RESUMO
BACKGROUND: The efficacy of the recombinant, live, attenuated, tetravalent dengue vaccine (CYD-TDV) against virologically-confirmed dengue (VCD) has been documented in a phase 3 trial in Latin America (CYD15, NCT01374516). This is a descriptive secondary analysis of the efficacy and safety of CYD-TDV in participants from Colombia. METHODS: Data from 9740 Colombian participants 9-16 years of age who were randomized 2:1 to receive CYD-TDV or placebo were assessed to describe the vaccine efficacy of CYD-TDV against VCD and severe VCD. Estimation was made of the relative risk (RR) for hospitalized VCD cases and severe hospitalized VCD cases after the first dose of CYD-TDV, as well as a description of the incidence of hospitalized dengue from the start of the study and per year of the study until study completion. RESULTS: During the active phase of the trial in Colombia, the efficacy of CYD-TDV was 67.5% [95% confidence interval (CI): 58.3-74.7] against symptomatic VCD due to any serotype from injection 1 (month 0) to 25 months postinjection 1. Over 6 years, the RR across all 4 serotypes was 0.166 (95% CI: 0.09-0.29) in hospitalized VCD patients and 0.154 (95% CI: 0.04-0.50) in patients with severe hospitalized VCD. CONCLUSIONS: Analysis of the data from Colombia mimics the efficacy observed in CYD15 during the active surveillance follow-up (25 months), but with a sustained beneficial RR for dengue hospitalizations on the subsequent years of follow-up. In Colombia, where seroprevalence has been demonstrated to be high in several regions of the country, CYD-TDV is a useful tool to consider as part of an integrated control strategy against endemic dengue, a disease with a high economic impact on the health system.
Assuntos
Vacinas contra Dengue/imunologia , Dengue/prevenção & controle , Dengue Grave/prevenção & controle , Adolescente , Anticorpos Neutralizantes/sangue , Anticorpos Antivirais/sangue , Criança , Colômbia , Vacinas contra Dengue/administração & dosagem , Vírus da Dengue , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Imunogenicidade da Vacina , Incidência , Masculino , Sorogrupo , Vacinação/estatística & dados numéricos , Vacinas Atenuadas/administração & dosagem , Vacinas Atenuadas/imunologia , Vacinas Sintéticas/administração & dosagem , Vacinas Sintéticas/imunologiaRESUMO
Dengue virus (DENV) is the most common mosquito-borne viral disease. The World Health Organization estimates that 400 million new cases of dengue fever occur every year. Approximately 500,000 individuals develop severe and life-threatening complications from dengue fever, such as dengue shock syndrome (DSS) and dengue hemorrhagic fever (DHF), which cause 22,000 deaths yearly. Currently, there are no specific licensed therapeutics to treat DENV illness. We have previously shown that the MEK/ERK inhibitor U0126 inhibits the replication of the flavivirus yellow fever virus. In this study, we demonstrate that the MEK/ERK inhibitor AZD6244 has potent antiviral efficacy in vitro against DENV-2, DENV-3, and Saint Louis encephalitis virus (SLEV). We also show that it is able to protect AG129 mice from a lethal challenge with DENV-2 (D2S20). The molecule is currently undergoing phase III clinical trials for the treatment of non-small-cell lung cancer. The effect of AZD6244 on the DENV life cycle was attributed to a blockade of morphogenesis. Treatment of AG129 mice twice daily with oral doses of AZD6244 (100 mg/kg/day) prevented the animals from contracting dengue hemorrhagic fever (DHF)-like lethal disease upon intravenous infection with 1 × 105 PFU of D2S20. The effectiveness of AZD6244 was observed even when the treatment of infected animals was initiated 1-2 days postinfection. This was also followed by a reduction in viral copy number in both the serum and the spleen. There was also an increase in IL-1ß and TNF-α levels in mice that were infected with D2S20 and treated with AZD6244 in comparison to infected mice that were treated with the vehicle only. These data demonstrate the potential of AZD6244 as a new therapeutic agent to treat DENV infection and possibly other flavivirus diseases.
Assuntos
Antivirais/uso terapêutico , Benzimidazóis/uso terapêutico , Vírus da Dengue/crescimento & desenvolvimento , Dengue Grave/prevenção & controle , Animais , Linhagem Celular , Cricetinae , Vírus da Dengue/efeitos dos fármacos , Modelos Animais de Doenças , MAP Quinases Reguladas por Sinal Extracelular/antagonistas & inibidores , Interleucina-1beta/sangue , Camundongos , Dengue Grave/virologia , Transdução de Sinais/efeitos dos fármacos , Fator de Necrose Tumoral alfa/sangueRESUMO
BACKGROUND: Given that dengue disease is growing and may progress to dengue hemorrhagic fever (DHF), data on economic cost and disease burden are important. However, data for Mexico are limited. METHODOLOGY/PRINCIPAL FINDINGS: Burden of dengue fever (DF) and DHF in Mexico was assessed using official databases for epidemiological information, disabilities weights from Shepard et al, the reported number of cases and deaths, and costs. Overall costs of dengue were summed from direct medical costs to the health system, cost of dengue to the patient (out-of-pocket expenses [medical and non-medical], indirect costs [loss of earnings, patient and/or caregiver]), and other government expenditures on prevention/surveillance. The first three components, calculated as costs per case by a micro-costing approach (PAATI; program, actions, activities, tasks, inputs), were scaled up to overall cost using epidemiology data from official databases. PAATI was used to calculate cost of vector control and prevention, education, and epidemiological surveillance, based on an expert consensus and normative construction of an ideal scenario. Disability-adjusted life years (DALYs) for Mexico in 2016 were calculated to be 2283.46 (1.87 per 100,000 inhabitants). Overall economic impact of dengue in Mexico for 2012 was US$144 million, of which US$44 million corresponded to direct medical costs and US$5 million to the costs from the patient's perspective. The estimated cost of prevention/surveillance was calculated with information provided by federal government to be US$95 million. The overall economic impact of DF and DHF showed an increase in 2013 to US$161 million and a decrease to US$133, US$131 and US$130 million in 2014, 2015 and 2016, respectively. CONCLUSIONS/SIGNIFICANCE: The medical and economic impact of dengue were in agreement with other international studies, and highlight the need to include governmental expenditure for prevention/surveillance in overall cost analyses given the high economic impact of these, increasing the necessity to evaluate its effectiveness.
Assuntos
Dengue/economia , Dengue Grave/economia , Adolescente , Adulto , Idoso , Cuidadores , Criança , Pré-Escolar , Dengue/epidemiologia , Dengue/prevenção & controle , Pessoas com Deficiência , Programas Governamentais , Custos de Cuidados de Saúde , Gastos em Saúde , Humanos , Lactente , México/epidemiologia , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Dengue Grave/epidemiologia , Dengue Grave/prevenção & controle , Adulto JovemRESUMO
El dengue es una enfermedad viral transmitida por mosquitos que puede ser causa de gravedad y muerte. No existe droga antiviral reconocida como eficaz. Sin embargo, las regularidades de esta enfermedad han permitido la identificación de signos de alarma que anuncian extravasación de plasma e inminencia del choque. El inicio precoz del tratamiento de los pacientes mediante la reposición de líquidos cristaloides por vía intravenosa ha demostrado ser una medida efectiva y salvadora. Se necesita capacitación sistemática y acciones de reorganización de la atención médica en función de la epidemia. Se expone la contribución de los profesionales del Instituto de Medicina Tropical Pedro Kourí y otras instituciones cubanas a ese empeño(AU)
Dengue is a viral disease transmitted by mosquitoes which may be severe and cause death. No antiviral drug has been recognized as effective. However, the regularities of this condition have made it possible to identify warning signs announcing plasma leakage and the imminence of shock. Early start of treatment with intravenous crystalloid fluid replacement has proven to be an effective, life-saving measure. Systematic training actions and reorganization of medical care are required during an epidemic. The paper describes the contribution of professionals from Pedro Kouri Tropical Medicine Institute and other Cuban institutions to this effort(AU)
Assuntos
Humanos , Masculino , Feminino , Dengue Grave/prevenção & controle , Dengue/mortalidade , Dengue/terapia , Cuba , Dengue/diagnóstico , Cristais Líquidos/normasRESUMO
BACKGROUND: Dengue fever (DF) outbreaks present regionally specific epidemiological and clinical characteristics. In certain medium-sized cities (100 000-250 000 inhabitants) of São Paulo State, Brazil, and after reaching an incidence of 150 cases/100 000 inhabitants ("epidemiological threshold"), clinical diagnosis indicated dengue virus (DENV) infection. During this period, other seasonally infectious diseases with symptoms and physical signs mimicking DF can simultaneously occur, with the consequential overcrowding of health care facilities as the principal drawbacks. Confirmation of clinical diagnosis of DF with serological tests may help in avoiding faulty diagnosis in patients, who might later undergo dengue hemorrhagic fever (DHF) and the dengue-shock syndrome (DSS). Furthermore, demographic and hematological profiles of patients are useful in detecting specific early characteristics associated to DF, DHF and DSS. METHODS: From March to June, 2007, 456 patients from Marilia in northwest São Paulo State who had only been diagnosed for DF by clinical criteria, underwent serologic testing for non-structural 1 (NS1) DENV antigens. Individual results were used in comparative analysis according to demographic (gender, age) and hematological (leukocyte and platelet counts, percentage of atypical lymphocytes) profiles. Temporal patterns were evaluated by subdividing data according to time of initial attendance, using recorded variables as predictors of DENV infection in logistic regression models and ROC curves. RESULTS: Serologic DENV detection was positive in 70.6 % of the patients. Lower leukocyte and platelet counts were the most important factors in predicting DENV infection (respective medians DENV + = 3 715 cells/ml and DENV- = 6 760 cells/ml, and DENV + = 134 896 cells/ml and DENV- = 223 872 cells/ml). Furthermore, all demographic and hematological profiles presented a conservative temporal pattern throughout this long-lasting outbreak. CONCLUSIONS: As consistency throughout the epidemic facilitated defining the conservation pattern throughout the early stages, this was useful for improving management during the remaining period.
Assuntos
Vírus da Dengue/isolamento & purificação , Dengue/epidemiologia , Dengue/prevenção & controle , Surtos de Doenças , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Demografia , Dengue/virologia , Feminino , Testes Hematológicos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Dengue Grave/epidemiologia , Dengue Grave/prevenção & controle , Dengue Grave/virologia , Adulto JovemRESUMO
Introducción. El dengue es una enfermedad infecciosa sistémica, viral transmitida por el mosquito Aedes. La OMS calcula que cada año se producen entre 50 y 100 millones de infecciones por este virus en el mundo. En México en el transcurso de la última década ha habido un incremento de casos, especialmente de tipo hemorrágico.Métodos. Se realizó una búsqueda sistemática de artículos en cuatro etapas, retrospectiva a 10 años relacionada a dengue grave en PubMed, BVS, Tripdatabase y sitios Web; obteniendo 149 resultados, siendo útiles 40 para el desarrollo de esta guía: revisiones sistemáticas, meta análisis, ensayos clínicos aleatorizados, estudios observacionales y Guías de Práctica Clínica.Resultados. Revisiones sistemáticas mencionan que la desnutrición grado 2 o 3 proteico calórica severa protege contra la vasculopatía del dengue y que la fase crítica comienza alrededor del período de desaparición de fiebre, la leucopenia avanza y hay una rápida disminución de plaquetas, esto precede a la manifestación más específica y potencialmente mortal de esta fase: incrementa la permeabilidad capilar conduciendo a la pérdida de plasma y aumento en él hematocrito; un estudio transversal prospectivo encontró que infecciones sucesivas del virus del dengue aumentan el riesgo de dengue grave y un estudio multicéntrico refiere que las fallas orgánicas más desarrolladas fueron respiratorias, cardiovasculares, neurológicas y hepáticas.Conclusiones. La implementación de las recomendaciones están dirigidas principalmente a las intervenciones de enfermería que contribuyen a la prevención, recuperación, disminución de complicaciones y limitación de daños para el paciente con dengue grave.
Introduction. Dengue fever is a systemic, viral infectious disease transmitted by the ""Aedes"" mosquito. WHO estimates that each year occur between 50 and 100 million infections by this virus in the world. In Mexico over the course of the last decade, there has been an increase in cases, especially of hemorrhagic type. Methods. A systematic search of articles was carried out in four stages, back at 10 years related to severe dengue in PubMed, VHL, Tripdatabase and Web sites; 149 results, being useful 40 for the development of this guide: systematic reviews, meta analysis, clinical trials randomized, observational studies and clinical practice guidelines. Results. Systematic reviews mentioned malnutrition grade 2 or severe caloric protein 3 protects against vascular disease of dengue and the critical phase begins around the time of the disappearance of fever, leukopenia advances and there is a rapid decrease in platelets, this precedes the manifestation more specific and potentially deadly this phase: increases capillary permeability, leading to the loss of plasma and increase the hematocrit; a prospective cross-sectional study found that successive infections of the dengue virus increases the risk of serious dengue and a multicenter study concerns that more developed organic failures were respiratory, cardiovascular, neurological and hepatic.Conclusions. The implementation of the recommendations are directed mainly to the nursing interventions that contribute to the prevention, recovery, reduction of complications and limitation of patient with severe dengue.
Introdução. Dengue é uma doença infecciosa sistêmica, viral transmitida pelo mosquito ""Aedes"". O que estima-se que cada ano produzirá entre 50 e 100 milhões de infecções por este vírus no mundo. No México, durante a última década tem sido um aumento de casos, especialmente do tipo hemorrágico. Métodos. Uma busca sistemática dos artigos foi realizada em quatro etapas, em 10 anos relacionados com graves da dengue no PubMed, BVS, Tripdatabase e Web sites; 149 resultados, sendo 40 útil para o desenvolvimento deste guia: revisões sistemáticas, meta análise, ensaios clínicos randomizados, estudos observacionais e diretrizes de prática clínica.Resultados. Revisões sistemáticas mencionado o grau de desnutrição 2 ou proteína calórica grave 3 protege contra doença vascular de dengue e a fase crítica começa na época do desaparecimento da febre, leucopenia avança e há uma rápida diminuição de plaquetas, isto precede a manifestação mais específica e potencialmente mortal nesta fase: aumenta a permeabilidade capilar, levando à perda de plasma e aumento do hematócrito; um estudo transversal prospectivo descobriu que infecções sucessivas do vírus da dengue a aumentam o risco de dengue grave e um estudo multicêntrico refere-se que os defeitos orgânicos mais específica e potencialmente mortal nesta fase: aumenta a permeabilidade capilar, levando à perda de plasma e aumento do hematócrito; um estudo transversal prospectivo descobriu que infecções sucessivas do vírus da dengue a aumentam o risco de dengue grave e um estudo multicêntrico refere-se que os defeitos orgânicos mais desenvolvidos eram respiratórias, cardiovasculares, neurológicas e hepáticas. Conclusões. A implementação das recomendações são direcionados principalmente para eles, as intervenções de enfermagem que contribuem para a prevenção, recuperação, redução de complicações e a limitação de danos para o paciente com dengue grave.
Assuntos
Humanos , Dengue Grave/complicações , Dengue Grave/diagnóstico , Dengue Grave/enfermagem , Dengue Grave/epidemiologia , Dengue Grave/imunologia , Dengue Grave/mortalidade , Dengue Grave/patologia , Dengue Grave/prevenção & controle , Dengue Grave/sangue , Dengue Grave/terapiaRESUMO
Introducción: la inmunidad del hospedero desempeña un papel importante en determinar el desarrollo de las infecciones por dengue y del cuadro severo de la enfermedad. Sin embargo, otros factores intervienen en el complejo mecanismo de la patogénesis, como la variación entre las cepas virales. Objetivos: evaluación de la capacidad neutralizante de un grupo de sueros de posconvalescientes frente a 2 cepas de dengue 4 pertenecientes a un mismo genotipo. Métodos: se emplearon sueros de 68 individuos con un cuadro de fiebre del dengue y 35 con un cuadro clínico de fiebre hemorrágica del dengue. Resultados: los títulos de anticuerpos neutralizantes en los sueros estudiados fueron bajos y se observó una capacidad neutralizante diferente entre las 2 cepas de dengue 4 del genotipo II. Se observaron diferencias significativas en los títulos de anticuerpos neutralizantes de los sueros procedentes de individuos con infección secundaria y con la forma severa de la enfermedad. Conclusiones: estos resultados demuestran la complejidad de los anticuerpos neutralizantes, que se producen después de una infección por el virus dengue con diferentes cepas de un mismo serotipo, lo cual conduce a obtener resultados diversos por esta técnica que podría ser la causa de la trasmisión continuada de múltiples cepas de dengue.
Introduction: host immunity plays an important role in determining the development of dengue infections and the severe form of the disease. However, other factors, such as the variation between viral strains, are also involved in this complex pathogenesis mechanism. Objectives: evaluate the neutralizing capacity of a number of sera from post-convalescing patients against two dengue 4 strains from the same genotype. Methods: examination was conducted of sera from 68 individuals with dengue fever and 35 with dengue hemorrhagic fever. Results: neutralizing antibody titers were low in the sera analyzed. Different neutralizing capacity was found between the two dengue 4 strains from genotype II. Significant differences were observed between neutralizing antibody titers in sera from individuals with secondary infection and with the severe form of the disease. Conclusions: results reveal the complex nature of the neutralizing antibodies produced after a dengue infection with different strains of the same serotype, leading to diverse results by this technique, which could be the cause of the continued transmission of multiple dengue strains.
Assuntos
Anticorpos Neutralizantes , Convalescença , Dengue Grave/imunologia , Dengue Grave/prevenção & controle , Dengue/prevenção & controleRESUMO
The burden of dengue in Nicaragua has been steadily rising during the last three decades; however, there have been few efforts to quantify the burden (measured in disability-adjusted life years [DALYs]) and cost to society. Using primary data from the Nicaraguan Ministry of Health (MINSA), the total cost and burden of dengue were calculated from 1996 to 2010. Total costs included both direct costs from medical expenditures and prevention activities and indirect costs from lost productivity. The annual disease burden ranged from 99 to 805 DALYs per million, with a majority associated with classic dengue fever. The total cost was estimated to be US$13.5 million/year (range: US$5.1-27.6 million). This analysis can help improve allocation of dengue control resources in Nicaragua and the region. As one of the most comprehensive analyses of its type to date in Nicaragua and Latin America, this study can serve as a model to determine the burden and cost of dengue.
Assuntos
Efeitos Psicossociais da Doença , Dengue/economia , Custos de Cuidados de Saúde , Dengue Grave/economia , Dengue/epidemiologia , Dengue/prevenção & controle , Avaliação da Deficiência , Humanos , Nicarágua/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Dengue Grave/epidemiologia , Dengue Grave/prevenção & controleRESUMO
Dengue and dengue hemorrhagic fever are mosquito-borne viral diseases that coincide with the distribution of Aedes aegypti (L.), the primary vector in the tropical and semitropical world. With no available vaccine, controlling the dengue vector is essential to avoid epidemics. This study evaluates the efficacy of a new smoke-generating formulation containing pyriproxyfen and permethrin in Puerto Libertad, Misiones, Argentina. A fumigant tablet (FT) was applied inside the houses by the community members and compared with a professional application. A treatment combining the application of fumigant tablets indoors and ultralow volume fumigation outdoors was also assessed. The community perceptions and practices about dengue disease and the acceptance of this new nonprofessional FT were evaluated through surveys. Results show >90% adult emergence inhibition and 100% adult mortality with these treatments. More than 80% of the residents applied the FT and preferred participating in a vector control program by using a nonprofessional mosquito control tool, instead of attending meetings and workshops promoting cultural changes.
Assuntos
Aedes , Participação da Comunidade , Insetos Vetores , Controle de Mosquitos/métodos , Permetrina , Piridinas , Animais , Argentina , Dengue/prevenção & controle , Vírus da Dengue , Fumigação/métodos , Humanos , Larva , Dengue Grave/prevenção & controle , Inquéritos e QuestionáriosRESUMO
Arboviruses continue to be a significant source of disease, especially in regions where their insect hosts are endemic. This article highlights these diseases, with particular focus on dengue, yellow fever, and viral hemorrhagic fever. A general background is provided, as well information concerning diagnosis and treatment.
Assuntos
Aedes/virologia , Flavivirus , Insetos Vetores/virologia , Dengue Grave/diagnóstico , Febre Amarela/diagnóstico , Animais , Humanos , Dengue Grave/tratamento farmacológico , Dengue Grave/epidemiologia , Dengue Grave/prevenção & controle , Dengue Grave/virologia , Febre Amarela/tratamento farmacológico , Febre Amarela/epidemiologia , Febre Amarela/prevenção & controle , Febre Amarela/virologiaRESUMO
Evaluar los resultados de las acciones de control y eliminación de un brote de dengue en Santiago de Cuba en septiembre de 2001. Se realizó un estudio descriptivo transversal retrospectivo para describir el brote de dengue y las acciones en su control y eliminación. Este brote aportó 38 casos confirmados serológicamente, así como otros 16 casos en otras ßreas de salud. La implementación de medidas rápidas y efectivas en la lucha antivectorial, la organización de la detección y el manejo de casos, así como la participación comunitaria y de los organismos del estado, permitieron localizar este episodio y lograr su eliminación en 45 d. Las experiencias en la lucha antivectorial y el empleo precoz del tratamiento con insecticidas de acción residual resultaron elementos claves en el control del brote.
To asses result of the actions aimed at control and eradication of a dengue outbreak in Santiago de Cuba in september 2001. A descriptive retrospective cross-sectional study was performed in order to describe the dengue outbreak and the actions aimed at control and eradication. This outbreak gave rise to 38 serologically confirmed cases as well as other 16 cases in other health areas. The implementation of rapid and effective actions as part of the anti-vector fight, the organized detection and management of cases as well as the community and central state bodies involvement made it possible to eradicate this outbreak in 45 days. The experiences accumulated in the anti-vector fight and the early use of residual action pesticide treatments were key elements for the control of this dengue outbreak.
Assuntos
Humanos , Feminino , Criança , Adolescente , Dengue Grave , Dengue Grave/prevenção & controle , Dengue Grave/transmissão , Estudos Transversais , Epidemiologia Descritiva , Estudos RetrospectivosRESUMO
Dengue emerged as a public health burden in Southeast Asia during and following the Second World War and has become increasingly important, with progressively longer and more frequent cyclical epidemics of dengue fever/dengue hemorrhagic fever. Despite this trend, surveillance for this vector-borne viral disease remains largely passive in most Southeast Asian countries, without adequate laboratory support. We review here the factors that may have contributed to the changing epidemiology of dengue in Southeast Asia as well as challenges of disease prevention. We also discuss a regional approach to active dengue virus surveillance, focusing on urban areas where the viruses are maintained, which may be a solution to limited financial resources since most of the countries in the region have developing economies. A regional approach would also result in a greater likelihood of success in disease prevention since the large volume of human travel is a major factor contributing to the geographical spread of dengue viruses.
Assuntos
Aedes/patogenicidade , Dengue/epidemiologia , Dengue/prevenção & controle , Controle de Mosquitos/organização & administração , Prática de Saúde Pública , Aedes/virologia , Animais , Sudeste Asiático/epidemiologia , Vírus da Dengue , Surtos de Doenças , Monitoramento Ambiental , Monitoramento Epidemiológico , Humanos , Incidência , Insetos Vetores/crescimento & desenvolvimento , Laboratórios/provisão & distribuição , Vigilância da População , Dengue Grave/epidemiologia , Dengue Grave/prevenção & controleRESUMO
Dengue is the most important vector-borne disease in the Americas and threatens the lifes of millions of people in developing countries. Imprecise morbidity and mortality statistics underestimate the magnitude of dengue as a regional health problem. As a result, it is considered a low priority by the health sector with no timely steps for effective control. Dengue is perceived as a problem of 'others' (individually, collectively and institutionally), therefore responsibility for its control is passed on to others (neighbors, the community, municipality, health institutions, or other governmental agencies). With no precise risk indicators available there is little opportunity for timely diagnoses, treatment, health interventions or vector control (poor surveillance). Solutions only targeting the vector reduce the impact of interventions and there is no sustainable control. Without political commitment there are insufficient resources to face the problem. This paper discusses the challenges for prevention and control in the Americas.
Assuntos
Controle de Doenças Transmissíveis , Dengue/epidemiologia , Programas Nacionais de Saúde , Adolescente , Adulto , Aedes/virologia , Idoso , Idoso de 80 Anos ou mais , Animais , Criança , Dengue/prevenção & controle , Dengue/transmissão , Exposição Ambiental , Feminino , Humanos , Incidência , Lactente , Insetos Vetores/virologia , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Dengue Grave/epidemiologia , Dengue Grave/mortalidade , Dengue Grave/prevenção & controle , Índice de Gravidade de Doença , Adulto JovemRESUMO
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.
Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Dengue/epidemiologia , Surtos de Doenças , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Dengue/mortalidade , Dengue/prevenção & controle , Surtos de Doenças/prevenção & controle , Humanos , Incidência , Lactente , Pessoa de Meia-Idade , Fatores de Risco , Dengue Grave/epidemiologia , Dengue Grave/mortalidade , Dengue Grave/prevenção & controle , Índice de Gravidade de Doença , Adulto JovemRESUMO
Dengue is the most important vector-borne disease in the Americas and threatens the lifes of millions of people in developing countries. Imprecise morbidity and mortality statistics underestimate the magnitude of dengue as a regional health problem. As a result, it is considered a low priority by the health sector with no timely steps for effective control. Dengue is perceived as a problem of "others" (individually, collectively and institutionally), therefore responsibility for its control is passed on to others (neighbors, the community, municipality, health institutions, or other governmental agencies). With no precise risk indicators available there is little opportunity for timely diagnoses, treatment, health interventions or vector control (poor surveillance). Solutions only targeting the vector reduce the impact of interventions and there is no sustainable control. Without political commitment there are insufficient resources to face the problem. This paper discusses the challenges for prevention and control in the Americas.
El dengue es la enfermedad transmitida por vector más importante en las Américas, que amenaza la vida de millones de personas. Las cifras subestiman la magnitud del problema y el dengue no figura como prioridad para las autoridades en salud y no se identifica como problema (baja percepción de riesgo), por lo que las medidas para el control se realizan tardíamente. El dengue se considera un problema de "otros" (individuo, colectividad, institucional) y la responsabilidad del control se desvía hacia otros (vecindario, comunidad, municipio, el Ministerio de Salud, etc.). Se carece de indicadores de riesgo precisos, por lo que no hay oportunidad para acciones de diagnóstico, tratamiento, prevención y control vectorial. Con intervenciones poco efectivas no hay control sostenible y sin compromiso político no hay recursos suficientes para enfrentar este problema sanitario. Este artículo aborda los desafíos para la prevención y el control del dengue en las Américas.