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HEALTH-BRAZIL: Education, the Only Weapon Against Dengue

Fabiana Frayssinet

RIO DE JANEIRO, Mar 28 2008 (IPS) - After taking a number of emergency measures to combat the current dengue epidemic in Rio de Janeiro, health officials in Brazil have committed themselves to investing in education and awareness-raising in the future, as the only effective means of preventing further outbreaks of the disease.

That conclusion was expressed to IPS in an interview with Victor Berbara, the head of health vigilance and civil defence in the Rio de Janeiro state government, who did not attempt to disguise his concern over the epidemic, which has caused 41,978 cases of dengue fever in and around Rio de Janeiro and 54 confirmed and 60 suspected deaths in the first three months of the year.

Emergency measures adopted in the last few weeks have included an increase in the number of hospital beds, hydration tents set up to provide first aid to people on the streets, and recruitment of fire fighters and even the army in providing assistance and eliminating potential mosquito breeding grounds.

Dengue fever is a viral disease transmitted by the Aedes aegypti mosquito, which picks up the virus when it feeds on the blood of an infected person, and infects other people when it bites them. The symptoms are fever, headache and muscle pain.

But haemorrhagic dengue causes intense abdominal pain, nausea and bleeding under the skin and into mucous linings, and can be fatal. There is no cure, only treatment of symptoms.

The Aedes aegypti mosquito prefers to lay its eggs in clean water that has accumulated in artificial containers like discarded tires, flower pots or old oil drums in shady areas close to human dwellings, although it has apparently adapted now to dirtier water.

The actual number of cases may be higher than 42,000, as notifications of cases in municipalities in the interior take longer to reach the central authorities, said Berbara.

The fact that only 10,292 cases were notified in March compared to 17,216 in February and 14,470 in January “does not mean the epidemic is in decline,” Berbara acknowledged.

For now the epidemic, which Berbara said is worse than that of 2002, not in the number of cases but in terms of the mortality rate, is especially concentrated in the western part of Rio de Janeiro.

Dengue fever claimed 91 lives in the state of Rio de Janeiro in 2002, including 64 in the capital.

Berbara does not rule out the possibility that the strength of the epidemic in the region may be due to the existence of a larger number of people who are susceptible because they did not contract dengue virus type 3 in 2002.

“Those who had this type of virus in 2002 became resistant to that strain. But the western part of Rio de Janeiro has received a large influx of migrants from other regions in the last few years, because of the high level of real estate speculation,” he explained.

The incidence of dengue is closely “linked to social questions like living conditions, quality of housing, and the availability or lack of basic sanitation, garbage collection and clean water supplies,” said the official.

In areas where these conditions are not in place, dengue is more widespread, said Berbara. He also set forth the “hypothesis” that the higher number of cases in Rio de Janeiro might be due to “the increase in rainfall in this period and thus the proliferation of mosquito breeding grounds in places where water has accumulated, like flooded areas and puddles.”

The government is also worried about another factor, which could lead to an increase in cases in other areas, like the southern part of Rio de Janeiro: the return of dengue virus type 2, seen in the 1990s.

Type 2 “is coming back again, and could affect susceptible people in the south and in other areas,” said Berbara.

Another theory is that the higher level of mortality seen this year may be caused by a more aggressive virus.

That is why “we will not say the southern region (of Rio de Janeiro) is free of dengue,” clarified the official.

After several weeks of wavering, the state government has now decided to speak out clearly about the epidemic, admitting that there have also been outbreaks in other cities in the state of Rio de Janeiro like Angra dos Reis, Campos dos Goytacazes, Natividade and Cantagalo.

After squabbling between federal, municipal and state authorities as to who was responsible for the spread of the epidemic, the state government now says that this is not the time to point fingers.

Health Minister Jose Gomes Temporao had stated that one of the main reasons for the increase in the number of fatal dengue cases in Rio de Janeiro was the failure of the state’s hospital system to detect and treat cases early enough.

Berbara, meanwhile, said that above all, a lack of education and prevention measures was to blame for the extent of the epidemic.

“Preventing an epidemic is difficult; there will always be epidemics,” because every viral illness has its own natural cycle, as history has shown, said the expert. But unlike other viral diseases such as chicken pox and smallpox, “dengue is spread by a vector, the mosquito, and vector control measures have somehow failed,” he added.

Areas where basic health care and education are lacking “are a gateway for the epidemic,” said Berbara.

The main vector control measure is education,” he said, underlining the need for awareness-raising and prevention efforts, so that people permanently eliminate potential mosquito breeding grounds.

Although the mosquito develops rapidly to adulthood, in just six or seven days on average, the eggs can remain dormant for up to a year and a half, even in dry spots.

In the past, various media campaigns have been carried out to encourage people to take prevention measures. But as outbreaks of dengue became less frequent and widespread, such efforts began to fall by the wayside.

“Our greatest concern now is providing medical assistance,” said Berbara. “We see the doctors, fire fighters and army working. We have passed a law making it obligatory for people to allow the prevention brigades to enter their houses.”

“But during the rest of the year, we have to keep the vector under control by means of education,” he stressed.

“Only when people are informed and understand that prevention must become routine will we see results. That is our challenge, and we have to invest in that,” he said.