With 980 deaths from dengue, Brazil approaches a record in one year

The year 2022 is already one of the worst in Brazil in terms of dengue. Until the 10th of this month, there were 1,406,022 probable cases of the disease and 980 confirmed deaths –another 94 are under investigation–, a level similar to that of 2015, when there was a record 1,688,688 probable cases and 986 deaths.

“We are experiencing the biggest dengue epidemic in our history. We are going to break the record and reach the sad mark of a thousand deaths from dengue in just one year”, says infectologist Alexandre Naime Barbosa, professor of medicine at Unesp and vice-president President of SBI (Brazilian Society of Infectology).

Data from the Ministry of Health show that the Midwest region has the highest incidence rate, with 2,005 cases per 100,000 inhabitants. Then come the South (1,045 cases), Southeast (514 cases), Northeast (422 cases) and North (257 cases).

“People are not seeing the risk and an alert needs to be issued. The population needs to be made aware, governments need to act and health teams need to be prepared to respond because we are going to have a very large flow of patients now that it has started to rain in the Southeast region”, says Barbosa.

In Brasilia alone there are 67,895 probable cases. Afterwards, there are Goiânia, with 53,657; Aparecida de Goiânia (GO), with 25,416; Joinville (SC), with 21,420; Araraquara (SP), with 21,031; and São José do Rio Preto (SP), with 19,887.

“We are experiencing global warming and the mosquito has reached regions where we did not have dengue before,” says Barbosa. “Meteorologists are warning that it will be a very rainy summer and 2023 will start with a big dengue epidemic.”

The forecast by Alberto Chebabo, president of SBI, also points to difficult months. “We are going to have a major epidemic in 2023”, he points out, noting that the peak of cases occurs between March and May.

This year is also the third with the most probable cases of chikungunya, another disease transmitted by the Aedes aegypti🇧🇷 There are 170,716 records, just below the total observed in 2016 (277,882) and 2017 (185,593). Until December 10, there were 90 deaths from the disease.

For infectologists, growth is related to a set of factors. They say, for example, that mosquito control actions were practically ended with the onset of the pandemic. Without the awareness campaigns, dengue was forgotten and the reduction in care favored the increase in the mosquito population.

Barbosa says that, in the last four years, the Ministry of Health has not invested in prevention campaigns to reinforce the need to eliminate outbreaks of aedes aegypti. The infectologist also mentions that the lower number of cases and deaths in 2021 led to a false sense of security and a change in the individual perception of risk, and that the SBI warnings throughout the year were ignored by the press, the population and mainly by the public. managers.

“I participated in a congress with the health secretaries in May and warned that we could reach a thousand deaths. Was investment made in the campaign after that? No”, he criticizes. He also mentions the lack of coordination between the federal government, states and municipalities for actions such as visits by health agents and carrying out smokes.

Furthermore, the increase coincides with the disease cycle, which peaks at approximately three-year intervals, as the circulating type changes –dengue has four serotypes.

For example: there is a wave now, which means that we will have a very large number of people infected with the serotype that is circulating. In the coming years, part of the population will still have temporary immunity to this strain and cases will drop, but then another serotype will come along and the process will start all over again.

For experts, the cycle will only be broken after there is a widely used vaccine available. Currently, there is Sanofi on the private market, but it can only be applied to people who have already had dengue.

The other two vaccines on the horizon are Takeda’s, which submitted the registration request to Anvisa (National Health Surveillance Agency) in 2021, and Butantan’s, still in the testing phase.

Infectologists say that Takeda’s showed good efficacy rates and could be studied for use in public health, since it does not require previous contact with the virus.

Butantan’s vaccine, on the other hand, is seen with optimism and caution.

According to information released by the institute, the vaccine is 79% effective in preventing the disease even after two years of application. The data, however, have not yet been sifted by other researchers, which will happen when they are submitted to a scientific journal. It also weighs the fact that the study is still ongoing.

Actions

Questioned, the Ministry of Health states that it monitors the epidemiological situation of arboviruses and invests in various actions to combat the mosquito, such as prevention campaigns, distribution of insecticides and larvicides to states and municipalities, and meetings with managers to assess the scenario and strategies for combat.

The folder argues that the number of cases is impacted by epidemic peaks, which have been increasing in periods that are repeated every 3 to 5 years, and that it is important to consider lethality. In this sense, it highlights that the years 2014 and 2017 had a fatality rate higher than that of 2022, respectively 0.080, 0.077 and 0.069.

The São Paulo State Health Secretariat, in turn, indicated that in 2022 it made available more than R$ 200 million to support municipalities in the fight against dengue, zika and chikungunya, in addition to mobilization actions.