- by Mauro Abati

Paraná dengue battle: Brazilian state is pioneer in vaccination

The Paraná dengue battle is not new, but high rates of dengue fever in the region have prompted the government to take serious, and innovative actions to tackle the disease.

Paraná is a big and important state located in southern Brazil. Its economy is the fourth strongest of the country and its population is more than 11 million people.

But lately, the state is in the spotlight due to the high numbers of people infected with dengue fever. Just from August 2015 to July 2016, the State’s Health Department has recorded over 56,000 confirmed cases, which caused a total of 61 deaths. Besides that, it is estimated that this epidemic cost R$ 330 million (about €91 million) in healthcare expenses.

Parana dengue battle continues. Image of the Aedes mosquito, with a caution.

Image via www.saude.pr.gov.br

Thinking about the future of the disease and the effect on the population, the Paraná Government launched a daring and pioneering program of dengue immunization.

It was the first state in all of the Americas to introduce a public and free vaccination program to fight dengue. The state has bought 500,000 doses of Dengvaxia, a dengue vaccine developed by Sanofi Pasteur, a French pharmaceutical company. The vaccine has been approved in 11 countries and endorsed by the World Health Organization.

The vaccines were distributed in the 30 most highly-epidemic municipalities. These cities concentrate 84% of the cases and 91% of the total deaths in the state. Most cities (28) are vaccinating young people between 15 to 27 years of age, while the two cities with the top dengue burden in the state (Paranaguá and Assaí) vaccinated individuals from 9 to 44 years of age. These two cities had more than 8,000 cases for every 100,000 inhabitants.

The goal was to vaccinate 80% of this population – at least 400,000 people. During the first stage of the dengue vaccine program, from August 13th to September 24th, 50% of this goal was reached: more than 200,000 Paranaenses were vaccinated. There will be two more rounds of vaccination as three doses are required.

Governor Beto Richa and other authorities announcing the innovative approach to controlling dengue in the region.

Governor Beto Richa and other authorities announce the innovative approach to controlling dengue in the region. Photo by Pedro Ribas

“It was a very satisfactory experience. At first, as it was an innovative action, we had difficulty attracting the public to come and have the vaccine. It is a range of people that don’t usually deliberately attend Health Centers, especially teenagers because they are young and ‘strong’. They think this kind of disease won’t reach them, even if someone of their family already has been infected,” said João Luís Crivellaro, State Coordinator of Immunization.

According to the Coordinator, another factor making it difficult to convince people to come forward was that the program was rolled out during the winter, a non-epidemic period when the disease cases are very low. This may make people think they dengue is not a risk for them.

The Strategies behind the Paraná dengue battle

Because of these obstacles, the State Health Department had to take different and innovative actions to pursue and convince people to go and get the vaccine: “We had to go offer the vaccine to the community. If people won’t go to the Health Center, the Health Center has to come to them. We put vaccination spots in universities, schools, gyms, theaters, supermarkets. We didn’t just have health professionals vaccinating- we had experts talking, discussing and guiding people about the importance of the vaccine,” said Crivellaro.

He also highlighted the communication strategies to increase the numbers of following the campaign: “We had to innovate and speak the public’s language. We used our Facebook page and other social media, including text messages through Whatsapp, to communicate with the young public. The communication material distributed had to have a different approach as well. Besides that, we registered everyone who took the first dose and we will remember them when it’s time to take the second and third doses,” he said.

Another strategy used by the Health Department of Paraná was to ask for famous artists, TV presenters, influencers, and athletes born in the state to take the vaccine and reinforce the importance of it. One of them was Ágatha Rippel, beach volley silver medalist at the Rio 2016 Olympic Games and born in the city of Paranaguá.

Like Ágatha, 27-year-old physics teacher Rafael Coutinho also lives in Paranaguá, one of the two cities most affected by dengue in the state. He already had dengue fever earlier this year and knows how important it is to be vaccinated. As a teacher, he approved of the government’s actions and tried to spread the importance of vaccination to his students: “Dengue really puts your body down, and I realized that a lot of people here think the mosquito won’t get them, so they just don’t take the preventive actions, even though they know everything about the disease,” he said.

“The campaign was very positive here in Paranaguá,” said Coutinho. “I saw a lot of actions not only in the school but also in the streets and the neighborhoods of the city. A good point to highlight is that the professionals were vaccinating students during class periods, which student cooperation.”

Image of Governor Beto Richa witnessing an individual receiving the dengue vaccine.

Governor Beto Richa witnessing an individual receiving the dengue vaccine. Photo: Pedro Ribas

Now the first phase is finished, Paraná Health Department wishes to see a significant decrease in dengue numbers, once more people are immunized and the viral circulation is lower. In addition to the vaccination program, the Paraná Government is still investing in preventive actions and environmental vigilance to avoid new epidemics.