This year, the city of São Paulo investigated 15 cases of death from suspected dengue and discarded all of them. Last week, however, the first death from the disease in 2023 was confirmed. According to the Municipal Health Secretariat (SMS), in every suspected dengue death, a detailed investigation of the case is carried out, in accordance with the Ministry of Health guidelines. . Until last week, the city registered 5,629 cases of dengue. In all of last year, there were 11,910 cases, with two deaths. “The epidemiological investigation evaluates several aspects and situations involving the clinical case, such as collected laboratory tests and their results, evaluations and clinical reports, epidemiological aspects and information from the death certificate”, says the secretariat. According to the SMS, interviews with relatives and close people are part of the investigation process, which includes home visits by the health surveillance unit. After evaluating all the information, the case is discussed with epidemiologists from the SMS and also from the State Department of Health to clarify whether the main cause of death was in fact dengue fever or whether it was other pathologies or clinical conditions of the patient. However, infectologists suspect that the numbers may be higher because of the way the guideline is interpreted. For the coordinator of the Committee on Arboviruses of the Brazilian Society of Infectology (SBI), Kleber Luz, the cause of death is always the event that leads to death, which triggers the entire process that will lead the individual to die. “For example, a 98-year-old is assaulted, pushed and dies. Certainly, someone aged 98 has several comorbidities, but, in this case, the cause of death was violence. Even if he has several diseases, if he had not fallen , the event that triggered that north would not have happened.” According to the doctor, this is the so-called underlying cause, that is, even if the person had comorbidities, he was fine until the event. So, in the case of dengue, when the individual catches the disease, it decompensates the other comorbidities that also contribute to death, but the cause is dengue. “Those with comorbidities are always more likely to die from an infection,” he explained. For Kleber Luz, the interpretation of cases can lead to underreporting of deaths from dengue. He emphasized that the important thing when communicating a notifiable disease is that the data serve to generate public health and control actions. “When you report that 20 people have died of dengue, you understand that you have to kill the mosquito [Aedes aegypti], otherwise nobody will take action, because there will always be a justification for that death.” According to Maurício Lacerda Nogueira, researcher and deputy director of Graduate Studies at the Faculty of Medicine of Rio Preto, the fact that the number of dengue cases increase in some regions of the state and not in others, it is a natural process that follows the pace of the last 30 years in the country. Nogueira stressed that dengue is a serious disease, which can lead to death. Therefore, regions with great experience in dengue have lower mortality than others, since the preparation of the health system and the training of professionals to care for the disease can generate a significant reduction in mortality. “Now, what is the difference between dying with dengue and dying from dengue? Dying with dengue is crossing the street and a truck picks you up, it’s an unrelated death. Now, if the person has a comorbidity and has important disturbances caused by dengue, he dies with that comorbidity, for me, it’s like dying of dengue, yes, because he was stable and dengue took away the stability. That’s how it happens with covid and with influenza “, highlighted Lacerda. Emphasizing that he does not know the cases, the researcher points out that the record of 100 cases of dengue with only two deaths attributed to the pathology does not seem real. For him, there may be an interpretation “Attributing it to the comorbidity, without understanding the role of dengue in the outcome, is strange. And it is correct to say that this interpretation can lead to a lower record of deaths from the disease. We, in São José do Rio Preto, use the same protocol as the Ministry of Health, and the results are very different.” Prevention and combat Kleber Luz recalled that actions against the dengue mosquito are already established with the control of breeding sites and larvae, through raising awareness and educating the population, and using smoke, in case of many mosquitoes and high transmission of the disease. “By tradition, the actions are always insufficient, because the population almost never cooperates in its entirety with the control from the breeding grounds, throwing garbage, pet bottles, tires on the streets, which accumulates a lot of water and favors the growth of larvae.” Lacerda highlighted that the actions are the same as they have been for 30 years and that the problem has only gotten worse, which is proof that the model that has been worked on is very inefficient and leaves the disease to follow its biological cycle naturally. “The fight against the centralized vector has already shown that it is not very efficient. We are advancing quickly to new strategies in the near future, such as vaccines and combating the release of mosquitoes, whether transgenic, or with bacteria that prevent transmission, but until then, I don’t see these strategies”, he said. São Paulo reported that, so far, there were 1,523,914 actions to prevent the Aedes aegypti mosquito in the city in 2023. In all, there were 339,460 visits, house to house; 13,798 inspections in special properties and strategic points; 1,138,286 actions blocking breeding sites and nebulization, among other specific activities. Last year, the 28 health surveillance units carried out around 5 million routine preventive actions. and Other Arboviruses. In April, 20,000 traps for the self-dissemination of larvicide began to be installed in the city. product in the breeding grounds in order to eliminate the mosquito while still in its larval stage, preventing it from developing into an adult stage”, says the text. For the 2023 seasonality, the Municipal Health Department also invested in expanding the fleet of vehicles for transporting endemic disease control agents and in the acquisition of 30 more vehicular nebulization equipment, in addition to calling for a public tender for 703 new servers for the Municipal Health Surveillance Network. In March, the city hall intensified its actions to block the mosquito in the administrative districts with the highest number of cases of the disease in the last epidemiological week. The state of São Paulo closed the year 2022 with 332,139 confirmed cases of dengue, distributed in 617 municipalities, and 287 deaths. According to the State Department of Health, São Paulo registers, this year, a drop of 27% in dengue cases and 37% in deaths, compared to the previous year. So far, 25,157 cases and 94 deaths from the disease have been reported in the state. In the same period of 2022, 171,486 thousand cases had been registered, with 150 deaths.
Agência Brasil
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