Flu epidemic affects at least 17 states in Brazil

The flu epidemic already affects at least 17 states in the country, which say they have noticed an unusual increase in visits for influenza in recent weeks. Instabilities in notification systems, however, do not allow us to know the size of this growth.

In addition to São Paulo and Rio de Janeiro, the places with the clearest advance of the disease or the highest number of infections with the H3N2 variant are Amazonas, Bahia, Espírito Santo, Minas Gerais and Rondônia, according to the survey carried out by leaf with all state health departments.

Only six units of the Federation claimed not to have noticed an increase in demand until this Thursday (23), half of them in the Midwest: Federal District, Mato Grosso and Mato Grosso do Sul, in addition to Sergipe, Tocantins, Ceará. Another four secretariats did not respond or did not confirm.

Despite the rapid expansion of the disease, few governments now see the situation as an epidemic. Most speak of alert, including the administrations of São Paulo and Bahia, which differs from the understanding of epidemiologists such as Paulo Lotufo, from the Faculty of Medicine at USP.

“Today the epidemic is already nationwide. It has broken out everywhere, there is no need to do an account. The records in December already indicate this, although there are departments denying it. It is necessary to guide the population”, he says. Care is the same as for Covid-19 — vaccine, mask, alcohol gel and distance.

Adding the numbers reported by the secretariats, the country registers at least 1,312 cases and 10 deaths from flu-like illness caused by the H3N2 strain, the main one in circulation. More than half of the cases (772) are in Amazonas, but the state did not detail whether the variant was confirmed in all of them by laboratory analysis, as in other places.

This national total is likely underreported. First, because virus identification is usually done by sampling. Second, because the care of patients with flu syndrome is not mandatory notification by the municipalities.

Outbreak situations, however, must be mandatorily notified to the states, as well as cases of severe acute respiratory syndrome (SRAG). The problem is that, with the hacker attack on the Ministry of Health, the health and surveillance units have not been able to notify or extract data for almost two weeks.

The parameter, then, is a perception of increased demand for health facilities. In Rio de Janeiro, where the influenza outbreak began, the daily average of consultations for flu-like illness jumped from 167 in early November to 5,112 in early December. Last week, it slowed to 4,094.

“Today we are calmer, but November and early December were very bad. It was almost overnight. We closed on a Friday, calm, Covid under control, and the next week there were five times more visits than the average”, he says Marcos Goldraich, doctor at a family clinic in the Rocinha favela.

So far, 362 cases and 36 deaths have been confirmed in the state this year, against 214 cases and 69 deaths in 2019 (considering all strains) —2020 was disregarded as it was an atypical year for other respiratory diseases.

Soon after, broadcasting started to grow in São Paulo. The state, according to preliminary data, still has fewer cases (665) and deaths (50) of SRAG from influenza than last year (713 cases and 74 deaths), but the numbers may be higher due to the problem in the system.

Bahia was another place that has already registered deaths from H3N2, of two elderly people over 80 years old who were not vaccinated — one of them with cardiac and neurological diseases. Until Tuesday (21), there were 185 patients confirmed in the state, of which 61 needed hospitalization, almost all in Salvador.

The advance of influenza together with Covid, which pressures demand in the UPAs, was one of the factors cited by Governor Rui Costa (PT) to cancel the 2022 Carnival. “You know that movie Missão Impossível? We’re in Missão Impossível 3”, stated. Despite this, the government does not treat the flu as an epidemic.

In part of the North of the country, the rainy season aggravated the transmission of the disease. “The Amazon is in the seasonal period, which corresponds to the intensification of rainfall in the Amazon region, therefore in the epidemic period for respiratory viruses”, informed the Amazonian secretariat, with 679 of the 772 cases of H3N2 this year concentrated in Manaus.

In the same region, Rondônia and Acre treat the increase as an outbreak. In December alone, the first state registered 485 cases of influenza A (not specified), up from 38 last year. The second had 93 notifications of this type this month alone, 37 of which were of the H3N2 variant.

Roraima highlights a jump from 13,701 to 16,876 in flu syndromes between 2019 and 2021, but does not confirm whether the growth was recently caused by the flu or because of Covid in the rest of the year, for example. There is no confirmation of the new strain in the state, but monitoring was reinforced.

Minas Gerais, on the other hand, noted the increase through the proportion of flu cases in emergency consultations, which rose from 12% in mid-September to 37% in early December. The central laboratory of the state (Lacen/MG) detected 67 positive samples for H3N2 in the last month.

“It can be said that we have in the state the anticipation of the seasonality of the flu with characteristics of local transmission, sustained by the influenza virus and also associated with the circulation of other respiratory viruses that cause flu syndrome”, informed the secretariat.

In Espírito Santo, there were 74 positive results for the variant so far (0.48% of the samples of suspected cases analyzed). Since the last 14th, the Espírito Santo government has been warning about the increase in the demand for assistance, insisting on the expansion of vaccination of priority groups.

Pernambuco stated that it had 43 records of the H3N2 virus since last Saturday (18th).

The south of the country, in turn, has 40 confirmed cases of the strain, with one death in Paraná of ​​a 77-year-old elderly woman who had been vaccinated in October. The three states in the region, however, reject the classification as an outbreak or epidemic.

“There is no reason to panic”, said the Secretary of Health in Paraná, Beto Preto, on Monday (20). “These cases are directly related to the low adherence of the population to vaccination, which, although not developed to prevent this H3N2 variant, increases immunity and makes infection by severe syndromes difficult,” he said.