As of January 30, the country (Brazil) has recorded 217,000 cases of dengue , more than triple the same period last year.
This month, 15 people died from complications from the disease and there were 149 deaths under investigation, compared to 41 in the same period of time in 2023.
The situation is very worrying because, historically, the months of March, April and May concentrate more cases.
We are far from the peak of the epidemic.
How did we reach this alarming number of cases and deaths under investigation, with very high infestation rates, which could worsen in the coming months?
The current situation is the result of the sum of several factors and several errors.
Some of them can be considered uncontrollable, such as excessive heat and intense rain.
But this is completed by a set of very serious failures in controlling the vector (the Aedes aegypti mosquito ) and in communication with the population.
The existence of conditions conducive to dengue was heightened and worsened by the dismantling of disease and vector control intelligence in states and municipalities in the four years of the previous government, from 2019 to 2022.
Not only were the vector and endemic control teams disbanded, but highly trained epidemiologists left the Ministry of Health under the previous administration due to a lack of working conditions.
Whether for political reasons or a profound ignorance of Brazilian health needs, vector control has been neglected.
The result is the worsening of a situation that we have been fighting against for four decades, since the resurgence of the disease in the 1980s.
Very well adapted to cities, Aedes aegypti took advantage of the growing and disorderly occupation, the accumulation of waste, junkyards and landfills with accumulated water, the lack of basic sanitation and water drainage.
Virtually eradicated in the 1940s with the campaign against urban yellow fever, the mosquito resurfaced and was never eliminated again.
Not even a profound urban reform would be able to eliminate it from the cities.
Remembering that this mosquito transmits dengue, Zika, chikungunya and yellow fever when infected by one of these viruses.
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Urgent training for healthcare professionals
As an immediate measure, we need to train ourselves to reduce deaths from dengue, a disease that does not have a high fatality rate.
The majority of dengue deaths still result from healthcare professionals underestimating the severity of the infected patient.
This directly impacts the quality of service provided.
The warning signs of dengue that indicate progression to a serious condition are often not obvious, but can be identified by someone who is familiar with the disease’s evolution.
If the patient arrives with signs of severe dengue , every doctor can recognize the severity.
But the challenge that has emerged is identifying the warning signs of dengue C.
These are patients who must be promptly hospitalized and placed on vigorous hydration.
In general, people with special clinical conditions, social risk or comorbidities (high blood pressure, diabetes, chronic obstructive pulmonary disease, kidney disease and hematological diseases, among others) suspected of having dengue should have a blood count done to be properly diagnosed.
Only after this examination is it possible to know whether the patient needs to be hospitalized.
The tendency of healthcare professionals, however, is to want to release the patient quickly.
They hydrate and flush the individual without waiting for the blood test results.
This can lead to errors, as the blood count result of a patient classified as dengue B, but with comorbidities , can reveal that this person has a significant chance of worsening the condition.
In the recent epidemic, I witnessed three cases where this occurred.
These patients faced serious complications and had to return to the health service to be hospitalized due to failure to recognize the warning signs.
Fortunately, everyone survived.
Currently, I collaborate with the State University of São Paulo (UNESP), where I teach, to train basic health units in several municipalities, aiming to improve the recognition of severity.
Situations like this highlight the need for training health professionals to improve procedures and ensure adequate treatment.
Not for lack of resources, but rather of training, private hospitals have less experience than public services in dealing with serious cases of dengue.
In 2015, the biggest epidemic to date, we had more than half of the deaths in the state of São Paulo occurring in private hospitals in the capital of São Paulo and Campinas (SP).
Therefore, it is essential to also train private health services to guarantee adequate treatment.
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We are unable to educate to prevent dengue
We have learned a lot in four decades of combating the vector.
The first lesson is that there needs to be joint action by governments, citizens and families to combat the disease.
Recently, the Minister of Health, Nísia Trindade, made this appeal during a meeting with councils, institutions and representatives of states and municipalities.
It is the pure truth. Most transmissions occur at home.
The female Aedes aegypti, which transmits the disease, prefers to stay close to people, inside houses, preferably at skirting height.
However, even though we’ve been telling people for years to be aware of mosquito breeding sites inside their homes, it hasn’t worked.
The reports I frequently hear from vector control agents, those who visit residents, confirm that the population continues to think that the mosquito comes from the neighbor’s house, from the vacant lot, from the school. Never from your own backyard.
Serious mistake, as the agents attest.
In other words, we continue to fail to hold people properly responsible for the breeding sites present in their own homes, as well as ours.
Vector control teams also face increasing challenges entering homes.
People became more fearful during the COVID pandemic, which continues to increase due to safety reasons.
These are understandable circumstances, but bad for healthcare professionals.
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The population’s resistance highlights the complexity of the work of the agents, who not only eliminate breeding sites, but apply different control measures.
This includes the use of larvicides that are not harmful to humans, closing water tanks and introducing bacteria that prevent larvae from developing.
Strategies to combat dengue are being reviewed. It is already known that intensive spraying, for example on the streets, does not reach the main larvae and breeding sites in homes.
Furthermore, studies with transgenic mosquitoes have not generated significant results after more than 10 years of research, with no consensus on their effectiveness.
In addition to the daily effort to raise awareness among the population made by vector and endemic disease control agents, there is reason for optimism in the battle against dengue.
The start of vaccination next February with the Qdenga vaccine, produced by the pharmaceutical company Takeda, marks the beginning of a strong blow to the disease.
The vaccine showed an excellent safety profile and reduces the chances of hospitalization due to severe dengue by 87%.
The strategy of vaccinating younger people, recommended by the World Health Organization, is a smart measure, targeting a group that is likely to maintain protective habits in the future.
It is worth remembering that the positive prospects for the vaccine should not serve as a pretext to weaken surveillance, stop training doctors or invest in mosquito control teams.
The battle is long and we now have a strong ally, but we need to use all possible prevention resources.
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*This article is republished from The Conversation under a Creative Commons license. Read the original article.
