The number of dengue cases has skyrocketed in Brazil, and the reagent used to carry out the exam that confirms the disease is out of stock in the public and private network.
According to the Ministry of Health, the delivery of new molecular kits for the diagnosis of dengue, chikungunya and zika is scheduled for June, but supplies for treatment have been sent.
According to the latest federal epidemiological bulletin (week 18), probable notifications tripled compared to the same period last year (up 146.5%, from 307,133 to 757,068 cases).
Cases reported to the Union by municipalities and states rose 56.7% (from 542,970 to 850,657 patients) and confirmed cases increased by 65.7% (from 254,836 to 422,342 contaminated).
The recommendation of the Ministry of Health at the moment is that dengue cases are “confirmed by laboratory criteria or by clinical-epidemiological criteria”, according to a document from the folder.
For places where it is not possible to perform laboratory tests, “the recommendation is to follow the diagnostic protocols by clinical criteria, notifying the suspected case with the diagnosis by clinical-epidemiological criteria”.
The note also says that in the “impossibility of carrying out specific laboratory confirmation or for cases with inconclusive laboratory results, confirmation by epidemiological link with a laboratory confirmed case should be considered”.
In São Paulo, the number of confirmed dengue cases remained stable, but deaths from dengue rose from 41 to 77 (an increase of 87.8%). The state recorded in 2022, until May 2, 107,400 cases of dengue against 104,000 cases in the same period of the previous year.
The São Paulo State Department of Health said that it “sent letters to the federal agency to send new tests, but there was no sign of a new delivery” and that the “acquisition and distribution of tests for the detection of dengue are the responsibility of the Ministry of Health”. “, with the state government “only redistributing the item”.
Also according to the folder, the lack of the exam does not prevent the clinical diagnosis or treatment of the patient by the municipalities and that the “suspension of serology collection for non-serious cases is already provided for in the guidelines for the prevention and control of urban arboviruses in the state” .
The state’s CVE (Center for Epidemiological Surveillance) ranks cities with higher-than-expected cases for their seasonal dengue history.
This list is used to define where the collection of samples for confirmation of the diagnosis by serology will be suspended, even when the reagent is available.
The ranking is not disclosed, according to the state, as it is a very dynamic update table — it is necessary to have been for four consecutive weeks with a higher-than-expected increase in cases, and the entry and exit of cities is constant.
This is the case of Barretos, a municipality in the interior, 233 km from the capital of São Paulo, which this week was declared a dengue epidemic by the state.
With the high number of suspected cases, tests are no longer carried out in the city. The city’s municipal health secretary, Kleber Rosa, said that now patients who seek the public health network with three or more symptoms of the disease will receive direct treatment.
“Even without the specific test for dengue, we will continue to do the blood counts to control the platelets of patients”, said Rosa.
In Ribeirão Preto, which has kept dengue rates low in the last two years, the total number of patients with dengue symptoms also skyrocketed.
In the emergency care of the private health plan Unimed Ribeirão, the daily demand for testing for the disease grew seven times compared to the same period last year and at least since Monday the network has been without reagents.
In a statement, the network said that “the non-supply of specific laboratory supplies for the NS1 test is momentary”, “generalized due to the high demand of dengue cases in the region in recent days” and that there was “delay in the delivery of suppliers of this input for all laboratories”.
Patients with symptoms of dengue are undergoing tests capable of confirming the diagnosis and guiding treatments, such as blood count and antibody tests, which would be “sufficient to guide clinical management, with the NS1 exam being of a complementary nature only (confirmation diagnosis).”
For physician Amaury Lelis Dal Fabbro, professor at the Department of Social Medicine at the University of São Paulo (USP) Ribeirão Preto School of Medicine (FMRP), even if the diagnosis is possible, the lack of reagents can affect the surveillance system epidemiology of dengue.
According to him, virological and serological tests for dengue help to deal with a “reasonably unspecific” symptomatology, which can eventually be confused with other viruses. “It is essential for the epidemiological surveillance system to confirm cases, or at least a certain number of cases, to be sure what type of virus is circulating in the population,” Fabbro said.
The two basic types of specific blood tests are serological, which identifies antibodies against dengue and confirms the diagnosis, and virological, which shows which dengue virus has infected the patient and is circulating at that moment — this is what is missing. in the country.
“This information [de sorologia] is essential for virology, because each serotype has a different behavior in the population and it is essential that tests are available”, said the doctor.
Denis Henrique da Silva, 43, a salesman and civil engineer, has had symptoms of dengue since last week. “I felt a lot of pain in the body, in the joint, without the strength to do anything, fever. An experience I never had, not even when I got Covid I was like this”, he said.
His case was only confirmed with laboratory tests and the appearance of red spots. “My platelets dropped a lot in three days. I looked for the UPA in Barretos and they didn’t do the test [de dengue]was only detected through the platelet, but [é] It’s really bad to spend a month not knowing if it’s true or not”, he said.
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