Rhina Domínguez

Introduction. In El Salvador, there was a need to establish indicators that could provide an overview of the population’s mental health status. In response, the National Institute of Health led the implementation of the first National Mental Health Survey, becoming a pioneering effort in interinstitutional collaboration. This article documents the full scope of the first National Mental Health Survey experience, from its conception and methodological and operational design to fieldwork execution and the lessons learned throughout the process. Results. A total of 6837 households participated, yielding a response rate of 82.9%. Response rates varied across age groups and by sex: adolescents (63.5 %) and older adults (64.0 %) demonstrated lower levels of participation, as did adult men. These disparities posed challenges to representativeness and raise important considerations regarding potential barriers to participation. The implementation strategy integrated digital data collection tools, intensive training of field personnel, and close collaboration with local communities and institutions, which helped to overcome logistical barriers and foster trust at the community level. Conclusion. The first National Mental Health Survey establishes a robust baseline of mental health indicators to inform public policy and program development. The experience demonstrates that high-quality data can be produced in resource-limited settings through technical leadership, strategic partnerships, and strong institutional commitment, offering a replicable model for national mental health surveillance in similar contexts.

Mental health has been a relevant topic since 1940, however, its explicit visibility as a right began in the year 2000, when states were invited to recognize it as part of the right to health. Following this awareness-raising process, the Central American countries have developed public policies, based on their legislatures, for the creation of laws, regulations, plans and mental health policies. Currently, there is no analysis that describes the main historical events, legal framework and public policy on mental health as a right in Central America. The objective of the review is to identify main historical milestones, the current status and the challenges that persist in the region to strengthen the approach to mental health as a fundamental right of the populations. Search strategy, websites of Ministries of Health, Central American justice bodies, and Google Scholar and Google database, from 1949 to 2023. The construction of public policies on mental health in Central American countries presents advances, setbacks or stagnation according to their national context. There is still a poor political disposition in various Central American countries to promote a Mental Health Law or update existing mental health laws and documents.

Introducción. La discapacidad se acompaña de dificultades físicas, mentales, intelectuales o sensoriales. En el mundo se calcula que el 15 % de la población tiene algún tipo de discapacidad. Esta condición es un concepto dinámico que involucra la relación entre la persona, entorno físico y ambiente social. Objetivo. Determinar los factores asociados a gravedad de discapacidad en la Encuesta Nacional de Salud, El Salvador. Metodología. Estudio transversal analítico, a partir de la Encuesta Nacional de Salud 2021, incluyó a personas registradas con discapacidad en los ejes: vista, audición, caminar, cognición, autocuidado y comunicación, registrados mediante el cuestionario del Grupo Washington. Se utilizó estadística descriptiva, pruebas U de Mann Whitney; la asociación se determinó por Odds Ratio, intervalos de confianza al 95 % y valor de p < 0,05. Se construyó un modelo de regresión logística. Resultados. El 17,1 % de las personas presentaron discapacidad, el 58,4 % pertenece al sexo femenino y el 62,9 % a zona urbana. El tipo de discapacidad por indicador de gravedad con mayor frecuencia fue leve con el 63,7 %, el 37,4 % presentó dificultad funcional para ver y la prevalencia total de la condición de discapacidad en los ejes evaluados por la Encuesta Nacional de Salud fue de: 17,1 % (IC 95 %: 16,8-17,4). El factor que presentó mayor asociación fue la presencia de enfermedades crónicas con Odds Ratio de 2,1 (IC 95 %: 1,15-1,76) p < 0,05. Conclusión. La edad avanzada y la presencia de enfermedades crónicas fueron los factores asociados a la gravedad de la discapacidad.

COVID-19, caused by the SARS-CoV-2 virus, is a highly pathogenic emerging infectious disease. Healthcare personnel (HCP) are presumably at higher risk of acquiring emerging infections because of occupational exposure. The prevalence of COVID-19 in HCP is unknown, particularly in low- to middle-income countries like El Salvador. The goal of this study was to determine the seroprevalence of anti-SARS-CoV-2 antibodies among HCP in El Salvador just prior to vaccine rollout in March 2021. We evaluated 2176 participants from a nationally representative sample of national healthcare institutions. We found 40.4% (n = 880) of the study participants were seropositive for anti-spike protein antibodies. Significant factors associated with infection included younger age; living within the central, more populated zone of the country; living in a larger household (≥7 members); household members with COVID-19 or compatible symptoms; and those who worked in auxiliary services (i.e., housekeeping and food services). These findings provide insight into opportunities to mitigate SARS-CoV-2 risk and other emerging respiratory pathogens in HCP in El Salvador.

Purpose: The effectiveness of coronavirus disease 2019 (COVID-19) vaccination schemes and the combination of vaccines of various platforms for administering booster doses is still being studied since it will depend on the population's response to vaccines. We aimed to evaluate the safety, protection, and immunogenicity of the Salvadorean population's third dose booster COVID-19 vaccine and the potential benefit of homologous vs. heterologous regimens. Materials and Methods: This is an analytical observational cohort study in a population aged 18 to 65 years that was primarily vaccinated with AstraZeneca, Sinovac, or Pfizer/BioNTech. Volunteers were recruited (n= 223) and followed up for 3 months after receiving the 3rd vaccine (BNT162b2) as a booster. Adverse reactions were monitored, serum anti-spike immunoglobulin G (IgG) was assessed by chemiluminescence, and a polymerase chain reaction was carried out when subjects developed clinical signs. Results: The cohorts finally included 199 participants, and we observed only mild adverse effects in all cohorts. A significant increase in specific IgG levels was found after the booster dose in all cohorts. The heterologous scheme with Sinovac showed the greatest increase in antibody titer, and a decrease was observed in all participants after 3 months. During the follow-up period, 30 participants showed symptomatology compatible with COVID-19, but only four were laboratory-confirmed and they showed mild clinical signs. Conclusion: These findings indicate that the booster doses used were safe and promoted an immediate increase in immunogenicity, which decreased over time. The heterologous regimen showed stronger immunogenicity compared to the messenger RNA-based homologous scheme.

Dear editor: Nowadays, there are commercially available rapid carbapenemase tests that can generate results in less than two hours. One of these tests is Rapidec® CARBA NP, based on the direct detection of carbapenemase hydrolysis by carbapenemase-producing bacteria. The agility in detecting these enzymes is relevant in our country, as described in the article by Villatoro et al. in Alerta in 2018. They reported that carbapenemase-producing bacteria were isolated in 26 of 31 hospitals in El Salvador from 2014 to 20161. This test analyzed the presence of carbapenemases in 122 isolated samples belonging to the Enterobacteriaceae family, as well as in non-fermenting bacilli, with decreased susceptibility or resistance profiles to any of the following carbapenemics: ertapenem, imipenem or meropenem. These were analyzed from five hospitals in the public health network of El Salvador between March 2020 and August 2021.

Objective: To quantify rates of influenza illness and assess value of influenza vaccination among pregnant women in Panama and El Salvador.Methods: Pregnant women were enrolled and followed each week in a prospective cohort study to identify acute respiratory illnesses (ARI). Nasopharyngeal swabs obtained from women with febrile ARI were tested by reverse‐transcription polymerase chain reaction for influenza and other respiratory viruses.Results: We enrolled 2556 women between October 2014 and April 2017. Sixteen percent developed at least one ARI; 59 had two ARI, and five had three ARI for a total of 463 ARI. Women in El Salvador and Panama contributed 297 person‐years (py) and 293 py, respectively, during influenza circulation. Twenty‐one (11%) of 196 sampled women tested positive for influenza. Influenza incidence was 5.0/100 py (5.7/100 py in El Salvador and 4.3/100 py in Panama). Only 13% of women in El Salvador and 43% in Panama had been vaccinated against influenza before influenza epidemics (P < 0.0001).Conclusions: One in six pregnant women developed ARI and more than one in ten ARI were attributable to vaccine‐preventable influenza. While women were at risk of influenza, few had been vaccinated before each epidemic. Such findings suggest the utility of evaluations to optimize vaccine timing and coverage.

El Salvador, has been one of the last countries in the Americas to report COVID-19 cases. Since January 2020, the Government implemented a diversity of preventive measures, even before the reporting of the first cases. One of the foremost measures taken was the home quarantine for people with or without COVID-19 related symptoms. To avoid contagion, measures were taken to forbid the entrance of tourist to the country coming from China and other countries such as Italy, South Korea, Spain, Germany and Iran. Measures were intensified as the COVID-19 cases worldwide and particularly in Latin America were increasing. Testing to detect the COVID-19 was implemented in February 2020. On march 13th 2020, the Government issued a home quarantine at national level for 30 days. During that time, all kind of work, academic or tourism related activities were suspended, with the exception of those activities related to provide supplies for the pandemic. Crowds of people all over the territory were prohibited and the public and private health system external consultations were suspended giving priority to the sanitary emergency. On March 14th, the commercial flights were prohibited, and on March 17th all international borders and non-official points of entries were closed. Lately, and with the increment of positive cases in the central American region, a nationwide state of emergency was pronounced. On March 18th the first COVID-19 positive case was identified in the country, a Salvadorean national coming from abroad. The first quarantine lost effect as of April 11th, being prorogated for four days to give time to the National Legislative Assembly to discuss a new quarantine. A second 15 days quarantine was approved, which was prorogued for another 15 days on April 30th. As of June 16th, the population was allowed to circulate and do some activities with some restrictions and the recommendation to implement biosecurity measures such as the personal distancing, use of masks and hand sanitizers. Measures were applied in commercial establishments, offices, public transportation and public areas, to reduce the infection risk for the population. The public and private industries and academic sectors adopted the strategy of home working for most of their employees. Notwithstanding, every day activities were gradually reestablishing and, for the end of the year 2020, all activities were almost completely regained, except the academic activities of the public and private education sector, which continued in a virtual mode. According to government data, once the house quarantine was over, the contagion increased. During the first week of August, the first epidemiological curve presented a maximum of 449 cases. Lately, a rapid reduction of positive cases started, presenting a very different performance from what was expected. On the second week of September, a new increment was observed, reaching 330 daily cases. All countries around the world presented under reporting of cases and deaths due to the magnitude of the pandemic emergency. Some countries have taken steps to undertake seroprevalence studies to develop an approximation to the real number of deaths by COVID-19. In El Salvador, the official reporting of COVID-19 suspicious deaths has been made based on data from those who died having being tested and confirmed by RT-PRC tests. The epidemiological surveillance of new COVID-19 cases, has been strengthened through the installation of mobile booths for sampling. This can present an impact on cases, given that asymptomatic cases can be easily detected, providing the opportunity to take epidemiological measures when necessary. Nevertheless, distribution and use of tests should be made taking into consideration the epidemiological aspects, priorities, and the identification of suspected cases, populations at risk, age groups and so forth. The impact of the pandemic has bared a toll upon the health system, the economy and the social ways of the population. General consultations were temporarily suspended as well as those related to specialties, being evident in the reporting system, where consultations, controls and new case reports have diminished. The population will be affected if they are not attended in their health needs by an adequate medical consultation or control, and can adopt a self-medication behavior developing other types of illness or worst, the resurgence of contagious diseases which were already controlled under a strict surveillance in pre pandemic time. Despite all preventive measures implemented to reduce the risks of transmission, it is difficult to determine if they have had a positive impact in the pandemic control, due to a diversity of factors such as the pandemic occurrence and intensity, availability of laboratory tests, the characteristics of the country and of the Salvadorean population, which can be different from other countries. Notwithstanding, it is important to continue developing research that can lead to the prevention of the illness. In the following years, no doubt, the social and economic impact will be perceived by the population in general, and particularly by those in conditions of vulnerability; therefore, early mitigation measures are in order to deter the negative sequels of the pandemic. Finally, it is important to highlight the fact that the results concerning the pandemic care in the country should be presented to the attention of different scientific media given that this is the way to scientifically and epidemiologically report it, to contribute to the decision making for a better understanding and a better approach to the pandemic in El Salvador and other countries. Therefore, the country’s scientific community must take this opportunity to make the best with the scientific information and platforms for the publication of their research, data and epidemiological analysis.