The Aedes mosquito is spreading dengue and other diseases, but Brazil is fighting back

The Paraná dengue vaccine program, introduced earlier this year, will pay off by reducing spending on hospital care as well as keeping people in work and protecting the tourist industry. That’s the view of Health Secretary Michele Caputo, the official responsible for running the ground-breaking initiative.

Interview: Michele Caputo Neto, Health Secretary in Paraná, says the prevention plan is designed to protect the population

Are you proud that Paraná is the first Brazilian State to introduce the vaccine?

Yes, we are very proud and we know that Paraná has the technical capacity and appropriate infrastructure to incorporate a new vaccine in the public system. We have one of the best health public systems in this country, and our vaccination campaigns obtain the best coverage. All this gives us the credentials to innovate and go forward in the control of the disease in the State.

Why have you decided to lead the way? Is the burden of dengue higher in your state than all the others in Brazil?

The decision to vaccinate the population is an additional strategy to control dengue in Paraná and will not replace the necessary measures to control the mosquito Aedes aegypti.

We have taken solid initiatives to attend the interests of our population. We have invested R$ 50 million to purchase such doses, but it is important to highlight the direct and indirect losses caused by dengue. We spent more than R$ 330 million dealing with the epidemics – through the mobilization of the State to help the families affected, caring for people in hospitals and purchasing equipment. This is in addition to the indirect impact on the economy: keeping away tourists and also people who stopped working. This is a public health investment we are making to protect our population.

Where will the vaccine be delivered and will it be free to the public?

The vaccine will be free and shall be made available to 500,000 people in 30 municipalities of the State.

How did you decide on the age ranges to target? Are you concerned that the inconsistency will cause confusion or resentment among the general public?

In 28 of the Paraná municipalities that were given priority for the campaign, the population to be vaccinated is in the age range of 15 to 27 years. This age group concentrates about 30% of the dengue cases in Paraná. In the municipalities of Paranaguá and Assai, the vaccine will target the age group between 9 and 44 years, because both municipalities have an incidence greater than 8,000 cases per 100,000 inhabitants.

The selection of the municipalities was based on the disease epidemiology in Paraná. The municipalities that suffered three epidemics or more in the last five periods, between 2010 and 2015 were taken into consideration. Another parameter is the current incidence with a cut above 500 cases/100,000 inhabitants; the number of hospitalizations for serious dengue; the number of dengue cases with hospitalization and age group of the dengue cases during the period from August 2015 to July 2016.

Are there awareness-raising measures or other initiatives planned to ensure high uptake of all doses of the vaccine?

The objective is to vaccinate at least 80% of the target public. At launch, we organized a great event in Paranaguá, where the local population and the press from throughout Brazil participated. We also plan to make a big effort of disclosure via press office throughout the period before we initiate the campaign.

On the vaccination, D-Day, August 13 (Saturday), health units remained open during the whole day. The campaign continued for three weeks, until August 31, in the Basic Health Units of the selected municipalities.

What other major anti-dengue measures are in place in Paraná? Is the vaccine program using funds diverted from other dengue programs or is it ‘new’ money?

The whole Government structure has been mobilized to control the dengue mosquito and several initiatives have been taken to contain the advance of the disease throughout Paraná.

The transfer of funds for the control of the mosquito that spreads dengue has already reached over R$ 120 million, without, however, being able to avoid new disease epidemics. The investments have been used in the temporary hiring of health agents, spraying insecticides, purchase of vehicles, acquisition of PPEs, consumption material, besides other expenses such as training of professionals, payment of fuel, maintenance of the fleet and production of education material.

“…we should obtain a reduction of 93% of serious dengue cases…”

The funds to purchase the vaccines represent an additional investment using the State Treasury’s own funds, which should be added up to the investments already made towards controlling dengue.

How and when will you measure the impact of the dengue vaccine program? Will you look at reported dengue cases, hospitalization or other factors?

This year vaccination should have an effective impact already next summer, since the first dose already provides protection against the disease, thus hopefully minimizing the number and intensity of new epidemics.

According to the studies, we should obtain a reduction of 93% of serious dengue cases, which should cause a reduction of 80% in hospitalizations for dengue. We plan to monitor the number and the seriousness of all confirmed cases in the municipalities where the population received the vaccine.

How do you collect information from the public about dengue cases?

In Brazil, all dengue cases must be notified to the health public authorities. They are notified to SINAN – Sistema de Informação de Agravos de Notificação, which is a national database. Here in Paraná we also have the dengue situation room that monitors the cases of the disease and the current situation in the 399 municipalities in the State on a daily basis.

The professionals working in that room maintain contacts with the municipalities’ technicians and with the health regional staff. With such information at hand, we issue a weekly bulletin with all the cases of dengue grouped by municipalities and health regions.

We also have the State Central Laboratory that uses a pioneering technology in this country, the Multiplex methodology for the simultaneous diagnostic of arbovirosis (viral diseases transmitted by insects). With the use of the Multiplex system, we are able to perform 1,400 tests per week.

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