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.

This study aimed to evaluate the psychometric properties of the Grief Impairment Scale (GIS) using a network psychometric model. A total of 1048 individuals from Peru and El Salvador participated. A network psychometric model was used to determine internal structure, reliability, and cross-country invariance. The results indicate that the GIS items were grouped into a single network structure through Exploratory Graph Analysis. Reliability was estimated by structural consistency, and it was found that when replicating the network structure within an empirical dimension, a single network structure was consistently obtained, and all items remained stable. Furthermore, the network structure was invariant, thus functioning similarly across the different country groups. In conclusion, the GIS presented solid psychometric evidence of validity based on its internal structure, reliability, and cross-country invariance. Therefore, the GIS is a psychometrically sound measure of functional impairment symptoms due to grief for Peruvian and Salvadoran individuals.

Perinatal mortality is an indicator that reflects the impact of maternal and infant care in a country. This study presents nine cases of perinatal mortality that occurred in the municipality of Panchimalco, El Salvador. The information was obtained from audit reports. The mothers of the deceased infants were aged between 17 and 43 years, did not use contraceptive methods, had incomplete prenatal controls and averaged a gestational age of 31 weeks. Three deliveries were attended in the community. Most perinatal deaths occurred before delivery due to unknown causes, and live births were preterm. We identified factors such as deficits in comprehensive care for women. Further studies are needed to determine the main factors influencing perinatal deaths in El Salvador. Motivation for the study. It is necessary to understand the maternal and infant characteristics of perinatal deaths. Additionally, it is required to generate evidence that contributes to a better understanding of these events. Main findings. Nine cases of perinatal deaths with maternal-fetal risk characteristics were identified. Most deaths occurred before delivery, with prematurity predominating in the neonates. Implications. Understanding the maternal and infant characteristics of perinatal deaths is essential for developing preventive strategies aimed at reducing risk factors related to perinatal mortality.
La mortalidad perinatal es un indicador que refleja el impacto de la atención materno-infantil de un país. Este estudio presenta nueve casos de la mortalidad perinatal ocurridos en el municipio de Panchimalco, El Salvador. La información se obtuvo de los informes de auditorías. Las madres de los fallecidos tenían edades entre 17 a 43 años, sin uso de anticonceptivos, con controles prenatales incompletos y un promedio de edad gestacional de 31 semanas, tres partos fueron atendidos en la comunidad. La mayoría de muertes perinatales ocurrieron antes del parto de causa desconocida y los nacidos vivos fueron prematuros. Se identificaron factores como el déficit en la atención integral a la mujer. Se requiere de nuevos estudios para determinar los principales factores que influyen en las muertes perinatales en El Salvador. Motivación para realizar el estudio. Es necesario conocer las características maternas e infantiles de las muertes perinatales. Además, es fundamental generar evidencia que contribuya a una mejor comprensión de estos eventos. Principales hallazgos. Se identificaron nueve casos de muertes perinatales y con características materno-fetales de riesgo. La mayoría de las muertes ocurrieron antes del parto y predominó la prematurez en los neonatos. Implicancias. El comprender las características materno-infantiles de las muertes perinatales, es esencial para desarrollar estrategias preventivas orientadas a disminuir los factores de riesgo relacionados con la mortalidad perinatal.

Toxoplasma gondii is a parasitic infection that can be transmitted in utero, resulting in fetal chorioretinitis and other long-term neurological outcomes. If diagnosed early, pregnancy-safe chemotherapeutics can prevent vertical transmission. Unfortunately, diagnosis of acute, primary infection among pregnant women remains neglected, particularly in low-and-middle-income countries. Clinically actionable diagnosis is complex due to the commonality of infection during childhood and early adulthood which spawn long-last antibody titers and historically unreliable direct molecular diagnostics. The current study employed a cross-sectional T. gondii perinatal surveillance study using digital PCR, a next generation molecular diagnostic platform, and a maternal-fetal outcomes survey to ascertain the risk of vertical toxoplasmosis transmission in the Western Region of El Salvador. Of 198 enrolled mothers at the time of childbirth, 6.6% had evidence of recent T. gondii infection-85% of these cases were identified using digital PCR. Neonates born to these acutely infected mothers were significantly more likely to meconium aspiration syndrome and mothers were more likely to experience labor and delivery complications. Multivariable logistic regression found higher maternal T. gondii infection odds were associated with the presence of pet cats, the definitive T. gondii host. In closing, this study provides evidence of maternal T. gondii infection, vertical transmission and deleterious fetal outcomes in a vulnerable population near the El Salvador-Guatemala border. Further, this is the first published study to show clinical utility potential of digital PCR for accurate diagnosis of congenital toxoplasmosis cases.

BACKGROUND: This study examined population genetics of Aedes aegypti in El Salvador and Honduras, two adjacent countries in Central America. Aedes aegypti is associated with yellow fever, dengue, chikungunya, and Zika. Each year, thousands of cases of dengue are typically reported in El Salvador and Honduras.
METHODS: In El Salvador, collections were obtained from five Departments. In Honduras, samples were obtained from six municipalities in four Departments. Mitochondrial DNA cytochrome oxidase I (COI) was sequenced, and consensus sequences were combined with available sequences from El Salvador to determine haplotype number, haplotype diversity, nucleotide diversity, and Tajima\'s D. A haplotype network was produced to examine the relationship between genotypes.
RESULTS: In El Salvador, there were 17 haplotypes, while in Honduras there were 4 haplotypes. In both El Salvador and Honduras, Haplotype 1 is most abundant and widespread. In El Salvador, haplotype H2 was also widespread in 10 of 11 sampled municipalities, but it was not present in Honduras. The capital of El Salvador (San Salvador) and the eastern region of ES had the highest haplotype diversity of regions sampled.
CONCLUSIONS: Haplotype 1 and H2 each belong to different phylogenetic lineages of Ae. aegypti. The most geographically widespread haplotype (H1) may have been present the longest and could be a remnant from previous eradication programs. These data may contribute to future control programs for Ae. aegypti in the two countries.

A search for anti-trypanosomal natural compounds from plants collected in El Salvador, a country particularly endemic for Chagas disease, resulted in the isolation of five lignan-type compounds (1-5) from Peperomia pseudopereskiifolia. The lignan derivatives 1, 2, and 4 are new. Their absolute configuration was determined by chemical derivatization. Compounds 1, 5, 6, and 8 exhibited anti-trypanosomal activity against the amastigote form of T. cruzi comparable to that of the existing drug benznidazole.

UNASSIGNED: This study aimed to identify the areas with the highest concentration of traffic accidents and injuries in the San Salvador Metropolitan Area (SSMA).
UNASSIGNED: Traffic accidents were analyzed spatially by point location and by the sum of events in areas of 200 m2. The point location was analyzed by \"nearest neighbor analysis\", while the areas with the sum of traffic accidents were analyzed by Getis-Ord Gi* to obtain the hot spots. The resulting hot spots with the highest concentration of traffic accidents in the SSMA were evaluated in the field using an observation form to collect data on infrastructure and road safety characteristics.
UNASSIGNED: Five areas with the highest number of traffic accidents and injuries, mainly containing primary roads, were identified by analyzing 8191 traffic accidents reported between 2014-2018.
UNASSIGNED: The sites with the highest concentration of traffic accidents and injuries were characterized by considerably damaged road infrastructure and the lack of safety systems for drivers and pedestrians. The spatial analysis of traffic accidents and injuries can contribute to improve surveillance and road safety in the SSMA.
UNASSIGNED: Identificar las áreas de mayor concentración de accidentes de tránsito y lesionados en el Área Metropolitana de San Salvador (AMSS).
UNASSIGNED: Los accidentes de tránsito se analizaron espacialmente mediante la ubicación puntual y por la sumatoria de eventos en áreas de 200 m2. La ubicación puntual se analizó mediante «análisis de vecinos más cercanos», mientras que las áreas con la sumatoria de accidentes de tránsito se analizaron mediante Gi* de Getis-Ord para obtener los puntos calientes. Los puntos calientes resultantes con mayor concentración de accidentes de tránsito en el AMSS se evaluaron en campo mediante un formulario de observación de las características de infraestructura y seguridad vial.
UNASSIGNED: Al analizar 8191 accidentes de tránsito reportados entre 2014‒2018, se identificaron cinco áreas con mayor cantidad de accidentes de tránsito y lesionados, principalmente sobre vías primarias.
UNASSIGNED: Los sitios de mayor concentración de accidentes de tránsito y lesionados se caracterizan por una infraestructura vial con daños considerables y falta de sistemas de seguridad para conductores y peatones. El análisis espacial de los accidentes de tránsito y lesionados puede contribuir a mejorar la vigilancia y seguridad vial en el AMSS.

BACKGROUND: Despite maternal flavivirus infections\' linkage to severe maternal and fetal outcomes, surveillance during pregnancy remains limited globally. Further complicating maternal screening for these potentially teratogenic pathogens is the overwhelming subclinical nature of acute infection. This study aimed to understand perinatal and neonatal risk for poor health outcomes associated with flaviviral infection during pregnancy in El Salvador.
METHODS: Banked serologic samples and clinical results obtained from women presenting for labor and delivery at a national referent hospital in western El Salvador March to September 2022 were used for this study. 198 samples were screened for dengue and Zika virus IgM, and statistical analyses analyzed demographic and clinical outcome associations with IgM positivity.
RESULTS: This serosurvey revealed a high rate of maternal flavivirus infection-24.2% of women presenting for labor and delivery were dengue or Zika virus IgM positive, suggesting potential infection within pregnancy. Specifically, 20.2% were Zika virus IgM positive, 1.5% were dengue virus IgM positive, and 2.5% were both dengue and Zika virus IgM positive. Women whose home had received mosquito abatement assistance within the last year by the ministry of health were 70% less likely to test IgM positive (aOR = 0.30, 95%CI: 0.10, 0.83). Further, statistical geospatial clustering revealed transmission foci in six primary municipalities. Pregnancy complications and poor birth outcomes were noted among the dengue and/or Zika virus maternal infection group, although these outcomes were not statistically different than the seronegative group. None of the resulting neonates born during this study were diagnosed with congenital Zika syndrome.
CONCLUSIONS: The high rate of Zika virus detected among pregnant women and the lack of Zika-specific neonatal outcomes monitoring during a non-outbreak year highlights the need for continued surveillance in Central America and among immigrant mothers presenting for childbirth from these countries. As changing climatic conditions continue to expand the range of the disease vector, asymptomatic screening programs could be vital to early identification of outbreaks and clinical management of cases.

In 2010, El Salvador introduced legislation aimed at reforming the country\'s Child Protective System (CPS), with a focus on promoting deinstitutionalization.
The study aim was to explore the impact of deinstitutionalization on the Salvadoran CPS.
The study was conducted in El Salvador, granting authors unique access to key informants with extensive experience in the country\'s CPS. Unlike the United States, which is divided into states, El Salvador is divided into departments, and CPS providers were recruited from all 14 departments. Focus groups were facilitated in the East, West, and Central zones to ensure representation from all regions.
Qualitative semi-structured interviews (n = 26) were conducted in June/July of 2019, which were then followed by focus groups (n = 4) in August 2019. The analysis of the data employed a combination of deductive and inductive thematic coding methods.
CPS providers offered valuable insights, categorized into five main themes: (1) Strengths of El Salvador\'s CPS, (2) Deinstitutionalization policy encompassing socioenvironmental contextual factors, (3) Challenges in the deinstitutionalization process, including insufficient follow-up on deinstitutionalized children, (4) Recommendations from participants, highlighting the importance of enhancing stakeholder coordination/collaboration, and (5) The necessity for a paradigm shift, emphasizing the need to redefine the social contract on protecting children from child maltreatment.
The Salvadoran CPS requires substantial systemic changes. Encouragingly, key informants have demonstrated a commitment to reform not only the deinstitutionalization process but also the broader CPS system in El Salvador including case management and quality of care in institutional settings.

Record-breaking levels of asylum seeking by families with young children continue at the United States/Mexico border, particularly the Rio Grande Valley sector. In this Commentary, our aim is to increase awareness by providing child and adolescent mental health care providers with an update on current migrant conditions, bringing to light issues of family separation previously highlighted in the Journal.1 For context, our international group has collected data, via 3 large-scale studies funded by the National Institutes of Health, from more than 600 Latinx immigrants seeking asylum at the US/Mexico border in the last 4 years, during which levels of violence, climate disruption, and poverty in the Northern Triangle of Central America (ie, El Salvador, Guatemala, and Honduras) and Mexico have propelled high and sustained levels of asylum seeking in the United States. We contribute expertise in clinical psychology, Latinx psychology, attachment disruption, and public health, as well as this front-row perspective.