O the number of dengue cases has skyrocketed in Brazil, and the reagent used to carry out the examination that confirms the disease is exhausted in the public and private network.
According to the latest federal epidemiological bulletin (week 18), probable declarations have tripled compared to the same period last year (+146.5%, from 307,133 to 757,068 cases).
Cases reported to the Union by municipalities and states increased by 56.7% (from 542,970 to 850,657 patients) and confirmed cases increased by 65.7% (from 254,836 to 422,342 infected).
The Department of Health’s recommendation at this time is that dengue cases should be “confirmed by laboratory criteria or by clinico-epidemiological criteria”, according to a document in the filing.
For places where it is not possible to carry out laboratory tests, “the recommendation is to follow the diagnostic protocols by clinical criteria, notifying the suspected case with the diagnosis by clinico-epidemiological criteria”.
The note also states that in “unable to perform specific laboratory confirmation or for cases with inconclusive laboratory results, confirmation by epidemiological link with a laboratory confirmed case should be considered”.
In São Paulo, the number of dengue confirmations remained stable, but dengue deaths increased from 41 to 77 (an increase of 87.8%). The state recorded in 2022, until May 2, 107,400 cases of dengue against 104,000 cases in the same period of the previous year.
The São Paulo state health department said it had “sent letters to the federal agency to send new tests, but there was no sign of a new delivery” and that “the acquisition and the distribution of tests for the detection of dengue fever are the responsibility of the Ministry of Health”. “, with the state government “merely redistributing the article.”
Also according to the file, the absence of an examination does not prevent the clinical diagnosis or the treatment of the patient by the municipalities and that the “suspension of the collection of serology for non-serious cases is already provided for in the directives of prevention and control”. urban arboviruses in the state”.
The state’s Center for Epidemiological Surveillance (CVE) ranks cities with higher-than-expected cases for their seasonal dengue history.
This list makes it possible to define where the taking of samples will be suspended for confirmation of the diagnosis by serology, even when the reagent is available.
The ranking is not disclosed, according to the state, because it is a very dynamic update chart – it must have been for four consecutive weeks with a higher than expected increase in cases, and the entry and exit of the cities are constant.
This is the case of Barretos, a municipality in the interior, 233 km from the capital São Paulo, which was declared this week a dengue epidemic by the state.
With the high number of suspected cases, testing is no longer being carried out in the city. The city’s municipal health secretary, Kleber Rosa, said now patients who come to the public health network with three or more symptoms of the disease will receive direct treatment.
“Even without the specific test for dengue, we will continue to do blood counts to check patients’ platelets,” Rosa said.
In Ribeirão Preto, which has kept dengue fever rates low for the past two years, the total number of patients with dengue symptoms has also skyrocketed.
In the emergency care of the private health plan Unimed Ribeirão, the daily demand for tests for the disease has increased sevenfold compared to the same period last year and at least since Monday the network has been without reagents .
In a statement, the network indicates that “the non-supply of specific laboratory supplies for the NS1 test is momentary”, “widespread due to the high demand for dengue cases in the region in recent days” and that there had “a delay in the delivery to suppliers of this input for all laboratories”.
Patients with symptoms of dengue undergo tests that can confirm the diagnosis and guide treatment, such as blood counts and antibody tests, which would be “sufficient to guide clinical management, the NS1 n ‘having only a complementary character (confirmation diagnosis). “
For the doctor Amaury Lelis Dal Fabbro, professor at the Department of Social Medicine of the University of São Paulo (USP) Ribeirão Preto School of Medicine (FMRP), even if the diagnosis is possible, the lack of reagents can affect the epidemiology of the dengue fever surveillance system.
According to him, virological and serological tests for dengue fever make it possible to deal with “reasonably non-specific” symptomatology, which can possibly be confused with other viruses. “It is essential that the epidemiological surveillance system confirms cases, or at least a certain number of cases, to be sure of the type of virus circulating in the population,” Fabbro said.
The two basic types of specific blood tests are serological, which identify dengue antibodies and confirm the diagnosis, and virological, which show which dengue virus has infected the patient and is circulating at the time — this is what which is lacking in the country.
“This information [de sorologia] is fundamental for virology, because each serotype behaves differently in the population and it is essential that tests are available,” said the doctor.
Denis Henrique da Silva, 43, salesman and civil engineer, has been showing symptoms of dengue fever since last week. “I felt a lot of pain in the body, in the joint, without the strength to do anything, fever. An experience that I never had, even when I caught the Covid j I was like that,” he said.
His case was confirmed only by laboratory tests and the appearance of red spots. “My platelets dropped a lot in three days. I looked for UPA in Barretos and they didn’t do the test [de dengue]was only detected through platelets, but [é] It’s such a shame to spend a month not knowing if it’s true or not,” he said.