Dengue In Brazil Research Articles

ESTRATÉGIAS DE COMBATE À DENGUE ATRAVÉS DA EDUCAÇÃO EM SAÚDE: UMA REVISÃO INTEGRATIVA

This study aimed to analyze, in the literature, what health education strategies are being used to control / combat dengue in Brazil. This is an integrative review developed in databases MEDLINE and LILACS and libraries SciELO and Cochrane, through crossing descriptors Dengue and Health Education. It was found five publications, of which emerged two thematic categories: Models and strategies used in health education and Problems identified in the process of health education. Programs to combat dengue present a model of verticalized, traditional, centered on the transmitter education, which uses unattractive strategies, with the need for changes in current education practices, replacing them with a way that promotes community participation. The articles presented as solution to the failures of the health education the development of strategies that prioritize popular participation and promote integral care. Descriptors: Dengue; Health Education; Public Health.

Postmortem Diagnosis of Dengue as an Epidemiological Surveillance Tool.

Dengue remains a problem in Brazil, and a substantial number of cases that progress to death are not diagnosed by health services. We evaluated the impact of a protocol adopted by the Coroner's Office Rocha Furtado (CO-RF) for the detection of unreported deaths from dengue in Brazil. We evaluated prospectively cases of deaths referred to the CO-RF with suspicion of dengue and those referred with other diagnosis in which the pathologists suspected dengue as the cause of death. Biological material was collected from all bodies autopsied, for which the suspected cause of death was dengue, between January 2011 and December 2012. Of the 214 bodies autopsied, 134 (62.6%) tested positive for dengue; of these cases, 121 were classified as dengue according to the World Health Organization's case definition (1997 or 2009, as appropriate). Thus, CO-RF detected 90 deaths from dengue, which were not suspected during disease progression. This CO-RF protocol, through a combined effort of the surveillance and laboratory teams, increased the detection of fatal dengue cases by 5-fold. This is the largest series of autopsies performed in cases of death related to dengue in the world to date.

Economic Impact of Dengue: Multicenter Study across Four Brazilian Regions.

BackgroundDengue is an increasing public health concern in Brazil. There is a need for an updated evaluation of the economic impact of dengue within the country. We undertook this multicenter study to evaluate the economic burden of dengue in Brazil.MethodsWe estimated the economic burden of dengue in Brazil for the years 2009 to 2013 and for the epidemic season of August 2012- September 2013. We conducted a multicenter cohort study across four endemic regions: Midwest, Goiania; Southeast, Belo Horizonte and Rio de Janeiro; Northeast: Teresina and Recife; and the North, Belem. Ambulatory or hospitalized cases with suspected or laboratory-confirmed dengue treated in both the private and public sectors were recruited. Interviews were scheduled for the convalescent period to ascertain characteristics of the dengue episode, date of first symptoms/signs and recovery, use of medical services, work/school absence, household spending (out-of-pocket expense) and income lost using a questionnaire developed for a previous cost study. We also extracted data from the patients’ medical records for hospitalized cases. Overall costs per case and cumulative costs were calculated from the public payer and societal perspectives. National cost estimations took into account cases reported in the official notification system (SINAN) with adjustment for underreporting of cases. We applied a probabilistic sensitivity analysis using Monte Carlo simulations with 90% certainty levels (CL).ResultsWe screened 2,223 cases, of which 2,035 (91.5%) symptomatic dengue cases were included in our study. The estimated cost for dengue for the epidemic season (2012–2013) in the societal perspective was US$ 468 million (90% CL: 349–590) or US$ 1,212 million (90% CL: 904–1,526) after adjusting for under-reporting. Considering the time series of dengue (2009–2013) the estimated cost of dengue varied from US$ 371 million (2009) to US$ 1,228 million (2013).ConclusionsThe economic burden associated with dengue in Brazil is substantial with large variations in reported cases and consequently costs reflecting the dynamic of dengue transmission.

Epidemiological Scenario of Dengue in Brazil.

Dengue is the most important reemerging mosquito-borne viral disease worldwide. It is caused by any of four Dengue virus types or serotypes (DENV-1 to DENV-4) and is transmitted by mosquitoes from the genus Aedes. Ecological changes have favored the geographic expansion of the vector and, since the dengue pandemic in the Asian and Pacific regions, the infection became widely distributed worldwide, reaching Brazil in 1845. The incidence of dengue in Brazil has been frequently high, and the number of cases in the country has at some point in time represented up to 60% of the dengue reported cases worldwide. This review addresses vector distribution, dengue outbreaks, circulating serotypes and genotypes, and prevention approaches being utilized in Brazil.

Dengue in Brazil and Colombia: a study of knowledge, attitudes, and practices.

Introduction This study was conducted in Brazil and Colombia,where dengue is endemic and vector control programs use chemical insecticides. Methods We identified knowledge, attitudes, and practices about dengue and determined the infestation levels of Aedes aegypti in one Brazilian and four Colombian communities. Results The surveys show knowledge of the vector, but little knowledge about diagnosis, prognosis, and treatment. Vector infestation indices show Brazil to have good relative control, while Colombia presents a high transmission risk. Conclusions Given the multidimensionality of dengue control, vertical control strategies are inadequate because they deny contextualized methods, alternative solutions, and local empowerment.

A ocorrência da dengue e variações meteorológicas no Brasil: revisão sistemática

Dengue is configures in recent decades as an important cause of morbidity and mortality in Brazil and around the world reaching the tropical and subtropical areas. To review the scientific literature on the occurrence of dengue in Brazil and its relationship with meteorological variables. A systematic review of studies published in databases (SciELO, PubMed, MEDLINE, Lilacs) using descriptors related to weather variations and dengue fever in Brazil, published between 1991 to 2010. It was selected 31 articles that had the study area nationwide. Most epidemiological studies use ecological design, the studies make use of entomological trapping, are common also series of studies of the disease and spatial analysis. It is evident relationship between dengue incidence with temperature and rainfall, the association is more significant from the second to fourth months of the year. Comparative studies of drought and rain show seasonal behavior of the disease. There are difficulties in establishing unique pattern of seasonality of disease incidence and weather variables for the country. Dengue is strongly related to meteorological variables. The seasonal variation in temperature and rainfall influences the dynamics of the vector and the incidence of the disease throughout the country, regardless of the climate category.

Determinants of Mortality from Severe Dengue in Brazil: A Population-Based Case-Control Study

Although increases in severity of mortality from dengue infection have been observed in Brazil, their determinants are not fully known. A case-control study was conducted by using the National Notifiable Diseases Surveillance System, including patients with severe dengue during 2000-2005. Cases were defined as patients that died and controls were those who survived. Hierarchical multivariate logistic regression was performed. During the study period, there were 12,321 severe cases of dengue and 1,062 deaths. Factors independently associated with death included age ≥ 50 years (odds ratio [OR] = 2.29, 95% confidence interval [CI] = 1.59-3.29), < 4 years of schooling (OR = 1.83, 95% CI = 1.47-2.28), a rural area (OR =2.84, 95% CI = 2.19-3.69), hospitalization (OR = 1.42, 95% CI = 1.17-1.73), and a high hematocrit (OR = 2.46, 95% CI = 1.85-3.28). Factors associated with a lower chance of dying were female sex (OR = 0.76, 95% CI = 0.67-0.87), history of previous dengue (OR = 0.78, 95% CI = 0.62-0.99), positive tourniquet test result (OR = 0.47, 95% CI = 0.33-0.66), laboratory diagnosis of dengue (OR = 0.75, 95% CI = 0.61-0.92), and a platelet count of 50,000-100,000 cells/mm(3) (OR = 0.56, 95% CI = 0.36-0.87). The risk profile identified in this study should serve to direct public health interventions to minimize deaths.

IMPACTO AMBIENTAL DERIVADO DAS AÇÕES DE CONTROLE E COMBATE A DENGUE NO RIO GRANDE DO NORTE

The growing presence of the problems arising from the occurrence of dengue in Brazil has beenstrengthening the control elements to vectors that transmit this disease. However, little isobserved adherence environmental issues associated with the techniques used for combatingthese agents, especially when the use of chemical high severity to human health. Therefore, theobjective is to draw attention to a reality that is out of the media and public knowledge, basicelements for generating a process of deploying an environmental management system inzoonoses control structures. The methodology used to conduct the study was a literature reviewand application of the FMEA technique for identifying and prioritizing key environmental aspectsand impacts. The items identified were prioritized against its occurrence, frequency, severity, legalrequirements and associated control measures used. From the results it is important to highlightthe extent of the problem of environmental and public health, should be established a cycle ofcontinuous improvement to calculate the environmental damage caused by such activities.

Dengue in Brazil

Dengue in Brazil

Quality of Life among Adults with Confirmed Dengue in Brazil

The main objective of this study was to measure the quality of life (QoL) during a dengue episode. We conducted a facility-based survey in central Brazil in 2005 and recruited 372 laboratory-confirmed dengue patients greater than 12 years of age in hospital and ambulatory settings. We administered the World Health Organization QoL instrument approximately 15 days after the onset of symptoms. We used principal component analysis with varimax rotation to identify domains related to QoL. The median age of interviewees was 36 years. Most (85%) reported their general health status as very good or good before the dengue episode. Although ambulatory patients were mainly classified as having dengue fever, 44.8% of hospitalized patients had dengue hemorrhagic fever or intermediate dengue. Principal component analysis identified five principal components related to cognition, sleep and energy, mobility, self-care, pain, and discomfort, which explained 73% of the variability of the data matrix. Hospitalized patients had significantly lower mean scores for dimensions cognition, self-care, and pain than ambulatory patients. This investigation documented the generally poor QoL during a dengue episode caused by the large number of domains affected and significant differences between health care settings.

P2-483 Dengue in Brazil: current situation and change in epidemiological pattern

IntroductionAe. aegypti, the commonest cause of Dengue fever in the world, was re-introduced to Brazil in the latter half of the 1970s. Favourable environmental conditions facilitated unchecked territorial expansion of...

New Perspectives for the Control of Parasitic Diseases Through the Use of Photodynamic Products

Parasitic diseases such as malaria, dengue or Schistosomiasis are a plague for millions of people mainly in underdeveloped and developing countries and often prohibit the economic development of the affected areas [1- 9]. Great efforts have been made in the past to extinct or at least control these diseases by means of medical treatment, pesticides, converting wetland etc. - but with limited success. An example of this fact is the epidemic of dengue in Brazil, more specifically in the state of Rio de Janeiro and yellow fever in the center west region of Brazil. An important problem of underdeveloped areas suffering from parasitic diseases is the poverty, which cuts off the supply with material necessary for countermeasures. In the frame of this project we intend to develop methods for pest control, which are very inexpensive and non-toxic and by this are also applicable for poor regions in the world which are infested by severe tropical diseases. The method of pest control is based on the action of photodynamic substances. In contrast to previous attempts we will use inexpensive natural substances which can easily be extracted from plants, such as chlorophylls and their derivatives. Chlorophyll does not show any toxicity in humans: chlorophyll is a colorant in the food industry (E-140 ? E-141).

Comparison of Three Commercially Available Dengue NS1 Antigen Capture Assays for Acute Diagnosis of Dengue in Brazil

BackgroundDengue is associated with explosive urban epidemics and has become a major public health problem in many tropical developing countries, including Brazil. The laboratory diagnosis of dengue can be carried out using several approaches, however sensitive and specific assays useful to diagnose in the early stage of fever are desirable. The flavivirus non-structural protein NS1, a highly conserved and secreted glycoprotein, is a candidate protein for rapid diagnosis of dengue in endemic countries.Methodology/Principal FindingsWe aimed to evaluate the potential use of 3 commercial kits in a panel of 450 serum samples for early diagnosis of dengue in Brazil. The PanBio Early ELISA (PanBio Diagnostics) showed a sensitivity of 72.3% (159/220) and a specificity of 100%, while the sensitivity of the Platelia™ NS1 assay (Biorad Laboratories) was 83.6% (184/220). However, the highest sensitivity (89.6%; 197/220) was obtained by using the NS1 Ag Strip (Biorad Laboratories). A lower sensitivity was observed in DENV-3 cases by all 3 kits. Serum positive by virus isolation were more often positive than cases positive by RT-PCR by all three assays and a higher detection rate was observed during the first four days after the onset of the symptoms. The presence or absence of IgM showed no influence in the confirmation by the pan-E Early ELISA (P = 0,6159). However, a higher confirmation by both Platelia™ NS1 (Biorad) and Dengue NS1 Ag Strip (Biorad) in the absence of IgM was statistically significant (P<0,0001 and P = 0,0008, respectively). Only the Platelia™ NS1 test showed a higher sensitivity in confirming primary infections than secondary ones.Conclusions/SignificanceThe results indicate that commercial kits of dengue NS1 antigen are useful for the laboratory diagnosis of acute primary and secondary dengue. It can be used in combination with the MAC-ELISA for case detection and as screening test to complement viral isolation.

Spatio-temporal modelling of climate-sensitive disease risk: Towards an early warning system for dengue in Brazil

This paper considers the potential for using seasonal climate forecasts in developing an early warning system for dengue fever epidemics in Brazil. In the first instance, a generalised linear model (GLM) is used to select climate and other covariates which are both readily available and prove significant in prediction of confirmed monthly dengue cases based on data collected across the whole of Brazil for the period January 2001 to December 2008 at the microregion level (typically consisting of one large city and several smaller municipalities). The covariates explored include temperature and precipitation data on a 2 . 5 ° × 2 . 5 ° longitude–latitude grid with time lags relevant to dengue transmission, an El Niño Southern Oscillation index and other relevant socio-economic and environmental variables. A negative binomial model formulation is adopted in this model selection to allow for extra-Poisson variation (overdispersion) in the observed dengue counts caused by unknown/unobserved confounding factors and possible correlations in these effects in both time and space. Subsequently, the selected global model is refined in the context of the South East region of Brazil, where dengue predominates, by reverting to a Poisson framework and explicitly modelling the overdispersion through a combination of unstructured and spatio-temporal structured random effects. The resulting spatio-temporal hierarchical model (or GLMM—generalised linear mixed model) is implemented via a Bayesian framework using Markov Chain Monte Carlo (MCMC). Dengue predictions are found to be enhanced both spatially and temporally when using the GLMM and the Bayesian framework allows posterior predictive distributions for dengue cases to be derived, which can be useful for developing a dengue alert system. Using this model, we conclude that seasonal climate forecasts could have potential value in helping to predict dengue incidence months in advance of an epidemic in South East Brazil.

Evolução temporal da dengue no município de Ribeirão Preto, São Paulo, 1994 a 2003

This epidemiological-descriptive study aimed to describe the temporal evolution of dengue cases in Ribeirão Preto, São Paulo State, between 1994 and 2003, according to month of occurrence and gender. Data were obtained from the compulsory notification forms provided by the Epidemiological Surveillance service of the Ribeirão Preto Municipal Health Secretary. We obtained incidence coefficients per 100,000 inhabitants, according to population estimates by the Brazilian Institute of Geography and Statistics. The city experienced a dengue epidemic in 2001, when the incidence coefficient reached 619.65 cases/100,000 inhabitants. We found 5553 cases during the study period, 0.07% of which occurred in 1994, 3.68% in 1995, 4.52% in 1996, 2.40% in 1997, 1.82% in 1998, 5.73% in 1999, 3.75% in 2000, 57.37% in 2001, 6.25% in 2002 and 14.39% in 2003. January to May were the months with the highest occurrence levels. As to the gender variable, we found a proportion of approximately 1:1, showing small fluctuations between men and women for dengue cases during the entire study period. Results indicate the need to study the theme and reinforce the role of teaching institutions to tackle dengue in Brazil.

Dengue: twenty-five years since reemergence in Brazil

This article revisits the epidemiology of dengue in Brazil, 25 years after its reemergence in the country, discussing the main determinants and implications for its control. The authors emphasize the clinical and epidemiological peculiarities of this viral disease in Brazil, which leads the world in both the number of cases reported and risk of occurrence of the disease. The article presents the changes occurring in the dengue epidemiological pattern in recent years, like the sudden age shift in the incidence of dengue hemorrhagic fever, and discusses possible associated factors. The article focuses specifically on the epidemic in Rio de Janeiro in 2008, this episode's impact on the international community, and the fear that the disease could spread to Europe. The authors conclude that the current situation emphasizes the need for the international scientific community to renew its efforts to generate knowledge allowing improvement and progress in the development of new tools and strategies for dengue prevention.

Dengue haemorrhagic fever-induced acute kidney injury without hypotension, haemolysis or rhabdomyolysis

Dengue fever (DF) is currently the most important human viral mosquito-borne infection of public health significance, with millions of infections each year. The main dengue vector is the female of the Aedes aegypti mosquito. There are four serotypes of the dengue virus (DEN-1–DEN-4), a RNA flavivirus. They are antigenically closely related, but whereas infection with one serotype produces lifelong immunity to that serotype, immunity to other serotypes lasts only a few months [1,2]. Approximately half the world’s population lives in areas potentially at risk for dengue and 50–100 million cases are estimated to occur annually [1,3]. Brazil is the leading American country in absolute number of cases and has the highest incidence rate of the disease in this geographic area [4]. The epidemiology of dengue in Brazil comprised two distinct periods. In the first (1986–1993), epidemic waves occurred in localized areas. In the second (1994–2002), there was a nationwide epidemic and endemic virus circulation. In this period, a total of 2 826 948 cases of dengue were reported, giving an incidence of 454/100 000 inhabitants. The number of infested municipalities increased from 44.5% in 1996 to 58.3% in 2002 [5]. Dengue virus infection may manifest clinically as undifferentiated fever, dengue fever (DF), dengue haemorrhagic fever (DHF) or dengue shock syndrome (DSS) [3]. Renal injury comprising creatinine increase, proteinuria, glomerulonephritis, acute kidney injury (AKI) and haemolytic uraemic syndrome has been reported in dengue patients [6–22]. To date, all DHF-induced AKI described cases have occurred in association with shock, haemolysis or rhabdomyolysis [11,12,14,15]. We describe, to the best of our knowledge for the first time, a case of DHF-induced AKI, where the renal injury occurred without haemodynamic instability, haemolysis, rhabdomyolysis or use of nephrotoxic drugs.

Higher genetic variation estimated by microsatellites compared to isoenzyme markers in Aedes aegypti from Rio de Janeiro

Aedes aegypti populations from five districts in Rio de Janeiro were analyzed using five microsatellites and six isoenzyme markers, to assess the amount of variation and patterns of gene flow at local levels. Microsatellite loci were polymorphic enough to detect genetic differentiation of populations collected at small geographic scales (e.g. within a city). Ae. aegypti populations were highly differentiated as well in the city center as in the outskirt. Thus, dengue virus propagation by mosquitoes could be as efficient in the urban area as in the outskirt of Rio de Janeiro, the main entry point of dengue in Brazil.

Early determination of the reproductive number for vector‐borne diseases: the case of dengue in Brazil

To evaluate a new method of deriving the reproductive number for vector-borne diseases from the early epidemic curves for vector-borne diseases with incubations in the vectors and in the hosts. We applied the model to several dengue epidemics in different climatic regions of Brazil: Brasilia, Belém, Fortaleza, Boa Vista. The new method leads to higher estimates of the reproductive number than previous models. At present, Aedes aegypti densities, the meeting of more compatible strains of viruses and mosquitoes, may lead to re-emergence of urban yellow fever epidemics.

Criadouros de Aedes (Stegomyia) aegypti (Linnaeus, 1762) em bromélias nativas na Cidade de Vitória, ES

Some insects that are vectors of human diseases have accompanied man in his migrations throughout the world and breed exclusively in the proximity of human dwellings. The mosquito Aedes aegypti has been responsible for epidemics of dengue in Brazil and its presence also constitutes a serious risk for future outbreaks of urban yellow fever. The failure of campaigns to eradicate this species justifies the search for alternative breeding sites, which may be beyond the reach of present control measures. In this study the occurrence of Aedes aegypti breeding sites in native bromeliads on rocky slopes was investigated in five areas of Vitória, capital of the Brazilian State of Espírito Santo, ES. Water contained in the bromeliads was collected with the aid of a suction apparatus to search for culicid larvae. The degree of infestation of buildings in adjacent urban areas was evaluated simultaneously. Culicid larvae were found in bromeliads in four of the five areas investigated, Aedes aegypti being present in two areas. The presence of breeding sites in bromeliads was not related to indices of infestation of buildings in adjacent areas. Further studies are necessary to define whether breeding sites in bromeliads constitute primary foci of Aedes aegypti, or are a consequence of high infestation levels in urban areas.