Author: Buck Banks

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]

From appointing his former campaign manager to keep his seat in the U.S. Senate warm to his televised man-hug with President Obama, Florida Gov. Charlie Crist’s latest smooth moves apparently are not sitting well with the state’s Republican base or its Independents as the run-up to the primary slowly approaches.

According to a new Quinnipiac poll released today, Fllorida Gov. Charlie Crist’s lead over former state house speaker Marco Rubio in the 2010 Republican U.S. Senate primary has been cut from 55 to 26 percent to 50 to 35 percent, but Crist still tops the leading Democrat, U.S. Rep. Kendrick Meek, 51 to 31 percent among all voters, while Rubio trails Meek 36 to 33 percent.

“Gov. Charlie Crist’s lead, which had been 29 points August 19, has come back down to earth. His margin is still formidable, but obviously Marco Rubio’s focus on convincing Republican conservatives that he, not Crist, is their kind of guy is bearing fruit,” said Peter Brown, assistant director of the Quinnipiac University Polling Institute.

“Among Republicans, 44 percent view Rubio favorably, 3 percent unfavorably, up from 24 to 6 percent August 19. But fully half don’t know enough about him to have an opinion. Filling in that blank slate for that half of GOP voters — positively by Rubio and negatively by Crist — will decide the nomination.

“Floridians now give Crist the worst overall job approval of his governorship, 59 to 31 percent, but governors of many other states would sell their first born — or at least their running mate — for numbers like that,” said Brown. “But because only Republicans can vote in the GOP primary, Rubio’s strong favorable/unfavorable ratio among Republicans is something that should worry the governor.”

Crist’s 51 to 31 percent lead over Meek is largely due to his 58 to 22 percent margin among independent voters. In a Rubio-Meek face-off, independents tip to the Republican by a small 31 to 27 percent margin.