Dengue fever alarms the capital and 23 other cities.

GazetaWeb - It all started with some aches and pains and a lack of energy. What could have been a simple viral infection, however, ended up taking accountant Regina Célia to the hospital. With the symptoms worsening and red spots appearing all over her body, she saw her platelet count, which should have been at 150, drop to 13 and soon received the diagnosis: she had dengue fever.

The disease manifested in its worst form, the hemorrhagic form, causing her to have 15 days of complete bed rest, in addition to needing to go to a hospital unit every 48 hours for blood tests. Gradually, her platelet count increased and, upon reaching 140, the patient could breathe a sigh of relief after the scare.

Regina Célia is just one of the many people from Alagoas affected by dengue fever in the state. In 2015 alone, 1.265 cases were reported, most of them in the milder form. Despite a slight decrease compared to last year – when there were 1.296 cases – four cities are in an epidemic situation and others are at risk of an outbreak.

According to a report from the State Health Secretariat (Sesau), Mata Grande, Inhapi, Ouro Branco, and Major Isidoro are currently experiencing an epidemic, with an incidence rate equal to or greater than 300 cases per 100 inhabitants. Contrary to what usually happens, where the highest incidence occurs in the capital, this scenario is even more worrying for the agency.

"We know that in a small population, everything that affects it has a greater impact and the disease spreads faster. And this is growing in other municipalities already on alert regarding the high incidence, which are Maravilha, Anadia and Junqueiro. This is changing daily and we are seeing very significant numbers from small municipalities," explains the director of Epidemiological Surveillance at Sesau, Cleide Moreira.

The three regions cited by the manager have between 100 and 300 cases per 100 inhabitants, and in addition to these, another 23, mostly in the Agreste and Sertão regions, are still at risk of an outbreak, which occurs when a contagious disease has an above-normal number of infections. "When we compare the numbers from 2014 and 2015, we see that there isn't a significant difference. What is most worrying is this concentration," she adds.

The capital city is also facing a difficult situation, with 19 neighborhoods on the verge of an outbreak. Those at highest risk are Gruta de Lourdes, Pinheiro, Ponta da Terra, Pajuçara, Poço, and Ponta Verde, with a Building Infestation Index (BIP) between 7,5 and 7,9% – a satisfactory percentage is one below one.

Teams have been closely monitoring the numbers and carrying out preventative work to avoid a more serious situation. "Since January 16th, the State Health Department has prioritized assistance and cooperation with municipalities with many cases. We have teams, a task force, working with these municipalities to prevent a more worrying situation, which is an epidemic situation."

No notification

Despite the high incidence rates of dengue fever in Alagoas, it seems that some municipal administrations are still not very concerned about the disease. According to the director of Epidemiological Surveillance, São Braz and Satuba have not reported any suspected cases of the illness, and part of the state has a rate well below "normal".

"We have some municipalities with no reported cases. This is inconceivable, as dengue transmission is very strong. And when you have municipalities with such high rates and others with zero cases, something strange is happening. They need to be more vigilant," says Cleide.

The manager emphasizes that this is concerning and may be masking the true risk scenario for dengue fever. She stresses the need for cities not to rely on passive reporting, but rather to actively search for patients in places such as homes, public spaces, and workplaces.

"Of course, we don't want them to present cases, but it's necessary to do active case finding to identify what's happening. We recommend that surveillance work be more intensive so that we have the real number of cases and can act, preventing us from encountering an epidemic situation when we first notice it."

Control

Cleide Moreira also points out that, in parallel, it is also important for administrations to adopt other methods to combat Aedes aegypti breeding sites, including deploying agents in the streets for more intensive control. Other measures that can be adopted include urban cleaning and community awareness campaigns.

However, all of this must be done regularly to prevent outbreaks. "These actions are routine. The municipality needs to reinforce everything at this time: the collection and proper disposal of garbage, the cleaning of vacant lots, squares and cemeteries, and the inspection of tire shops to ensure they don't leave used tires exposed to the elements."
According to her, this should help reduce the population of the transmitting mosquito, as well as other actions spearheaded by Sesau, with the task force formed by technicians from the Directorates of Epidemiological Surveillance and Primary Care, who have been visiting the cities most affected by the disease.