(January 14, 2011 - by Ralph Kurtenbach) A flu outbreak in Ecuador's highland and coastal regions is taxing capacities of hospitals, including HCJB Global Hands' health facility in the nation's capital, Quito.

The Health Ministry's National Director of Epidemiology, Juan Moreira, reported that of 900 respiratory patients tested, 61 were positive for the H1N1 strain of influenza A. H1N1 is the influenza strain that reached global pandemic proportions in 2009.

"The first cases [in December] showed in a 'rapid test' as positive for Influenza A," said Dr. Richard Douce, an infectious diseases specialist who serves as medical director of Hospital Vozandes-Quito (HVQ).

Tests at Ecuador's national laboratory, Izquieta Pérez, also revealed influenza A, but not H1N1. Then on Tuesday, Jan. 11, HVQ received confirmation that HVQ had in fact treated one case of H1N1.

"I believe that there was a shift in the predominant strain around the third week of December," said Douce.

"The hospital has been full, with no available beds for the last three weeks and lots of action in the intensive care unit," he added. "I understand that for some weeks, beds have not been available in any intensive care units in Quito, and we've had to turn patients away from our emergency room due to a lack of available beds."

Three people have died of proven influenza A, while another 12 have died with a clinical syndrome suggestive of influenza, but without laboratory confirmation. Under a triage system, patients suspected of influenza are issued masks or confined to a negative pressure isolation chamber to curtail transmission of the disease in the HVQ emergency room.

The hospital continues to serve as a sentinel site in Ecuador for the detection of the H1N1 virus as well as other emerging strains of influenza. During the last several years this surveillance has confirmed both H1N1 and an influenza A subtype, H3N2, at HVQ.

During the last several years the data collection has been done in collaboration with the U.S. Navy Tropical Disease Research Laboratory in Lima, Peru. "So surely we have H1N1 circulating now," Douce said. As many as four different flu viruses may be circulating simultaneously.

A Quito newspaper, El Comercio, reported earlier this week that Hospital Enrique Garcés in south Quito has indeed treated five patients for influenza A (H1N1). Staff members at that state-run facility are testing as many as 120 patients per day for influenza. Director Marco Ochoa said his staff has isolated a 14-bed area for those who require hospitalization.

Douce added that neighborhood clinics operated by HVQ have been swamped with flu cases. Staff members were vaccinating about 200 patients per day until the vaccine supply ran out. "The source of vaccines here in the city seems to have dried up," he said. "I was awaiting another supply of the flu vaccine just this morning, but I'm not certain that it arrived."

Amid Ecuador's flu epidemic, President Rafael Correa declared a healthcare state of emergency and allocated an additional US$400 million to the $1.2-billion Health Ministry budget. In a regular Saturday broadcast, the president did not blame the epidemic as factoring into the appropriation, but pointed to increased use of government health centers after outpatient visits were made free.

In this country of 12 million, 30 million outpatient visits were made in 2010, according to Correa. His administration has since announced plans to strengthen the infrastructure by intervention in 32 of the country's 127 state-run hospitals. The state of emergency is expected to last 60 days.

Sources: HCJB Global, EFE, El Comercio, El Telégrafo