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Dengue fever: a call for local, national, and international action

2008; Elsevier BV; Volume: 372; Issue: 9634 Linguagem: Inglês

10.1016/s0140-6736(08)61069-7

1474-547X

Maurício L. Barreto, Maria Glória Teixeira,

Zoonotic diseases and public health

The dengue fever outbreak in the state of Rio de Janeiro, Brazil, with its epicentre in the city itself, resulted in more than 158 000 reported cases and over 9000 hospital admissions between January and April, 2008. The confirmed death toll has exceeded 230, with 116 still under investigation. In your April 12 Editorial (p 1216),1The Lancet International action needed on dengue.Lancet. 2008; 371: 1216Scopus (3) Google Scholar you call for a “cohesive international action plan to help affected countries tackle disease prevention and also to assist in the scale-up of immediate treatment to affected populations”. We agree, but would like to qualify this call. Brazil, despite dedicating around US$1 billion per year to dengue control and care, has met with frustrating results,2Teixeira MG Costa MCN Barreto ML Mota E Dengue and dengue hemorrhagic fever epidemics in Brazil: what research is needed based on trends, surveillance, and control experiences?.Cad Saude Publica. 2005; 21: 1307-1315Crossref PubMed Google Scholar as have other countries.3Ooi EE Goh KT Gubler DJ Dengue prevention and 35 years of vector control in Singapore.Emerg Infect Dis. 2006; 12: 887-893Crossref PubMed Scopus (403) Google Scholar The international, national, and local communities need to focus their efforts on three major targets. First, there is a need to develop new approaches to vector control, since the existing ones are ineffective, expensive, and environmentally aggressive. Second, an efficacious tetravalent vaccine affordable to the population at risk is important. Current vaccine development efforts will take several years to come to fruition, and even then the vaccine could be unaffordable to those in most need.4Whitehead SS Blaney JE Durbin AP Murphy BR Prospects for a dengue virus vaccine.Nature. 2007; 5: 518-528Google Scholar Finally, dengue in the tropics has its roots in the way the urban population has expanded explosively, while that of the basic infrastructure has lagged behind.5Tauil PL Urbanização e ecologia da dengue.Cad Saude Publica. 2001; 17: 99-102Crossref PubMed Google Scholar It is worth remembering that the cities of the industrialised north suffered from cholera, plague, and other epidemics in the 19th century, but that these problems were solved by transforming the cityscapes on the basis of evidence from public-health and biomedical research of that time. More than a century later, we urge the large tropical cities to follow the proposals (updated where necessary) of the likes of Edwin Chadwick, John Snow, and Louis Villermé. We declare that we have no conflict of interest.