Campinas is the main focus of spotted fever in SP – 06/15/2023 – Health

No other city in São Paulo has as many cases of spotted fever as Campinas, 93 km from São Paulo. The municipality alone accounts for 11% (115) of just over a thousand registrations in the state, from 2007 until this year, that is, an average of seven per year.

And the notifications by city gathered by the Secretary of State for Health, the most recent, still do not even include the current outbreak, registered following two events promoted at Fazenda Santa Margarida. The space is in Joaquim Egídio, a district in the eastern part of Campinas classified as an area at risk for the disease.

So far, there has been confirmation that the disease killed four participants of Feijoada do Rosa, held on May 27.

Two more cases are investigated: that of a 40-year-old woman, who has been hospitalized since Saturday (10th), and that of a 38-year-old woman also hospitalized on Saturday (10th) with suspicion of having contracted the disease. She, however, went to a concert by singer Seu Jorge on the farm a week after the feijoada.

The disease is a longstanding problem in the city of more than 1.2 million inhabitants, the third largest population in the state, only behind the capital and Guarulhos.

“Those who live in or visit Campinas must be informed that green areas are at risk of Rocky Mountain spotted fever”, said this Wednesday (14) Andrea von Zuben, director of Devisa (Department of Health Surveillance).

On the same day, the municipal management announced that, from now on, every risk area must have posters, banners or plaques that indicate the risk of transmission of the disease.

The other four cities that historically gather more cases of infection are close to Campinas. They are Piracicaba (87), Valinhos (51), Santa Bárbara D’Oeste (47) and Americana (40), with an average of 2 to 5 five cases annually.

In the five municipalities, the disease resulted from the bacteria Rickettsia rickettsii, transmitted by the tick Amblyomma sculptum, known as the star tick. It is common for capybaras to serve as hosts for this species, which also takes refuge in horses.

Spotted fever from this type of bacteria is serious and can quickly lead to death.

One of the explanations for the spread of the disease in the interior of São Paulo is the transformation of land use and occupation, according to biologist Stefan Vilges de Oliveira, professor at the Faculty of Medicine at the Federal University of Uberlândia.

“Native forests have been modified over the years with the expansion of agriculture, which ends up providing food for the main host of ticks, the capybaras”, he explains, one of the organizers of the guide “Spotted Fever: Epidemiological, Clinical and Environmental Aspects” .

Oliveira claims that it is complex to control the disease, since its dissemination involves wild animals. One of the ways out, in his view, is to warn the population about the risk areas and warn about the need to seek medical help quickly in case of symptoms.

Metropolitan region and coast

Santo André and São Bernardo do Campo, in the metropolitan region of São Paulo, occupy the sixth and seventh place in the historical series, with 33 and 32 cases respectively. But the first city had its last case in 2018 and the second in 2020.

The capital of São Paulo, in turn, appears in the tenth position, with 27 cases accumulated since 2007, the last of which in 2021.

In common, these three cities observed the transmission of Rocky Mountain spotted fever by another tick: the Amblyomma aureolatumwhich also carries the Rickettsia rickettsii. Its hosts can be dogs and cats with access to areas of the Atlantic Forest.

Episodes of the disease on the coast of São Paulo were much rarer. Ubatuba, for example, totaled 12 cases since 2007. In Caraguatatuba, there were seven; São Sebastião had five and Bertioga, only one.

In these municipalities, the infection was associated with the bacterium Rickettsia parkeriwhose vector is the tick Amblyomma ovale, and the symptoms are considered less severe compared to those caused by the bacteria Rickettsia rickettsii.

Lethality

From 2007 until this year, the lethality of Rocky Mountain spotted fever was never below 34%, a rate observed both in 2007, when there were 12 deaths in 35 cases, and in 2008, a year with 16 deaths in 47 cases.

These data include cases registered in São Paulo in which the infection occurred not only in the state itself but also outside it, which are few.

The highest proportion was observed in 2014: out of 85 patients, 60 died due to the disease, which corresponds to 71%.

Four years later, São Paulo had its highest number of cases. There were 115, with 63 deaths (55%).