The Heat Is Online

Brazil Fights Worst Ever Dengue Outbreak

Brazilians take strong steps to fight a deadly mosquito

The Boston Globe, March 10, 2002

RIO DE JANEIRO – (AP) More than 50,000 volunteers, soldiers, firefighters, and health workers took to the streets yesterday in an attempt to stamp out mosquitoes held to be responsible for a dengue fever outbreak.

The mobilization, called ''D-Day Against Dengue,'' seeks to eradicate bodies of standing water where the Aedes aegypti mosquito can lay its eggs, and to give instructions on the perils of standing water, in plant trays, drains, swimming pools, or used tires.

''This is serious,'' said Ana Luisa Nascimento, a 27-year-old teacher, as she handed out pamphlets in the Ipanema neighborhood. ''My daughter's had dengue. My maid's son and two of my students have contracted dengue. It's no joke.''

So far this year, more than 72,000 people across the state have been diagnosed with the disease, and 28 have died, according to the state's health authorities.

Because of underreporting, many specialists say that the number of cases could be three times higher than official figures suggest. Smaller outbreaks of the disease, which causes severe headaches and joint pains, have been reported in seven other states.

''In 30 days, we hope we can present the citizens of Rio de Janeiro more positive results in the fight against dengue,'' the health minister, Barjas Negri, said as he kicked off the campaign yesterday.

Also known as breakbone fever, dengue is usually not fatal. But the more serious form, hemorrhagic dengue, has a death rate of 5 percent, according to the US Centers for Disease Control and Prevention. There is no vaccine.

In Santa Teresa, a neighborhood high in Rio's hills, volunteers marched with rubber mosquitos as they passed out pamphlets.

The neighborhood's colonial-style architecture provides many hidden areas where water can accumulate, and it has reported 933 cases of the disease, according to the Municipal Health Secretariat.

Tourism officials set up stands in front of large hotels, and distributed pamphlets in English, advising tourists to wear mosquito repellent and providing other information about the disease.

Residents are also turning to pet stores to buy plastic collars containing citronella, a sharp-smelling oil that repels mosquitos.

''People are wearing them on their wrists, like bracelets,'' said Lucia Fairon, a sales clerk at the Pet From Ipanema store. ''The demand is enormous. We've already run out and ordered more.''

The clear plastic collars were meant to protect dogs and cats from filariasis, a mosquito-borne disease that affects the lymph vessels and that causes chronic swelling in animals, but also to repel dengue-carrying mosquitoes.

The disease was common in colonial times, and was widely thought to be eradicated here until two decades ago. Cuba, Peru, and El Salvador have also reported recent outbreaks.

This year's epidemic is by far the worst, surpassing the 1991 epidemic that killed 24 people.

This story ran on page A8 of the Boston Globe on 3/10/2002.
Copyright 2002 Globe Newspaper Company.

Dengue mosquito becomes Brazil's public enemy No.1, March 1, 2002

SAO PAULO - Brazil's most-wanted killer this year isn't a gangster or drug king, but a white-spotted mosquito that has so far claimed at least 20 lives and threatens to sting a presidential candidate's aspirations.

Faced with one of the worst outbreaks of dengue fever in recent years, Brazil has mobilized more than 1,000 army troops and thousands of health workers to smoke out the disease-carrying Aedes aegypti mosquito.

Almost 40,000 cases of dengue had been officially registered in Rio de Janeiro state, the worst-hit area, so far this year. The number of cases in January alone in the state was the worst in a decade.

But a period of heavy rains has provided ample breeding grounds for the mosquito across the country and, given its propensity for travel, the disease is quickly spreading, hitting blue-collar workers and soap opera stars alike.

"It's democratic. We've found larva even in wealthy neighborhoods," said Nelson Nagamura, chief of a regional dengue program in Sao Paulo, Brazil's largest city.

So far, there have been only 10 cases contracted in the Sao Paulo, with another 361 imported into the metropolitan area of 16 million people. But with elections in October, politicians are scrambling to appear to be doing all they can to stop the outbreak.

Saturday was Sao Paulo's "D-Day" against dengue and Mayor Marta Suplicy toured a working class neighborhood with health workers who gave out pamphlets and bags of sand to fill the dishes that collect stagnant water beneath flower pots.

The best way to kill the mosquito, health official say, is to get rid of the water where it lays its eggs.


Dengue is usually not deadly but can cause high fevers, headaches, muscle and joint pain, lack of appetite and fatigue. However, some people can develop the potentially fatal hemorrhagic dengue from repeated exposure.

There are no vaccinations or treatment drugs for dengue and sufferers are told to rest and drink plenty of liquids until the symptoms pass, usually after one week.

Brazil wiped out the mosquito as part of its campaign against yellow fever in the 1950s. Twenty other countries in the Americas also got rid of the bug via a widespread coordinated effort that lasted into the 1970s.

But certain countries like the United States did not kill off the bug, and as trade between the region's countries flourished and urban centers swelled, political interest and funds to keep the mosquito out waned.

"With a lot of exports from the U.S. to other countries the mosquito went piggy back and went on," said Jorge Arias, a regional advisor for the Pan American Health Organization.

With 390,701 cases reported last year, Brazil is by far the leader in number of cases in the Americas. But, with a land mass bigger than the continental United States and a population of 170 million, it is also the largest country in Latin America.

And Colombia reported 10 times more cases of hemorrhagic dengue while Costa Rica's incidence rate was four times bigger than Brazil's.

Still, the death toll is quickly nearing last year's 28, with 20 cases registered in just Rio state so far. Although the government has yet to release a national count, Rio's leading newspaper O Globo says the state death toll could climb to 45 if recent fatalities are confirmed for dengue.

And the extent of the problem means that even if Brazil manages to wipe out the mosquito, it can easily fly back in. "You have to have constant coverage. And you have to have intersectorial action. This is not the problem of one minister alone," Arias said.

Indeed, the dengue outbreak has already put the heat on Brazil's former Health Minister Jose Serra, who stepped down last week to run for president under the ruling PSDB party.

Known for his tough campaign against tobacco companies and a successful battle to cut the price of AIDS drugs, dengue threatens to sully his record. Already he's been dubbed the "presidengue."

"It definitely doesn't help," said Carlos Lopes, a political analyst at SantaFe Ideias consultants in Brasilia.

"A friend of mine from the PSDB said the other day she wasn't going to vote for Serra because her kid got dengue."

The intensity of the outbreak is partially due to the arrival of a new type of dengue virus to which Brazilians have not yet built up resistance.

But experts also blame part of the problem on a lack of funds and a decentralization of the dengue effort that can render one city's successful efforts futile if another city fails to wipe out the mosquito.

Those afflicted by the disease have also criticized the grinding bureaucracy that accompanies efforts to have themselves tested or get their homes sprayed against the bug.

"A public health policy against dengue could have prevented my getting dengue, but not one that starts the last one or two months," said Sergio Gwercman, 24, who says he contracted the disease while in Bahia state for Carnival celebrations.

Most Brazilians, meanwhile, are dealing with the disease as best they can. Sales of insecticide and citronella candles are up as people become more vigilant. In Rio, where this year's Carnival king fell ill to dengue, radio stations are even airing the "Get lost, dengue" samba.

"The mosquito bites and it can kill," it says. "Empty that bucket, show your will." (Additional reporting by Andrei Khalip in Rio de Janeiro).

Story by Carlos A. DeJuana