peripheral populations are more exposed to dengue

“My Spider-Man is sulking, sad. He is so strange”. General services assistant Juliana Pereira, 28 years old, is used to little Vitor, 3 years old, jumping from one corner to another, just like a superhero. Fast on the bike, chasing the ball and non-stop around the house. But the boy spent the week with a high fever and pain, without leaving his mother’s lap. All because of dengue.

They live in a house in Cidade Estrutural, a peripheral administrative region of the Federal District, “surrounded by bush, garbage, stagnant water and a lack of infrastructure”, as the mother, who also had the disease in February, says. “I can’t go to work because I need to take care of them,” says Juliana. The other resident of the house, Jeferson Muniz, 25 years old, Juliana’s brother, also hadn’t been able to go to work for 5 days because of the symptoms of the disease.

Vulnerability

Infectious disease doctor José Davi Urbaez says that social conditions are causes of the spread of dengue. “It is very clear that, in the case of dengue and, generally, all infectious diseases, they are great markers of this vulnerability because it is constructed”, he assesses. Populations with less basic sanitation, decent housing, employment, education and access to healthcare, according to the doctor, are more vulnerable to the spread of diseases such as dengue.

Jeferson, little Vitor’s uncle, complained of, in addition to body pain, shortness of breath and a lot of nausea. He works at a car wash all day and even tried to work while sick, but he couldn’t handle the pace. Surrounded by public health professionals and lying on a stretcher, in one of the treatments he received, he improved after being medicated and receiving intravenous hydration with serum.

During the week, the family was together in a care tent installed by the Federal District government next to the region’s Basic Health Unit, to reinforce care in the face of the health crisis in the country’s capital, which has the highest number of deaths caused by the disease. illness. At UBS, 2,391 cases of the disease had already been confirmed as of Friday (1st). In fact, the ten posts with the most notifications of the disease were all in the most vulnerable areas, which accounted for 27,264 cases.

Capital in surge

According to information from the Ministry of Health, as of Saturday (March 2), there were 77 confirmed deaths in the Federal District, equivalent to 29.8% of the number of deaths in the country, out of a total of 258, due to dengue fever to date. . There were another 60 incidents under investigation.

In total, the DF had more than 102,757 diagnoses of the disease, which represented almost 10% of cases throughout Brazil, which surpassed the mark of more than one million notifications during the week. Service stations on the outskirts lead in notifications of the disease.

“What scared me most was the possibility of dengue getting more serious. We are poor and we are very afraid”, says Juliana, who is afraid of everyone getting sick at the same time. She’s seen her neighbors look bad in recent weeks.

Infectious disease doctor Hemerson Luz explains that it can happen that people who have had dengue once present a more serious condition on a second occasion. “Due to an immune system reaction, a worse inflammatory response may occur. The term hemorrhagic dengue fever is no longer used.”

The doctor understands that urban social conditions can influence the spread of the disease. “We know that today dengue is a disease that can be prevented with measures to combat the mosquito and also with the vaccine that is coming”, he explains.

Responsibility

The expert points out that any abandoned object that accumulates water could end up being a breeding ground for mosquitoes. “Remember that Aedes aegypti eggs can remain in dry land for up to 1 year, waiting for water to fall and accumulate. The entire fight is based on eliminating these creators, such as thrown objects, water tanks without lids, that vase that has a small dish with water underneath”, he warns. Hemerson Luz says that all this care is necessary with the responsibility of public bodies and citizens.

The specialist’s recommendation is that people should seek health support for symptoms such as the classic condition that includes headache, high fever, tiredness, pain behind the eyes. There is a possibility of red spots appearing on the skin. The doctor asks for special attention to the existence of abdominal pain, vomiting and a drop in blood pressure.

In fact, it was because of abdominal pain that elderly caregiver Joseana Rosa, 49 years old, had to think about taking care of herself. She also went to the clinic at Cidade Estrutural and told the doctors that she hadn’t slept for 2 days and felt body pain, which she had difficulty explaining. “I had a lot of fever and nausea. This disease, for me, was worse than covid (which was diagnosed in 2022)”, compared the patient. Joseana also thought about going to work and facing an almost 50-minute bus ride to work. She gave up after taking the first step toward the door.

Anguish

About 20 km from Estrutural, a family was desperate at the Emergency Care Unit in Ceilândia, the largest administrative region in the Federal District. Physiotherapist Amanda Oliveira, 33 years old, was distressed by the situation of mother Maria Luzemar, 57 years old, admitted to the red room to receive intensive oxygen support and monitoring of vital signs.

“My mother started with a high fever and it got worse in the morning. She had blood when she had a bowel movement and was delirious. She asked us to help urgently.” A week ago, her mother stopped going to work as a barbecue seller in the neighborhood where she lives. “She couldn’t take it anymore,” Amanda said.

At the door of the UPA, family members of patients wait for the possibility of receiving news and the possibility of making visits.

Next to the UPA, the Air Force Field Hospital, staffed by military personnel from other regions of the country, includes doctors, nurses, nursing and laboratory technicians, with activities 24 hours a day. Retired Francisca Miranda, 65 years old, was accompanied by her daughter Taynah, 28 years old, because she could barely move. They live in Ceilândia, a region where public health units have the most notifications, 25,250 as of Friday, representing one in every four cases of dengue in the Federal District.

Children and elderly

According to infectologist Hemerson Luz, anyone can have the disease worsen. “But it can be worse in very young children, or even in elderly people, pregnant women, people who have comorbidities. And a big focus of attention today is precisely children and adolescents, where vaccination programs are starting,” he explains.

To combat dengue, doctor Hemerson Luz argues that the public health system can rely on the use of technologies to identify which street or neighborhood has the most cases. “The mosquito has a very small flight range, only around 200 meters. The use of drones to search for these places that may be accumulating trash can be used by public authorities to carry out this search. This is everyone’s duty.”

Rio de Janeiro

In Rio de Janeiro, a city that has already experienced recent epidemics of the disease, such as in 2002, 2008 and 2012, a dengue care center operates at the Hélio Pellegrino Polyclinic, in Praça da Bandeira, in the north of the city. Different cases also arrive there. Concern for children is part of the place’s routine.

Hairdresser Jaqueline Souza, for example, took her 6-year-old son Gabriel after the boy developed a high fever. “He started to fall down. Then the pain soon came. He complained a lot about the pain in his back, eyes and legs as well. Then, the chicks,” he detailed. When she judged that the boy was a little better, she took him to school. But it was still too early to get back to the routine. She picked the boy up from school because the symptoms returned.

On the same day, while attending the polyclinic, self-employed Nelson Amado reveals that he had had symptoms for a week. “A very strong pain in my body and I had a fever. I couldn’t stay at work any longer and went home,” he said. After the exam, it was found that there was an infection and he became more concerned about hydration. “It’s the second day I’ve been back here at the Polyclinic.”

Climate changes

The spread of the disease in large cities is a cause for warning for doctor Carlos Starling, vice-president of the Minas Gerais Society of Infectious Diseases. “What draws attention is that the number of cases has increased a lot in recent days, not only of dengue, but also of covid. So we are, at the moment, living with two epidemics at the same time,” he said.

For the specialist, prevention work will still need to be more effective. For him, the number of cases should continue to increase until the end of April, when the temperature should start to drop. “As a result, the mosquito population also decreases and, consequently, the transmission of the disease as well. The seasonal period for dengue traditionally lasts until April,” he explains. However, the expert warns that climate change could alter this logic.

The increase in temperature alters the rainfall regime, and this could, in theory, cause this period to extend until June, when the number of cases traditionally drops drastically. “What should greatly change this epidemiological profile is the greater availability of vaccines in the coming years. But for this year, vaccines will still not have the impact that we would like them to have.”

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