Byline: Loida Avelar Martinez

In the eastern zone of [El Salvador], there have been reports of patients with simultaneous infection [co-infection] of influenza A (H1N1) and classical dengue fever, confirmed by the Vice Minister of Health, Eduardo Espinoza. In total, there have been four such cases of
co-infection in the country nationwide.

Of these, two are from the eastern zone, and the other two are minors who were treated at the Benjamin Bloom Children’s Hospital months ago, said the health official.

A day earlier, the head of the Health Surveillance Unit, Julio Armero, said he feared that in Upire, Nueva Esparta (La Union), where a fourth outbreak of the virus had been reported to the Department, there was a cross of influenza A (H1N1) and dengue, which could lead
to a major outbreak.

The Vice Minister of Health, Violeta Menjivar, does not believe that there will be an intersection of the disease at the national level, because preventive sanitary measures have been implemented and reinforced, and there is a focus on identifying and finding
preventive processes.

Communication with Honduras has been established in order to implement joint sanitary policies and avoid a major outbreak related
to the flow of people, she said.

“In La Union, there are combined [infections with] (H1N1) and dengue, so we have concentrated efforts of monitoring, education, prevention and elimination of [mosquito] breeding sites,” said the deputy minister.

Also, the Ministry of Health closed the case of the 9-month-old infant that had died in Guajiniquil, and he was suspected of having
had H1N1. The mother took the infant from the [health center] before specimens were obtained, and, in addition, there was no autopsy. But the death was most probably due to H1N1 because three of the sisters of the child had H1N1, and one of them was also co-infected with dengue virus.

Up to the present, El Salvador has reported 6 deaths from dengue hemorrhagic fever and 22 from H1N1 infection.

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Communicated by:
ProMED-mail Rapporteur Mary Marshall

[This press report does not indicate whether the influenza cases described are consequences of infection by seasonal A (H1N1) influenza virus or the pandemic (H1N1) 2009 influenza virus. According to the PAHO Regional Update of 16 Oct 2009, trends of acute respiratory disease were reported as decreasing or unchanged in Central America, with the exception of El Salvador, which reported a new increasing trend. The intensity of acute respiratory disease was mostly low/moderate in Central America, again with the exception of El Salvador, which again reported high intensity [infection] ().

Therefore, it is likely that the La Prensa report refers to patients simultaneously infected with dengue virus and the pandemic (H1N1)
2009 influenza virus.

As of 16 Sep 2009, according to WorldPress (), so far this year (2009), El Salvador has reported 2431 confirmed cases of dengue fever, which constitutes a
significant increase from last year’s 927 cases.

Consequently, it not surprising that a number of co-infections have been recorded. Unfortunately, this report gives no description of the
course of the illnesses resulting from these co-infections, which appear to have been non-fatal (with the exception of one possible but
unconfirmed case of co-infection).

[Of note, the 18 Sep 2009 edition of China View
(ProMED archive no. 20090921.3322) reported that the 2431 cases are for the 1st 8 months of 2009, with the outbreak continuing.
Doubtless, there are more cases than that to date, as the DHF death total in this report is 6, versus 3 in the earlier report. Of
concern is that all 4 dengue virus serotypes are circulating in El Salvador at the time of this most recent report. - Mod.TY]