In early 2008, the Brazilian Ministry of Health reported that while the overall incidence of dengue fever cases in most of Brazil had decreased in comparison to the same period in 2007, the number of cases in Rio de Janeiro State had increased by more than 100%. By mid-March 2008, it had became evident, despite attempts at denial on the city administration's part, that the city of Rio de Janeiro in particular and the state as a whole were going through a dengue fever epidemic.
As of March 22, the affected areas in Rio are not the ones usually visited by tourists. The epidemic has exposed, once again, the higher vulnerability of low-income communities and the deficiencies of the public health system in Brazil. Nevertheless, Rio is under a health alert. Travelers should learn as much about dengue fever as possible and stay updated about the latest developments. Travel health insurance providing for stays in private hospitals should be seriously considered prior to Brazil travel.
Dengue fever - and its more severe form, dengue hemorrhagic fever (DHF) - is a tropical disease caused by a virus and borne by the same mosquito that transmits yellow fever - the Aedes aegypti. While there is effective immunization against yellow fever, no vaccine has been developed for dengue fever. Prevention consists of eliminating the mosquito and its breeding sites as well as avoiding bites through coverage and the use of repellents.
Because dengue fever is a viral infection, no medicine can be prescribed to cure it, but early diagnosis is crucial so that steps such as extra hydration, an important element in dengue fever recovery, can be carried out as soon as possible and so that patients that need to be hospitalized don't lose any precious time.
Dengue Fever Cases in Rio
Between January 1 and March 21, 2008, 48 people died of dengue fever infection in Rio de Janeiro State. Thirty of those victims were infected in the city of Rio de Janeiro and more than half were children under 15. As of March 21, exams were under way to determine if an additional 49 deaths in the state had been caused by dengue fever.
On March 21, Rio de Janeiro newspaper JB Online reported a total of 35,902 cases of dengue fever in Rio and adjacent towns since Jan. 1. On March 20 alone, 2,053 cases of dengue fever infection were confirmed - 1 case per minute on average.
The worst previous outbreak of the disease in Rio de Janeiro State had taken place in 2002, when 138,027 people were diagnosed with the disease and 90 people died.
All kinds of dengue fever may be fatal. Of all the deaths in the 2008 outbreak in Rio until March 21, only two were attributed to dengue hemorrhagic fever, the more severe form of the disease.
In a statement posted on their site on March 19, the Ministry of Health announced the creation of a crisis office to handle the outbreak, with support from the state government and the Armed Forces. The Ministry affirmed it had warned state governments of the risk of a dengue fever outbreak in the summer (December-March). The note attributed the situation in Rio de Janeiro to "low implementation of family health programs" and to inadequate attention to the problem.
São Paulo newspaper Folha Online reported that in an interview given on the same day the note was issued, Minister of Health José Gomes Temporão openly blamed Rio de Janeiro mayor Cesar Maia for the outbreak, to which Maia reacted with harsh criticism aimed at the Ministry. At the time, Maia was also quoted as saying the situation did not configure an epidemic. Later in the week, he admitted to an epidemic, but only in the district of Jacarepaguá.
On March 20, the Rio de Janeiro Doctors' Union - Sindimed - announced it would press charges against the city, state and federal governments for omission and negligence in the prevention of, and fight against, dengue fever in Rio.
According to Folha Online, on March 20 the Rio de Janeiro State Secretary of Health, Sérgio Côrtes, used the word "epidemic" for the first time to describe the dengue fever situation in the state, during an interview to RJ TV, a local TV station.
Most Affected Areas
Most cases of dengue fever infection in the summer of 2008 outbreak were recorded in Rio's west zone. Jornal do Brasil Online posted a list of the neighborhoods with the greatest incidence of dengue fever in the period:
The Port Area: Gamboa, Santo Cristo and Saúde
North Zone: Catumbi, Cidade Nova, São Cristóvão, Mangueira, Benfica, Ramos, Bonsucesso, Jardim América, Inhaúma, Jacaré, Vista Alegre
West Zone: Costa Barros, Anil, Gardênia Azul, Curicica, Pechincha, Taquara, Cidade de Deus, Camorim, Vargem Grande and Vargem Pequena.
A Deadlier Strain
In an interview on TV Globo's morning news Bom Dia Rio on March 19, epidemiologist Roberto Medronho, head of the Nucleus for Studies in Collective Health at the Federal University of Rio de Janeiro (UFRJ) and one of the greatest specialists in dengue fever in Brazil, stressed the fact that in the 2008 outbreak, the risk of death for infected patients is three times higher than in 2002.
He urged people to engage actively in the elimination of Aedes aegypti breeding sites and to learn about the symptoms that set dengue fever apart from other infections, so that prompt treatment can reduce the risk of death.
Medronho confirmed the epidemic status of the disease based on parameters set by the World Health Organization and the Pan-American Health Organization.
Some of the emergency steps taken by government officials to curb the dengue fever outbreak in Rio are an increase in the number of hospital beds, the use of special vehicles to expedite blood collection, and a request for help from the Armed Forces in the setting up of field hospitals and the spraying of affected areas.