Produção Nacional
Revisado por pares
Aedes aegypti control in Brazil
2016; Elsevier BV; Volume: 387; Issue: 10023 Linguagem: Inglês
10.1016/s0140-6736(16)00626-7
ISSN1474-547X
AutoresLia Giraldo da Silva Augusto, Aline do Monte Gurgel, André Monteiro Costa, Finn Diderichsen, Francisco Antônio de Castro Lacaz, Gabriel Parra-Henao, Raguel M Rigotto, Rubens Onofre Nodari, Solange Laurentino dos Santos,
Tópico(s)Mosquito-borne diseases and control
ResumoOn Nov 12, 2015, faced with the increased incidence of cases of microcephaly and the possible association with Zika virus, the Ministry of Health in Brazil declared a public health emergency. On Dec 5, the Brazilian Government decided that measures should be aggressively implemented to reduce the risk of exposure to Zika virus by eliminating the vector mosquito Aedes aegypti.The strategy to eliminate the mosquito is based on pesticides (insecticides and larvicides) that have been applied since the dengue outbreak in 1986.1Ministry of Health (Brazil)Information System on Diseases of Compulsory Declaration. Incidence of dengue cases and deaths number in Brazil from 1990 to 2015.http://portalsaude.saude.gov.br/index.php/situacao-epidemiologica-dados-dengueDate: 2016Google Scholar Nevertheless, the results have been very disappointing. The incidence of registered dengue cases has increased, and in 2015 there were 1·6 million cases with 863 deaths (figure).1Ministry of Health (Brazil)Information System on Diseases of Compulsory Declaration. Incidence of dengue cases and deaths number in Brazil from 1990 to 2015.http://portalsaude.saude.gov.br/index.php/situacao-epidemiologica-dados-dengueDate: 2016Google Scholar Different insecticides (organophosphates and pyrethroids) and larvicides (organophosphates and growth regulators) have been successively used as a result of growing vector resistance.2Maciel-de-Freitas R Valle D Challenges encountered using standard vector control measures for dengue in Boa Vista, Brazil.Bull World Health Organ. 2014; 92: 685-689Crossref PubMed Scopus (27) Google Scholar Insecticide resistance is an example of evolutionary change, where the insecticide acts as a powerful selection factor that concentrates resistant mutants that were present in low frequencies in the original population.3Crow JF Genetics of insect resistance to chemicals.Annu Rev Entomol. 1957; 2: 227-246Crossref Google ScholarDespite these negative results, the Ministry of Health in Brazil has intensified the same strategy to face the epidemics of Zika and chikungunya, by mobilisation of the armed forces to survey households, addition of larvicide to water supplies, and by the use of thermonebulisation as an attempt to control the adult vector; despite serious concerns regarding Malathion.4International Agency for Research on Cancer (IARC)Malathion. IARC Monographs 112-07.http://monographs.iarc.fr/ENG/Monographs/vol112/mono112-07.pdfDate: 2015Google ScholarThe Revolving Fund for Strategic Public Health Supplies in the Pan American Health Organization has prioritised the purchase of pesticides. The prescribed model of implementation is centralised, vertical, and does not consider the steep social gradient where clusters of microcephaly areis found in poor outskirts of cities, where sanitary conditions are bad. Although official data point out that 92% of urban households in Brazil were connected to public water in 2010, there are 3 983 329 unserved households,5Sampaio AD Moraes LRS Limitações à universalização dos serviços públicos de abastecimento de água em localidades rurais: estudo a partir de quatro tipos de prestadores no Estado da Bahia, Brasil.Rev Eletrônica Gestão e Tecnol Ambient. 2014; 2: 138-151Crossref Google Scholar and intermittent water supply, forcing the population to store water for everyday consumption, and favouring mosquito breeding. And only 28% of rural households are connected to public water.5Sampaio AD Moraes LRS Limitações à universalização dos serviços públicos de abastecimento de água em localidades rurais: estudo a partir de quatro tipos de prestadores no Estado da Bahia, Brasil.Rev Eletrônica Gestão e Tecnol Ambient. 2014; 2: 138-151Crossref Google ScholarThe approach applied so far by the Government uses large resources on inefficient or unsafe vector control methods, instead of improving urban infrastructure and environmental sanitation, with a stable supply of potable water. Relying on a chemical war against the vector tends to pacify the population with false security, while a broad programme for better sanitary urban conditions could generate social mobilisation and co-responsibility of the population. Improvement of sanitary conditions is a long-term investment in population health, while pesticide use will have to be repeated. The Brazilian Association of Collective Health calls to stop the use of chemical products against A aegypti, especially in household water reservoirs, and prioritise sanitary measures.This online publication has been corrected. The corrected version first appeared at thelancet.com on March 10, 2016We declare no competing interests. On Nov 12, 2015, faced with the increased incidence of cases of microcephaly and the possible association with Zika virus, the Ministry of Health in Brazil declared a public health emergency. On Dec 5, the Brazilian Government decided that measures should be aggressively implemented to reduce the risk of exposure to Zika virus by eliminating the vector mosquito Aedes aegypti. The strategy to eliminate the mosquito is based on pesticides (insecticides and larvicides) that have been applied since the dengue outbreak in 1986.1Ministry of Health (Brazil)Information System on Diseases of Compulsory Declaration. Incidence of dengue cases and deaths number in Brazil from 1990 to 2015.http://portalsaude.saude.gov.br/index.php/situacao-epidemiologica-dados-dengueDate: 2016Google Scholar Nevertheless, the results have been very disappointing. The incidence of registered dengue cases has increased, and in 2015 there were 1·6 million cases with 863 deaths (figure).1Ministry of Health (Brazil)Information System on Diseases of Compulsory Declaration. Incidence of dengue cases and deaths number in Brazil from 1990 to 2015.http://portalsaude.saude.gov.br/index.php/situacao-epidemiologica-dados-dengueDate: 2016Google Scholar Different insecticides (organophosphates and pyrethroids) and larvicides (organophosphates and growth regulators) have been successively used as a result of growing vector resistance.2Maciel-de-Freitas R Valle D Challenges encountered using standard vector control measures for dengue in Boa Vista, Brazil.Bull World Health Organ. 2014; 92: 685-689Crossref PubMed Scopus (27) Google Scholar Insecticide resistance is an example of evolutionary change, where the insecticide acts as a powerful selection factor that concentrates resistant mutants that were present in low frequencies in the original population.3Crow JF Genetics of insect resistance to chemicals.Annu Rev Entomol. 1957; 2: 227-246Crossref Google Scholar Despite these negative results, the Ministry of Health in Brazil has intensified the same strategy to face the epidemics of Zika and chikungunya, by mobilisation of the armed forces to survey households, addition of larvicide to water supplies, and by the use of thermonebulisation as an attempt to control the adult vector; despite serious concerns regarding Malathion.4International Agency for Research on Cancer (IARC)Malathion. IARC Monographs 112-07.http://monographs.iarc.fr/ENG/Monographs/vol112/mono112-07.pdfDate: 2015Google Scholar The Revolving Fund for Strategic Public Health Supplies in the Pan American Health Organization has prioritised the purchase of pesticides. The prescribed model of implementation is centralised, vertical, and does not consider the steep social gradient where clusters of microcephaly areis found in poor outskirts of cities, where sanitary conditions are bad. Although official data point out that 92% of urban households in Brazil were connected to public water in 2010, there are 3 983 329 unserved households,5Sampaio AD Moraes LRS Limitações à universalização dos serviços públicos de abastecimento de água em localidades rurais: estudo a partir de quatro tipos de prestadores no Estado da Bahia, Brasil.Rev Eletrônica Gestão e Tecnol Ambient. 2014; 2: 138-151Crossref Google Scholar and intermittent water supply, forcing the population to store water for everyday consumption, and favouring mosquito breeding. And only 28% of rural households are connected to public water.5Sampaio AD Moraes LRS Limitações à universalização dos serviços públicos de abastecimento de água em localidades rurais: estudo a partir de quatro tipos de prestadores no Estado da Bahia, Brasil.Rev Eletrônica Gestão e Tecnol Ambient. 2014; 2: 138-151Crossref Google Scholar The approach applied so far by the Government uses large resources on inefficient or unsafe vector control methods, instead of improving urban infrastructure and environmental sanitation, with a stable supply of potable water. Relying on a chemical war against the vector tends to pacify the population with false security, while a broad programme for better sanitary urban conditions could generate social mobilisation and co-responsibility of the population. Improvement of sanitary conditions is a long-term investment in population health, while pesticide use will have to be repeated. The Brazilian Association of Collective Health calls to stop the use of chemical products against A aegypti, especially in household water reservoirs, and prioritise sanitary measures. This online publication has been corrected. The corrected version first appeared at thelancet.com on March 10, 2016 This online publication has been corrected. The corrected version first appeared at thelancet.com on March 10, 2016 This online publication has been corrected. The corrected version first appeared at thelancet.com on March 10, 2016 We declare no competing interests. Department of ErrorGiraldo da Silva Augusto L, Gurgel AM, Costa AM, et al. Aedes aegypti control in Brazil. Lancet 2016; 387: 1052–53—In this Correspondence, in the third paragraph, the last sentence should have read "…despite serious concerns regarding Malathion". This correction has made to the online version as of March 10, 2016. Full-Text PDF
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