The Brazilian Ministry of Health warns that more than 4.2 million cases are expected for this year, above the 4.1 million cases recorded by the Pan American Health Organization in the 42 countries of the region last year.
There were already predictions that this was going to be a bad year for Brazil in terms of dengue – the numbers of cases of this virus usually rise and fall every four years or so – but experts say that several factors, such as El Niño and the climate change, have greatly amplified this year’s problem.
“The historical maximum temperatures in the country and the extraordinary rainfall since last year, even before the summer, increased the number of mosquito breeding sites in Brazil, even in regions that previously had few cases of the disease,” commented the Minister of Brazilian health Nísia Trindade.
The number of dengue cases had already skyrocketed in Argentina, Uruguay and Paraguay in recent months, during the southern hemisphere summer, and the virus will move up other continents with the passing of the seasons.
“When we see waves in one country, we will usually see waves in other countries; To that degree we are interconnected,” said Albert Ko, an expert on dengue in Brazil and professor of public health at Yale University.
The World Health Organization has already warned that dengue will soon become an urgent global health problem, with a record number of cases in the last year and outbreaks in places, like France, that have historically never reported the disease.
In the United States, Gabriela Paz-Bailey, director of the dengue division of the department of vector-borne diseases at the Centers for Disease Control and Prevention, said she expected to see high rates of dengue infections in Puerto Rico this year and that there would also be more cases in the continental United States, especially in Florida, as well as Texas, Arizona and southern California.
Dengue is transmitted by Aedes aegypti, a species of mosquito that is establishing itself in new regions, including warmer, wetter parts of the United States, where it had never been seen until recent years.
There are still relatively few cases expected in the United States this year — hundreds, not millions — given the prevalence of air conditioning and mosquito nets. But Paz-Bailey warned: “When we see the trends in case numbers on the American continent, they are terrifying. “They have increased steadily.”
Last year, Florida reported its highest number of locally infected cases, 168, and California reported its first such cases.
Three-quarters of people who become infected with dengue do not have any symptoms, and among those who do, most seem to have a mild flu. But some dengue infections are serious, causing headaches, vomiting, high fever and intense joint pain that earned the disease the nickname “bone-breaking fever.” A severe case of dengue can weaken a person for weeks.
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Additionally, about five percent of people who get sick later go on to a condition called severe dengue, which causes plasma, the liquid, protein-rich component of blood, to leak out of blood vessels. Some patients may go into shock, which can lead to organ failure..
Severe dengue has a case fatality rate of two to five percent in people whose symptoms are treated with blood transfusions and intravenous fluids. However, when left untreated, the mortality rate is 15 percent.
In Brazil, state governments are setting up emergency centers to test for dengue and offer treatment. On Monday, the city of Rio de Janeiro declared a health emergency situation due to dengue, days before the start of the annual Carnival celebration, which brings together tens of thousands of people in open-air parties for several days and nights.
According to Trindade, high numbers of cases are being reported in Brazil’s southernmost states, which tend to be colder than Rio and the central and northern states. Residents of those areas will have little immunity to the disease due to lack of prior exposure.
Dengue has four serotypes, which are like cousin viruses. If you have already been infected with one of them, you are only protected for a short time from becoming infected with another, and people who have contracted one serotype of dengue in the past are at greater risk of developing severe dengue if they become infected with another serotype.
“Right now, serotypes are circulating in Brazil that have not circulated in 20 years,” said Ernesto Marques, associate professor of infectious diseases and microbiology at the University of Pittsburgh.
Brazil has already begun an emergency campaign to vaccinate children in areas with the highest or highest risk rates of dengue transmission, with a double-dose vaccine called Qdenga, made by Takeda Pharmaceutical Co., a Japanese pharmaceutical company. Brazil purchased 5.2 million doses to be delivered this year, plus another 9 million for delivery in 2025, and the company donated 1.3 million more, accounting for the majority of Qdenga’s global supply. A company spokesperson stated that Takeda is working on a plan to increase supply, with the particular goal of delivering to high-prevalence countries.
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Still, that’s only enough to cover less than ten percent of the Brazilian population for two years. The only good news about dengue in Brazil at the moment is the publication of the results of the clinical trial of a new vaccine that was tested at the Butantan Institute, a public health research center in São Paulo. That vaccine only requires one shot, and the trial found that it protected 80 percent of those vaccinated from developing dengue viral disease. The research center will ask the Brazilian government to approve the vaccine, and has facilities to produce it, so its goal is to start delivering vaccines in 2025.
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