Image via Disclosure/SESA

During the first half of 2017, the Brazilian state offered 30 cities the second of three doses against dengue. Those who missed out on the first dose were given a second chance to begin the vaccination program.

After launching the dengue vaccination program in 2016, Paraná State is now reflecting on the second phase of the dengue vaccination campaign – and gearing up for the third. It lasted from March to April and, in addition to the 154,000-second doses administered, 99,000 people who had not benefited from the first round of vaccination were given their first doses.

“People understood the importance of vaccination and the effort made by the state in buying and distributing the vaccine to the municipalities,” according to Dr. Júlia Cordellini, Superintendent of Health Surveillance of Paraná State.

One of the 30 cities involved in the dengue vaccination campaign has reached 100% of its target population, after vaccinating only 33% during the first round: it was Bela Vista do Paraíso, in the north of the state.

Seventeen out of these 30 cities have vaccinated between 80% and 99% of the target audience. One of them was Munhoz de Mello, also in the north of Paraná, that reached 83%, after vaccinating 87% during the first stage) Mauro Sérgio de Araújo, Health Secretary of Munhoz de Mello, says the small town of 3,900 inhabitants, has a vaccination team of 60 people.

“Almost everyone knows each other, so communication between our population was important, and we were able to handle all the demand,” he says. “Another thing was that we’ve seen a high number of dengue cases, so the population was alarmed and joined our cause.”

The city has adjusted details of the dengue vaccination campaign every week in order to maximize its impact. “We realized many people couldn’t attend the opening hours of the Health Unit, so we extended some of our working hours, or sent teams to companies to vaccinate the employees. We even sent professionals to do door-to-door vaccination and to convince the population of the importance of taking the vaccine.”

Population approves State’s actions

Jefferson Meneguite, 23, an electrical engineering student and poultry farmer, lives in Munhoz de Mello and agrees with the Health Secretary that the public came on board. “After the outbreaks here in town, we became apprehensive. There were 78 confirmed cases and when the campaign was launched, the population embraced it in order to avoid the spread of the disease,” he says. “Even those who didn’t go to the Health Units got vaccinated at their workplaces or homes. The campaign was everywhere”. From August 2016 to July 2017 there were no cases reported.

The results from Munhoz de Mello are seen as an example for the last 12 cities that received the vaccines: 11 of them vaccinated between 60% and 79% of the target population, while one city (Mandaguari, curiously also in the north of the state), reached only 59% of the target vaccinated.

“Paraná is the only state in the Americas to vaccinate its population for free, so people appreciate the magnitude of this great opportunity and they’re spreading the word about it,” says Dr. Cordellini.

Image of Dr. Júlia Cordellini

She highlights the difficulties some cities faced in reaching its targets. “All vaccines that cover teenagers and young adults are harder to handle [than infant immunizations],” she says. “This age group is a serious issue for us. That’s why we’re working so hard on these campaigns. Also, the fact that the vaccine is something ‘new’ on the medical market leads some people to hesitate, even though we are always reinforcing that the vaccine is safe and effective.”

The fact that the immunization is only complete after the third dose is another barrier: “It’s already hard to attract people to take one dose, so you can imagine how hard it is to get them to come to the health units three times to take all the doses and be totally immunized,” says Dr Cordellini.

She points to another factor that may discourage some younger people from having the vaccination: complacency “Young people nowadays haven’t experienced the major epidemics that older people did,” she says. “Cholera, typhoid fever, meningitis, congenital rubella syndrome, poliomyelitis and measles no longer circulate on the continent. Nowadays these diseases are under control and people have a higher quality of life thanks to vaccination campaigns.”

Vaccine confidence is key to beating dengue: Read More

Soon after the second round of dengue vaccination has finished, the Paraná Health Department began preparing for the third stage of the dengue vaccination campaign. Dr. Cordellini reveals some of the strategies that will be used to make the third stage even stronger than the previous ones.

“We are rethinking local strategies. We have to make every town act according to its reality,” she says. “We will bring immunization to schools, universities, and companies.”

While Health Units remain a crucial entry point for accessing care, authorities are keen to go where the population is to engage with the public about vaccination and highlight its positive impact on quality of life.

“We will also continue to use social media and ‘young’ language to attract our target audience,” Cordellini says.

Image by Venilton Küchler

The third stage of the dengue vaccination campaign is expected to happen next September.

Fighting Aedes aegypti: more than vaccination

Vaccination is only one of the actions taken by the Paraná Health Department to decrease the numbers of dengue cases in the state.

Dr. Cordellini says the positive story of Paraná’s anti-dengue drive does not mean that people can neglect other aspects of mosquito control. “Vaccination is a great and efficient tool, but we cannot forget about environmental control measures, especially taking extremely good care with our garbage”.

Since all the actions by the State and the population began, the total numbers look encouraging: the last epidemiological period has ended with 870 confirmed cases but no deaths from August 2016 to July 2017. This has meant 98% fewer cases compared with the previous period (from August 2015 to July 2016), which finished with 56,351 cases and 63 deaths.

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