Since 2023, the Ministry of Health (MS) has been constantly monitoring and alerting to the increase in dengue cases in Brazil. In this scenario, the department coordinated a series of actions to combat arboviruses, intensified efforts and reinforced awareness of prevention measures. One of the initiatives was the incorporation of the dengue vaccine, which will be applied to the population in endemic regions, in 521 municipalities, starting in February. The process was organized with the National Council of Health Secretaries (Conass) and the Council of Municipal Health Secretaries of Brazil (Conasems), following the recommendations of the Technical Advisory Chamber on Immunization (CTAI) and the World Health Organization (WHO).
“We have been in a dengue monitoring process since November last year. We established an Arbovirus Situation Room, also concerned with Chikungunya and Zika, because they are diseases associated with Aedes aegypti. The Room brings together the Health Surveillance team and several specialists. We had already warned about a prognosis of an increase in cases in these months, which has now been confirmed. As always, case records do not occur uniformly, due to the characteristics of our country, but in some regions we see this significant increase in cases”, highlighted the Minister of Health, Nísia Trindade, in a press conference on the subject this Thursday. fair (25/01).
Nísia Trindade warned that 75% of mosquito outbreaks are in homes, which shows the importance of control in these places. “Reducing dengue cases has to be an action by the government, but also by each citizen. It has to be a union of efforts. It is a disease that, in some cases, worsens, and to this end, we are adopting measures to avoid hospitalizations and deaths that are preventable,” she said.
Vaccination – Check the list of health regions covered
The health regions selected to receive the vaccines meet three criteria: they are made up of large municipalities, that is, more than 100 thousand inhabitants, with high dengue transmission recorded in 2023 and 2024, and with a greater predominance of the DENV- serotype. two. As a result, 16 states and the Federal District have municipalities that meet the requirements to start vaccination from 2024. Children and adolescents between 10 and 14 years old will be vaccinated, the age group that has the highest number of hospitalizations for dengue – 16. 4 thousand from January 2019 to November 2023, after elderly people, a group for which the vaccine was not authorized by the National Health Surveillance Agency (Anvisa). This is a group that brings together the largest number of health regions. The vaccination schedule will consist of two doses, with an interval of three months between them.
The definition of a target audience and priority regions for immunization was necessary due to the limited capacity to supply doses by the vaccine manufacturing laboratory. The first shipment with around 757 thousand doses arrived in Brazil last Saturday (20). The batch is part of a total of 1.32 million doses supplied by the pharmaceutical company. Another shipment, with more than 568 thousand doses, is scheduled for delivery in February. In addition to these, the Ministry of Health acquired the total quantity available by the manufacturer for 2024: 5.2 million doses. According to the company, they are expected to be delivered throughout the year, until December. For 2025, the department has already contracted 9 million doses.
Brazil is the first country in the world to offer the vaccine in the universal public system. The Ministry of Health incorporated the dengue vaccine in December 2023. The inclusion was quickly analyzed by Conitec
Other strategic actions to combat arboviruses
With the beginning of the rainy season and high temperatures, and in view of the warning issued by the WHO about the increase in arboviruses due to climate changes caused by El Niño, added to the national scenario of reappearance of serotypes DENV-3 and DENV-4, the Ministry of Health coordinated a series of preparatory activities for the 2024 seasonality.
According to the Weekly Report on Urban Arboviruses from the Ministry of Health, between epidemiological weeks 1 and 3 of this year, 120,874 probable cases and 12 deaths from dengue were recorded. In 2023, 44,753 probable cases and 26 deaths were reported in Brazil. The national scenario monitoring document was one of the initiatives made available for strategic monitoring.
In November, as part of regionalized communication actions, the Ministry of Health launched new social mobilization campaigns, focused on the reality of each region of the country and the peculiarities of this epidemiological scenario. In December, the National Arbovirus Room was installed, a permanent space for real-time monitoring of places with the highest incidence of diseases. With this measure, it is possible to strategically direct surveillance actions in the most affected regions.
Another initiative was to hold a national meeting to prepare for the period of high arbovirus transmission, with the participation of 27 states and 42 municipalities. In November, the department issued a Warning Note about the increase in cases of dengue and Chikungunya in the national territory.
To support states and municipalities in prevention and control measures, the Ministry of Health transferred R$256 million to the entire country, in an action to reinforce the fight against the disease. Of the total amount, R$111.5 million was transferred in 2023, in a single installment, to strengthen the surveillance and containment of Aedes aegypti – with R$39.5 million going to states and the Federal District and another R$72 million to counties. In addition, there will be a transfer of R$144.4 million to promote health surveillance actions across the country.
Still in 2023, the Ministry of Health qualified around 12 thousand health professionals, including doctors and nurses, to act as multipliers for clinical management, surveillance and control of the disease. The measure will allow professionals to quickly identify the disease. In this sense, the folder advises that the population seek the nearest health service when presenting the first symptoms.
The Ministry of Health normalized insecticide stocks, which had been in a critical situation since the beginning of 2023. In total, 142.5 thousand kilos of larvicide were distributed; 9,600 kilos of adulticide for residual application at strategic points; and 156.7 thousand liters of adulticide for space application at Ultra Low Volume (UBV). For 2024, new acquisitions were made, including 400 thousand kilos of larvicide and 12.6 thousand kilos of adulticide for residual application. All states are supplied with inputs.
Replenishment was also possible for diagnostic tests to control dengue fever: 125.2 thousand rapid test units were distributed, in addition to 47.6 thousand units of molecular biology tests. There was also the acquisition of oral rehydration salts and portable equipment for counting red blood cells and platelets.
The new management of the Ministry of Health also expanded, in 2023, the Wolbachia method as an additional strategy for controlling arboviruses. The ministry transferred R$30 million to expand the technology in six municipalities: Natal (RN), Uberlândia (MG), Presidente Prudente (SP), Londrina (PR), Foz do Iguaçu (PR) and Joinville (SC) , in addition to the cities already included in the research, which are Campo Grande (MS), Petrolina (PE), Belo Horizonte (MG), Niterói (RJ) and Rio de Janeiro (RJ). The initiative consists of releasing mosquitoes of the species Aedes aegypti infected by an intracellular bacterium of the genus Wolbachia, which only infects insects, and works by blocking the mosquito’s ability to transmit viruses.
The results of the 3rd Aedes aegypti Infestation Index Rapid Survey (LIRAa) and the 2023 Sample Index Survey (LIA) were recently presented. The numbers indicated that 74.8% of dengue mosquito breeding sites are in homes, such as in plant pots and plates, returnable bottles, drip pans, defrosting containers in refrigerators, drinking fountains in general, small ornamental fountains and materials in construction warehouses. (stocked toilets, pipes, etc.). The survey showed that elevated water storage deposits (water tanks, drums, masonry deposits) and at ground level (ton, drum, barrel, cisterns, well/cacimba) appear as the second largest breeding ground for vectors, with 22%, while tire and garbage dumps have 3.2%.
The Ministry of Health reinforces that the main measure is the elimination of mosquito breeding sites. Hence the importance of receiving Endemic Disease Control Agents and Community Health Agents, who will help find and eliminate possible breeding sites. For 2024, an agreement on assistance support for states in emergency situations is also underway.