never had this kind of epidemic in the world,” Mr. Córdova, the health secretary, responded testily to reporters this week when questioned about the handling of the crisis.

Epidemiologists are likely to have many leads to follow in determining how and where the flu originated.

La Gloria was not alone in experiencing a fierce outbreak in recent weeks. Public health officials in other parts of Mexico said they had noticed an unusual spike in cases in the beginning of April, when the normal flu season would usually be ending.

More than a month before the government confirmed the outbreak of swine flu, Verónica Ramos already knew something was amiss in La Gloria, where she is a teacher at the elementary school.

First, she said, a fourth-grade girl became sick; then more than half of that class had symptoms. The girl’s sister came down with fever, a cough and aches. Soon, one-third of the school’s 300 students were ill.

“Children get sick, I know that,” Ms. Ramos said. “And they infect each other. But it’s not common for so many to get sick so fast.”


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