Produção Nacional
Revisado por pares
Dengue outlook for the World Cup in Brazil
2014; Elsevier BV; Volume: 14; Issue: 7 Linguagem: Inglês
10.1016/s1473-3099(14)70807-2
ISSN1474-4457
AutoresEduardo Massad, Marcelo Nascimento Burattini, Raphael Ximenes, Marcos Amaku, Annelies Wilder‐Smith,
Tópico(s)Travel-related health issues
ResumoBecause the 2014 FIFA World Cup in Brazil is approaching soon, estimation of the dengue risk for this period in Brazil is important. We therefore commend Rachel Lowe and colleagues1Lowe R Barcellos C Coelho CA et al.Dengue outlook for the World Cup in Brazil: an early warning model framework driven by real-time seasonal climate forecasts.Lancet Infect Dis. 2014; (published online May 17, 2014.)http://dx.doi.org/10.1016/S1473-3099(14)70781-9PubMed Google Scholar on their Article in which they discuss how they developed an early warning system for dengue, based on a spatiotemporal Bayesian hierarchical model framework driven by climate and non-climate information.1Lowe R Barcellos C Coelho CA et al.Dengue outlook for the World Cup in Brazil: an early warning model framework driven by real-time seasonal climate forecasts.Lancet Infect Dis. 2014; (published online May 17, 2014.)http://dx.doi.org/10.1016/S1473-3099(14)70781-9PubMed Google Scholar They identified optimum trigger alert thresholds for scenarios of medium-risk and high-risk of dengue, thus enabling public health practitioners to implement early interventions. The paper correctly concludes that there is a higher risk of dengue in the cities of Fortaleza and Natal during the time of the World Cup. However, we disagree with the order of magnitude described in their paper.We calculated the risk of dengue for foreign visitors to the World Cup on the basis of past daily (not monthly) incidence in the 12 cities that will host the games.2Massad E Wilder-Smith A Ximenes R et al.Risk of symptomatic dengue for foreign visitors to the 2014 FIFA World Cup in Brazil.Mem Inst Oswaldo Cruz. 2014; 109: 394-397Crossref PubMed Scopus (24) Google Scholar Our calculations also included estimates of the expected number of visitors in each city, and the expected number of days that visitors will spend in each city, depending on each of the 32 possible schedules of the games. By multiplying these individual risks by the proportion of the expected number of visitors with respect to each stadium capacity, we estimated the expected number of dengue cases in each of these 12 cities. Our estimations are, on average, more than ten-times lower than those from Lowe and colleagues (table). We estimated the minimum expected number of dengue cases by taking the weighted mean considering the lower bounds of Lowe and colleagues' estimated incidences (plow, pmedium, phigh). We estimate 33 cases (range 3–59) among the projected 600 000 visitors. The strength of our analysis is that it includes correlations with the exact FIFA match schedule, and best-to-worst case scenarios. Our results support a low dengue risk for visitors to the World Cup, which is consistent with data recently published by GeoSentinel, a network of travel medicine providers.3Wilson ME Chen LH Health risks among travelers to Brazil: implications for the 2014 FIFA World Cup and 2016 Olympic Games.Travel Med Infect Dis. 2014; (published online April 18.)http://dx.doi.org10.1016/j.tmaid.2014.04.001PubMed Google Scholar, 4Wilson ME Chen LH Han PV et al.Illness in travelers returned from Brazil: the GeoSentinel experience and implications for the 2014 FIFA World Cup and the 2016 summer Olympics.Clin Infect Dis. 2014; 58: 1347-1356Crossref PubMed Scopus (39) Google ScholarTableExpected number of visitors and dengue cases for each of the Brazilian cities hosting the World Cup gamesLowe et al estimations1Lowe R Barcellos C Coelho CA et al.Dengue outlook for the World Cup in Brazil: an early warning model framework driven by real-time seasonal climate forecasts.Lancet Infect Dis. 2014; (published online May 17, 2014.)http://dx.doi.org/10.1016/S1473-3099(14)70781-9PubMed Google ScholarMassad et al estimations2Massad E Wilder-Smith A Ximenes R et al.Risk of symptomatic dengue for foreign visitors to the 2014 FIFA World Cup in Brazil.Mem Inst Oswaldo Cruz. 2014; 109: 394-397Crossref PubMed Scopus (24) Google ScholarExpected number of visitors*Source: EMBRATUR.plowpmediumphighMinimum expected number of dengue cases†Minimum number of expected cases (weighted mean)>1 × plow + 100 × pmedium + 300 × phigh.Expected number of dengue cases‡Average (best–worst) scenarios.Expected number of dengue cases per 100 000 visitors*Source: EMBRATUR.‡Average (best–worst) scenarios.Natal44 95232%20%48%>746 (2–9)13·3 (4·4–20·0)Fortaleza58 19534%20%46%>9210 (1–14)17·2 (1·7–24·1)Rio de Janeiro101 91062%25%13%>6611 (0–22)10·8 (0·0–21·6)Belo Horizonte36 78865%24%11%>213 (0–8)8·2 (0·0–21·7)Recife37 69357%24%19%>310 (0–1)0·0 (0·0–2·7)Cuiabá20 74071%22%7%>92 (0–4)9·6 (0·0–19·3)Brasília34 39173%20%7%>141 (0–1)2·9 (0·0–2·9)Salvador57 85556%27%17%>4500·0Manaus26 25263%25%12%>1600·0São Paulo101 15099%1%0%>200·0Curitiba34 782100%0%0%000·0Porto Alegre35 343100%0%0%000·0Total607 051>37033 (3–59)5·4 (0·5–9·7)plow=incidence lower than 100 per 100 000. pmedium=incidence between 100 and 300 per 100 000. phigh=incidence higher than 300 per 100 000.* Source: EMBRATUR.† Minimum number of expected cases (weighted mean)>1 × plow + 100 × pmedium + 300 × phigh.‡ Average (best–worst) scenarios. Open table in a new tab Predictions are still merely predictions and depend on assumptions from past experiences. Of course, the incidence of dengue in 2014 might be ten-times higher than ever; it is just unlikely to be so (in fact, the number of cases reported so far in 2014 are 43% fewer in Natal and 35% fewer in Fortaleza, than in 2013). However, health-care providers in countries where World Cup visitors will return should be at high alert for dengue, and report cases immediately to authorities. In doing so, timely surveillance can be established and provide the true number of dengue cases during the World Cup.The research was partially funded by LIM01-HCFMUSP, FAPESP, CNPq (EM, MNB, RX, MA), the Brazilian Ministry of Health (MNB), and Dengue Tools under the Seventh Framework Programme of the European Community (EM, AWS). We declare no competing interests. Because the 2014 FIFA World Cup in Brazil is approaching soon, estimation of the dengue risk for this period in Brazil is important. We therefore commend Rachel Lowe and colleagues1Lowe R Barcellos C Coelho CA et al.Dengue outlook for the World Cup in Brazil: an early warning model framework driven by real-time seasonal climate forecasts.Lancet Infect Dis. 2014; (published online May 17, 2014.)http://dx.doi.org/10.1016/S1473-3099(14)70781-9PubMed Google Scholar on their Article in which they discuss how they developed an early warning system for dengue, based on a spatiotemporal Bayesian hierarchical model framework driven by climate and non-climate information.1Lowe R Barcellos C Coelho CA et al.Dengue outlook for the World Cup in Brazil: an early warning model framework driven by real-time seasonal climate forecasts.Lancet Infect Dis. 2014; (published online May 17, 2014.)http://dx.doi.org/10.1016/S1473-3099(14)70781-9PubMed Google Scholar They identified optimum trigger alert thresholds for scenarios of medium-risk and high-risk of dengue, thus enabling public health practitioners to implement early interventions. The paper correctly concludes that there is a higher risk of dengue in the cities of Fortaleza and Natal during the time of the World Cup. However, we disagree with the order of magnitude described in their paper. We calculated the risk of dengue for foreign visitors to the World Cup on the basis of past daily (not monthly) incidence in the 12 cities that will host the games.2Massad E Wilder-Smith A Ximenes R et al.Risk of symptomatic dengue for foreign visitors to the 2014 FIFA World Cup in Brazil.Mem Inst Oswaldo Cruz. 2014; 109: 394-397Crossref PubMed Scopus (24) Google Scholar Our calculations also included estimates of the expected number of visitors in each city, and the expected number of days that visitors will spend in each city, depending on each of the 32 possible schedules of the games. By multiplying these individual risks by the proportion of the expected number of visitors with respect to each stadium capacity, we estimated the expected number of dengue cases in each of these 12 cities. Our estimations are, on average, more than ten-times lower than those from Lowe and colleagues (table). We estimated the minimum expected number of dengue cases by taking the weighted mean considering the lower bounds of Lowe and colleagues' estimated incidences (plow, pmedium, phigh). We estimate 33 cases (range 3–59) among the projected 600 000 visitors. The strength of our analysis is that it includes correlations with the exact FIFA match schedule, and best-to-worst case scenarios. Our results support a low dengue risk for visitors to the World Cup, which is consistent with data recently published by GeoSentinel, a network of travel medicine providers.3Wilson ME Chen LH Health risks among travelers to Brazil: implications for the 2014 FIFA World Cup and 2016 Olympic Games.Travel Med Infect Dis. 2014; (published online April 18.)http://dx.doi.org10.1016/j.tmaid.2014.04.001PubMed Google Scholar, 4Wilson ME Chen LH Han PV et al.Illness in travelers returned from Brazil: the GeoSentinel experience and implications for the 2014 FIFA World Cup and the 2016 summer Olympics.Clin Infect Dis. 2014; 58: 1347-1356Crossref PubMed Scopus (39) Google Scholar plow=incidence lower than 100 per 100 000. pmedium=incidence between 100 and 300 per 100 000. phigh=incidence higher than 300 per 100 000. Predictions are still merely predictions and depend on assumptions from past experiences. Of course, the incidence of dengue in 2014 might be ten-times higher than ever; it is just unlikely to be so (in fact, the number of cases reported so far in 2014 are 43% fewer in Natal and 35% fewer in Fortaleza, than in 2013). However, health-care providers in countries where World Cup visitors will return should be at high alert for dengue, and report cases immediately to authorities. In doing so, timely surveillance can be established and provide the true number of dengue cases during the World Cup. The research was partially funded by LIM01-HCFMUSP, FAPESP, CNPq (EM, MNB, RX, MA), the Brazilian Ministry of Health (MNB), and Dengue Tools under the Seventh Framework Programme of the European Community (EM, AWS). We declare no competing interests. Dengue outlook for the World Cup in Brazil: an early warning model framework driven by real-time seasonal climate forecastsThis timely dengue early warning permits the Ministry of Health and local authorities to implement appropriate, city-specific mitigation and control actions ahead of the World Cup. Full-Text PDF Interpretation of probabilistic forecasts of epidemicsWe are grateful to Eduardo Massad and colleagues1 for discussing the results of our study2 that addressed the potential for a dengue epidemic during the World Cup in Brazil. We believe our results are not comparable to point estimates obtained using deterministic models; however, we welcome the opportunity to discuss and clarify the interpretation of probabilistic forecasts of dengue risk. The approaches (including aim, methodological framework, data, and population) that we used2 differ in several ways from those used by Massad and colleagues3 to estimate the risk of acquiring dengue fever during the 2014 FIFA World Cup in Brazil. Full-Text PDF
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