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Brazil: 2020 Dengue

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  • Brazil: 2020 Dengue


    Paraná is the third state in Brazil with the highest number of dengue cases
    The trend is that cases will increase considerably in the coming days. Historically, the number of patients has grown since March.
    Joshua Caleb by Joshua Caleb
    February 29, 2020

    In the same month that Brazil confirmed its first case of a patient with a new type of coronavirus that emerged in China, an old acquaintance of Brazilians showed signs that it will infect even more people in 2020: the dengue virus, transmitted by the Aedes aegypti mosquito .

    The latest epidemiological bulletin from the Ministry of Health with data on dengue shows that the number of probable cases of the disease - those that are notified to the folder by the States - grew 19% in the first five weeks of the year compared to the same period in 2019 .

    94,149 probable cases were reported up to the fifth week of the year (more precisely from 12/29/2019 to 2/1/2020), compared to 79,131 in the same period last year.

    At the beginning of 2020, there is confirmation that at least 14 people died from dengue in the country. The comparison of deaths with 2019 is still uncertain, as the numbers can still change significantly as the results of laboratory analyzes arrive and as states and municipalities send their reports to the ministry. The data in the current bulletin, for example, still does not compute the cases and deaths recorded at the local level in February.

    But the ministry is already working with a scenario of increasing dengue cases for this year, and some municipalities and states across the country have declared an alert for a dengue epidemic - which is defined when there is a rate of 300 confirmed cases of disease for every 100 thousand population.

    Today, the country has an average incidence of 44.8 probable cases for every 100 thousand inhabitants, a value that is also higher than that registered in the bulletin of the same period last year (26.3 cases per 100 thousand; the comparison between newsletters from different years should be done with caution, as there are many changes and updates to numbers after they are published).

    The situation varies drastically within the country, and three states have already shot more than 200 cases per 100 thousand inhabitants: Acre (rate of 281.65 / 100 thousand); Mato Grosso do Sul (249.98 / 100 thousand) and Paraná (220.75 / 100 thousand).

    However, the upward trend in dengue this year can only be confirmed in the coming months - historically, the number of patients grows from March.

    Experts and government representatives interviewed by BBC News Brasil attribute the upward trend in dengue in 2020 to a combination of factors: first and perhaps more importantly, a powerful new circulation cycle for serotype 2 (there are 4 serotypes of the dengue virus, one classification that corresponds to the response of different antibodies in the infected); in addition to this, particular weather conditions in recent months and cultural and behavioral factors of the population.
    Over 8 thousand patients in a week in Paraná

    Maps of cases of the disease make the highlight in a part of the country that begins in Acre, passes through the Midwest and part of the Southeast, ending in Paraná. Northeastern states, such as Paraíba and Pernambuco, had few cases compared to units in other regions.

    In Paraná, the data on the growth of dengue is impressive. In February last year, the Ministry of Health pointed out that the State had 14 patients per 100 thousand inhabitants; today, that number reaches 220.7 - an increase of 1,471% in the incidence when comparing bulletins for the two periods.

    Since August, when the State started counting a new epidemiological period, almost 35 thousand cases of the disease have been confirmed. In the last week alone, there were 8,200 new patients. Also according to the state government, 14 people died of dengue this year - because they are provided by the state, these data are more up to date than those compiled by the Ministry of Health.

    “At the moment, we have an upward curve of the disease. The trend is for an impacting worsening situation, as the period with the highest incidence is yet to start in March, ”says Ivana Belmonte, coordinator of environmental surveillance at the Paraná Department of Health.

    According to her, the change in the type of circulating virus is one of the explanations for the increase in dengue in the State and in much of Brazil. From 2010 to last year, the vast majority of people who had dengue in Paraná were infected with type 1 of the disease. As of August 2019, serotype 2 was responsible for 83% of dengue infections in the state.

    A person can have the four serotypes of the disease, but once infection with one of them has occurred, permanent immunity is acquired for this type.

    “When you get type 1, you are immunized against it. That is why, after a discharge, the number of cases tends to decrease over a period. However, when the circulating serotype changes to 2, people are not immunized and end up contracting the disease. This is what is happening in Paraná and elsewhere ”, explains Belmonte.
    Dengue serotype 2 advances in the country

    In fact, according to information sent by the Ministry of Health to BBC News Brasil, the participation of serotype 2 in the number of dengue cases has grown in the last five years in the country, reaching the highest percentage in 2019: 65.6% of cases, followed by serotype 1 (30.4%) and serotype 4 (3.9%). Data for 2019 are preliminary and, for 2020, are not yet available.

    "At the end of 2018, type 2 of the dengue virus returned to circulation after 10 years and has been finding populations susceptible to the disease since then," explained the ministry in a note sent to the report.
    Creator of the '10 minutes against Aedes' campaign recalls that most mosquito breeding sites are inside people's homes

    Biologist Denise Valle, a researcher at the Flavivirus Molecular Biology Laboratory at the Oswaldo Cruz Institute (IOC / Fiocruz) and creator of the “10 minutes against Aedes” campaign, explains that, in 2019, serotype 2 has already pushed the number up dengue cases in several states. However, for several other places, the arrival of this type of virus is a novelty and, therefore, the numbers for 2020 must be high as well.

    “In 2019, serotype 2 circulated a lot, but it did not circulate in all regions of Brazil. In addition, we are having a very wet summer, with a lot of rain - which also helps to increase the number of breeding sites ”, he points out.

    Valle explains that the country is “hyper endemic for dengue, with epidemic periods” - which means, with “endemic”, that infections occur all year round, despite growing in the summer; and, with “hyper”, that there is more than one serotype circulating. The researcher also points out that, due to its continental dimensions, the country has different patterns of contamination by state and even within the same city.

    But, for the biologist, it is worth noting what has been observed in the South in recent years, symbolized in this 2020 with the presence of Paraná among the Brazilian states with the most cases.

    “Brazil has dengue all the time, but the South, with a colder climate, a higher Human Development Index (HDI) and better structured cities, was delaying the installation of Aedes aegypti. Today we see a consolidation of the installation of dengue in the South as well ”, points out Valle.
    'You can't wait for the government to clean your yard'

    Despite pointing to the importance of sanitation and urbanization in controlling the Aedes aegypti mosquito - which also transmits zika and chicungunha -, Valle draws attention to the role of people in combating dengue and other diseases.

    “Aedes is a domestic mosquito. Of every 10 breeding sites, 8 are inside people's homes ”, he highlights.

    Ivana Belmonte also mentions climate issues, such as increased rainfall in certain regions, in addition to cultural issues to explain the progress of dengue in Paraná this year.

    “The culture of eliminating mosquito breeding sites is still small in Brazil. It is necessary to make the population even more aware that the risk is real, that you or a relative may die of dengue, ”he explains.

    According to her, municipalities in Paraná have been working together to verify and eliminate breeding sites for Aedes aegypti, but even so, the contagion data has gone up.

    “The servers do house checks every two months, but that needs to come from people too. You can't wait for the government to clean your yard ”, he says.

    Santa Catarina, although it has not yet had a significant increase in dengue cases in 2020, already projects a rise in the coming months. The number of outbreaks of the mosquito - when cities identify Aedes aegypti breeding sites - grew 54% until February 15, reaching more than 7,600 points. The latest epidemiological bulletin also points out that 100 of the 295 municipalities in Santa Catarina face an “infestation” of Aedes aegypti.

    “Due to the proximity to Paraná and the circulation of tourists, we see a scenario of dengue growth,” says Tharine Dal Cim, a biologist at the Santa Catarina Department of Health. “We have had hotter summers and less severe winters. Typically, the colder winter controls mosquito proliferation. But the milder temperatures, and the fact that Aedes is adapting to these conditions, have increased the focus on the State ”.

    For the biologist, part of the South region is not yet used to facing dengue, as, in the population's imagination, colder states are free of the disease - high temperature is indeed an important factor in the proliferation of mosquitoes, but this does not shield the southern region of the country.

    “People think that there is no dengue here, that it only affects the Southeast and Northeast. So, there is an oversight with the mosquito proliferation ”, says Dal Cim.

    Source: BBC Brasil

  • #2

    State has 102,200 dengue cases and 78 deaths
    The bulletin released on Tuesday (07) by the State Department of Health confirms 14,527 new cases compared to the previous week, in addition to nine more deaths. There are 189 municipalities in epidemic and another 33 are on alert.
    Publication 07/04/2020 16:20

    The bulletin released on Tuesday (07) by the State Department of Health confirms 102,247 cases of dengue in Paraná, with an increase of 14,527 cases compared to the previous week. There are nine more confirmed deaths, bringing the number of deaths to 78. The accounting refers to the monitoring started in August 2019 and which continues until July this year.

    “We are living in a time of social isolation, people are spending most of their time at home. Therefore, we reinforce our request for everyone to contribute with a detailed check in the backyards and in the internal environments of the homes to eliminate the breeding grounds for the dengue mosquito. It is a matter of social responsibility ”, highlights the Secretary of State for Health, Beto Preto.

    He warns that the state is in a situation of dengue epidemic and that there is also the coronavirus pandemic. "We need to apply all preventive measures for both infections, and in the case of dengue it is already proven that the removal of outbreaks is the best alternative", he added.

    ELIMINATION - In the 37 cities in which the state health department promoted joint efforts to mechanically remove the breeding sites, the dengue incidence rate was reduced. The actions were coordinated by the Intersectoral Committee for Dengue Control in Paraná and, in some municipalities, counted on the participation of state military personnel, regional representatives of Civil Defense and Army soldiers, in addition to the Environmental Surveillance agents of the municipalities.

    Quinta do Sol, in the Midwest of the State, had an incidence rate of 17 thousand cases per 100 thousand inhabitants. In the last four weeks this proportion has dropped to 323 cases per 100 thousand inhabitants.

    In Barbosa Ferraz, also in the Midwest, the incidence was 11,183 thousand cases per 100 thousand inhabitants. After the task force, a reduction was found to 1,279 cases per 100 thousand inhabitants.

    In Guaíra, the incidence dropped to 124 cases per 100 thousand inhabitants. Before the mechanical removal from breeding sites, the rate was 5.755 thousand cases, properly.

    Another positive result, considered ideal, was found in seven other cities. Nova Cantu, Cruzeiro do Sul, Guairaçá, Inajá, Nova Aliança do Ivaí, Santo Antonio do Caiuá and Lupionópolis, which registered high rates of epidemic incidence accumulated in the period, did not present cases of indigenous dengue in the last four weeks, that is, they zeroed out the incidence in this period of analysis.

    REPORT - The nine deaths that were under investigation and were confirmed in this bulletin occurred in the following municipalities: 2 deaths in Cianorte (two women, without comorbidities, one aged 50 and another aged 39); 2 deaths in Toledo (an 88-year-old woman with hypertension and an 80-year-old man with hypertension and heart failure); one death in Londrina (89-year-old woman with chronic renal failure); one death in Ivaiporã (37-year-old woman with sequelae of cerebral palsy); one death in Rolândia (51-year-old man, without comorbidity); one death in Nova Aurora (59-year-old man, without comorbidity), and one death in Santo Antonio da Platina (a 15-year-old girl, also without a pre-existing history of illness).

    The bulletin released on Tuesday (07) also updates the number of municipalities in epidemic: there are 189. Another 33 are on alert.


    • #3

      DF registers 8 deaths caused by dengue and 16,230 cases of the disease
      The regions of Ceilândia, Gama, Sobradinho II, Santa Maria and Taguatinga are the ones with the highest number of dengue cases in the Federal District
      CM Cibele Moreira
      posted on 11/04/2020 09:41

      The Federal District registers six more deaths caused by dengue, totaling eight deaths in the first three months of the year. The most recent data were released by the Secretariat of Health in the Epidemiological Bulletin from weeks 1 to 12 of 2020, which shows the occurrences notified until March 28.

      Until March 21, the folder had accounted for two deaths from complications of dengue, one in the Guará region and the other in Ceilândia.

      Despite the significant increase, the number of deaths is lower compared to the previous year, when 12 people died from the disease. However, the number of cases doubled compared to the same period in 2019. From January to March 28, the Federal District recorded 16,230 probable dengue reports. Last year, that number was 8,110.

      The regions with the highest number of occurrences are: Ceilândia (2,032), Gama (1,667), Sobradinho II (1,194) and Santa Maria (1,182).


      • #4

        Brazil exceeds 500,000 dengue cases in the year
        Illness has already killed 181 people; another 201 deaths are being investigated
        By Agência O Globo | 4/11/2020 10:43

        Brazil has already registered more than 525 thousand probable cases of dengue and 181 deaths due to the disease in 2020. The numbers were released this Friday (10) by the Ministry of Health, and cover the first 14 weeks of the year, that is, go until the last Saturday (4). 15,051 cases and three deaths from chicungunha were also recorded, and 2,054 cases of zika. Both diseases, as well as dengue, are transmitted by the Aedes aegypti mosquito.

        According to the folder, until the tenth week of the year, the growth rate of cases was higher than that observed in 2019. Since then, there has been a decrease. But, according to the ministry's own bulletin, the cases are still in the process of being updated, that is, the numbers, especially in recent weeks, are preliminary and may still increase. Of the analyzed samples, type 2 dengue was the most common

        The Ministry of Health did not make a comparison between this year's and last year's data. But the bulletin released in 2019 with data from the first 12 weeks showed 273 thousand probable cases and 80 deaths.

        Of the 181 dengue deaths, 105, that is, more than half, were people aged 60 or over. Another 201 deaths from dengue and 19 from chicungunha are still under investigation.

        The occurrence of dengue now, alongside the advancing epidemic of the new coronavirus and also the emergence of cases of influenza, worries the Ministry of Health, as the Secretary of Health Surveillance of the portfolio, Wanderson de Oliveira, warned at a press conference in March 26th.

        "We are still entering the seasonality of respiratory viruses, such as influenza A, influenza B [causing flu]. Now we will have to monitor influenza A, influenza B, in addition to the other respiratory viruses, simultaneously with the circulation of the coronavirus. So the challenge will be to work at least three simultaneous epidemics: we have coronavirus, which is a novelty; we will have influenza, which is a routine, every year it happens; and we will also have the peak of dengue, "said Wanderson last month.

        In absolute numbers, Paraná was the state with the most dengue cases: 173.9 thousand, followed by São Paulo (148.4 thousand), Minas Gerais (43.5 thousand) and Mato Grosso do Sul (36.8 thousand) . Paraná was also the one that registered more deaths: 76, followed by São Paulo (45), Mato Grosso do Sul (20), Mato Grosso (12) and Distrito Federal (8).

        When analyzing the number of records of the disease in relation to the size of the population, the state most affected was also Paraná: 1,521.1 cases per 100 thousand inhabitants. Then there are Mato Grosso do Sul (1,325.5), Federal District (543.6), Mato Grosso (540.9) and Acre (458.5). These are the five states considered priority by the Ministry of Health.

        Deaths by chicungunha occurred in Rio de Janeiro, Bahia and Mato Grosso. These states, in addition to Espírito Santo, are the ones that most concern the Ministry of Health.


        • #5

          Dengue epidemic affects more than half of the cities in the state
          The report released on Tuesday (05) by the Department of Health counts 157,418 confirmed cases in Paraná and 122 deaths caused by the disease. The epidemic affects 223 cities.
          05/05/2020 15:00

          The dengue bulletin released this Tuesday (5th) by the State Department of Health counts 157,418 confirmed cases in Paraná and 122 deaths caused by the disease. The epidemic affects 223 cities - 55.8% of the municipalities in Paraná. These are cities that have, proportionally, an incidence greater than 300 indigenous cases per 100 thousand inhabitants.

          From the previous week to this week, the number of confirmed cases increased 10.78%, with 15,320 new registrations. The weekly update also confirms 11 dengue deaths that were under investigation.

          The Secretary of State for Health Beto Preto emphasizes to the population the need to maintain an effective fight against dengue, even in this period of confrontation with Covid-19.

          “The data is worrying and the State Government keeps alert and vigilant, supporting actions to combat and control dengue in all regions and municipalities. But we have to count on the support of the population, not to forget the care, even in this period when we face the coronavirus ”, he says.

          Monitoring of this epidemiological period of dengue began in July 2019 and will continue until July this year.

          ACTIONS - In Paranaguá, for example, the secretariat promoted training for health professionals on risk classification and dengue management. "The early identification of cases is essential for making decisions and implementing timely measures, mainly aiming to avoid the occurrence of deaths", said the physician Enéas Cordeiro Filho, from the Environmental Surveillance of the state secretariat, responsible for the training.

          The municipality of Paranaguá entered into an epidemic situation starting this week, with 521 indigenous cases, an incidence of 339.05 cases per 100 thousand inhabitants.

          The coordinator of Environmental Surveillance, Ivana Belmonte, said that the actions with the 1st Regional Health (Paranaguá) were reinforced as soon as the increase in cases was identified, and that training is among the main measures at this moment.

          She recalls that the municipality had a history of more than 15 thousand indigenous cases during the epidemic of 2015 and 2016. “Therefore, our alert is constant and we are at the disposal of the municipalities for this support and strengthening of control actions”.

          In addition to Paranaguá, six more municipalities reached the epidemic level this week: Santa Lúcia, Santa Tereza do Oeste, Campina da Lagoa, Kaloré, Sertanópolis and Leópolis.

          On alert, there are 24 municipalities: Foz do Jordão, Ibaiti, Ibema and Entre Rios do Oeste went on internship this epidemiological week. The alert situation indicates that cities have, proportionally, the incidence of more than 100 indigenous cases confirmed per 100 thousand inhabitants.

          According to the bulletin, 70 municipalities register cases of severe dengue.

          DEATHS - Of the 11 deaths confirmed this week, three are from people who lived in the city of Londrina: a 93-year-old woman with diabetes; a 55-year-old woman, without associated comorbidity, and a 24-year-old woman, also without comorbidity.

          Two deaths are from residents of Medianeira (a 91-year-old woman with no comorbidity, and a 89-year-old man with diabetes and high blood pressure); one death in Foz do Iguaçu (57-year-old woman with sequelae from stroke); one death in Cianorte (74-year-old man with several associated diseases); one death in Maringá (29-year-old man with no associated diseases); one death in Alvorada do Sul (72-year-old man with hypertension); one death in Florestópolis (76-year-old man with hypertension), and one death in Quatro Pontes (85-year-old woman with diabetes).


          • #6

            Coronavirus has killed more than Aedes aegypti in 4 years
            Paulo Henrique da Silva
            15/06/2020 - 08h17 - Updated 08h58

            Three months after the first confirmed death in Brazil, the new coronavirus has already surpassed, only in Minas, the deaths from dengue, chikungunya and zika in the last four years. The three diseases transmitted by Aedes aegypti killed 242 people, from 2017 to May this year. Covid-19 has taken the lives of 475 miners to date.

            Ease of transmission, urgency of hospitalizations in many cases and lack of immunity of the population help explain the greater lethality of the disease in China. In addition, further studies and protocols are needed to deal with the infection. Experts guarantee that only a vaccine can offer complete protection.

            “The higher mortality from Covid is due to the fact that it is a very new disease, which we are still learning to deal with. It requires an intensive care unit and a very good service structure ”, observes infectologist Carlos Starling.
            A member of the Committee to Combat Coronavirus Pandemic in B H, the doctor observes that, in the case of dengue, which also cannot be ignored by people, there are already procedures defined by health agencies.

            Without letting your guard down

            However, even with the lower lethality of diseases transmitted by the Aedes mosquito, the population cannot let their guard down. The alert is from the coordinator of the graduate program in Infectology and Tropical Medicine at UFMG, Manoel Otávio da Costa Rocha, who is a national reference in the fight against dengue.

            “We are still learning to cope (with Covid-19). It requires an intensive care unit and a very good service structure ”
            Carlos Starling - Infectologist

            He emphasizes the importance of no demobilization in relation to arboviruses amid the escalation of the new coronavirus. “Epidemiological surveillance is permanent. We have to monitor all infections, not only those that are appearing now, but those that have the potential to appear ”.

            Rocha cites Chagas Disease as an example. "We control it, but if you demobilize the health and surveillance system, the barber comes out of the woods and invades your home again."

            Pending a vaccine for Covid-19 in the coming months, Rocha points out that dengue, chikungunya and zika will continue to cause deaths in the country, mainly due to health issues. </CW>
            “Only 50% of Brazilians have treated sewage. If we do nothing that breaks the conditions of the vector in the peridomicile (external area) and home, dengue, which has been around for decades, will continue ”.

            Besides that:

            Last year, Minas had about 480 thousand cases of dengue. In 2020, so far, there are 74 thousand. “We had a greater number of notifications due to the extension of the rainy season. Previously, they focused more on summer, but what we noticed in 2019 and 2020 was this advance in the autumn season ”, says the coordinator of the State Arbovirus Surveillance Program, Carolina Dourado Amaral.

            Carolina points out that, in the comparison of 2020 with the last epidemic years (2010, 2013, 2016 and 2019), the numbers are not alarming. “We are in epidemiological week 21 and the number of dengue cases is not on the rise. Yes, we were surprised by the number of cases because it is not an epidemic year ”, he analyzes.

            For this number not to rise again, it is important to maintain care at home. “Because of the pandemic, people are inside the house. An average of 70% to 80% of dengue cases occur in these homes ”.


            • #7

              DF has record dengue deaths in one week
              Metropolises | 27/06/20 - 21h57
              Breno Esaki / Health Agency

              The Federal District confirmed eight more deaths from dengue from one epidemiological week to another and reached 33 deaths in 2020. The Secretariat of Health bulletin still points out that there are already 39,219 probable cases of the disease by June 13, 2020.

              The cities with the highest number of records were Ceilândia, with 4,527 cases; Gamma, with 4,424; and Santa Maria, with 3,386. Regarding deaths, Gama, with eight, is the Administrative Region with the most fatalities.

              To combat the proliferation of mosquitoes, the Environmental Surveillance says it has intensified its actions through Sanear Dengue, which concentrate efforts to raise awareness, eliminate outbreaks, collect garbage, rubble, carcasses and containers that can accumulate water.

              Another action has been the use of traps so that the female of Aedes aegypti when depositing the eggs is contaminated with the insecticide and takes it to other points where it will infect other mosquitoes and, thus, reduce the proliferation.

              Other diseases

              The Health Secretariat bulletin also presented the number of cases of other diseases transmitted by Aedes. According to the folder survey, there are 135 cases of chikungunya fever, 35 of zika and none of yellow fever in the Federal District.

              Ceilândia leads the number of occurrences of the two diseases. It has 25 records of chikungunya and seven of Zika.