Brazil and Argentina hit by Dengue, a viral disease transmitted by mosquito Temples of the Egyptians, mainly widespread in tropical and subtropical regions. While Brazil exceeds the threshold of 2 million cases in 2024 (historic record according to a report published by the Ministry of Health), Argentina begins to tremble: from the end of July 2023 to mid-March of this year at least 106 have already been recorded deaths and more than 151 thousand infected, according to the latest national epidemiological bulletin of the Ministry of Health. And in Italy? “We have the utmost attention, but for the moment we are calm – reassured the Minister of Health, Orazio Schillaci -. But let’s not lower our guard on this specific aspect.”
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An unprecedented epidemic in Argentina
Now Argentina is also the cause of concern. “The incidence achieved so far for the entire country is 321 cases per 100 thousand inhabitants”, specified the minister Mario Russo. The highest number of infections was recorded so far in the week from 3 to 9 March: “There are 23,723 and represent the historic maximum reported in a week”, specified the ministry.
“Even more are expected, because the mosquito season will extend due to climate change – warned the infectious disease specialist Rogelio Pizzi, dean of the Faculty of Medical Sciences of the National University of Córdoba and director of the Association of Faculties and Schools of Medicine of Latin America and the Caribbean (Alafem) -. The increase in temperatures and the change in rainfall patterns favor the adaptation of the mosquito, transforming a seasonal disease into a constant threat.”
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The virus runs from Brazil to Puerto Rico
The virus now most feared in tropical countries seems unstoppable. From Brazil to Puerto Rico it is reaping a chain of infections. In the first case, in Brazil Indeed, in less than three months, the record for Dengue infections in a year was broken, exceeding 2 million. To be precise, the country has so far recorded 2,010,896 cases, including confirmed ones and those under investigation, with an incidence coefficient of 990.3 per 100,000 inhabitants, the ministry’s monitoring group reported. There are 682 confirmed deaths and another 1042 are under investigation. According to authorities, Brazil has not recorded such a high number of cases in a single year for more than two decades.
But that is not all. Why the Dengue emergency is also extending to the Americas: the Secretary of Health of Puerto Rico, Carlos Melladoexplained that it had issued a “public health emergency declaration due to the disease”, underlining that “this year the cases (549 confirmed so far by the authorities) have exceeded historical figures”.
“The teams have been working on the Integrated prevention and control plan in response to arboviruses and we will expand the response implemented,” Mellado wrote in a note. The emergency declaration on the Caribbean island came into force on March 25, and will be valid for 90 days. Since last year, Dengue has been hitting the region hard, and the increase in cases has begun to worry, among other countries, Mexico and Peru.
Italy raises the threshold of attention
And in Italy? Should we worry or can we rest assured? What is certain is that the Ministry of Health has sent a new circular, the third, to the Regions. Which states: “Maximum surveillance is arranged and all regions and autonomous provinces are invited to prepare all the measures envisaged by the National Plan for prevention, surveillance and response to arboviruses, Pna 2020-2025, aimed at reducing the risk of autochthonous transmission of Dengue virus”.
What does “provide maximum surveillance” mean in particular? it is always the ministry that clarifies: “Strengthen the surveillance of human cases of Dengue throughout the national territory, especially in terms of timeliness, respect for communication flows and by raising awareness among health workers, including free-choice paediatricians and medical doctors general, to allow the rapid identification of cases; implement all the envisaged environmental remediation actions, aimed at reducing the proliferation and shelter sites for mosquitoes (for example: removal of potential larval outbreaks, cleaning and maintenance of immovable ones, mowing of uncultivated vegetation); arrange for the preparation, after planning, of local measures for monitoring and combating vectors; identify, as per the guidelines reported in the annex Pna 2020-2025, all potential sites at risk of introducing new mosquito species invasive, which ones Temples of the Egyptiansand prepare all surveillance and control measures aimed at preventing and combating the possible entry and subsequent spread of these potential vectors of arbovirus”.
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Other actions to follow
It’s not all. There are two more rules to be respected according to the ministry, the first is “to provide training-updating on the subject of Dengue, as well as other arboviruses considered in the Pna, aimed at healthcare personnel, operators responsible for carrying out cleaning, sanitization and disinfestation interventions and citizens, in order to create the optimal situation for the activation of useful measures to combat vectors and prevent exposure to bites and for the timely identification of cases of infection”.
The second is “to provide activities for correct communication, which increase awareness of the Dengue risk in the public sphere (schools, urban areas, recreational-sports places, etc.) and among healthcare workers, and which encourage active prevention and control behaviors of carriers, at the individual level and in the community”.
This is why Dengue grows
But what are the reasons for the continuous growth of Dengue? They would be to be found in those climate changes which in Brazil favor the faster reproduction of the mosquito, and which in southern Europe have led to the tropicalizationcreating the conditions for the mosquito temples of the Egyptians responsible for the contagion, is able to adapt to the new environment by generating a viral mix of dengue, but also of zika, yellow fever and chikungunya: all diseases transmitted by the tiger mosquito.
In recent years, cases of these pathologies in Italy have gone from a few dozen to a few hundred, with a notable increase in indigenous infections.
“Last year we had 83 patients who acquired the disease in Italy and not from abroad, this is evidently something that will tend to increase. Without alarmism it is a significant problem,” he said Massimo Andreoniscientific director of Simit. While for the professor of Hygiene at the Vita-Salute San Raffaele University of Milan, Gianni Rezza “It is right that we start providing information: if you go to an area where there is an endemic or epidemic, if you return with a fever you should also think about the disease”. “Making an early diagnosis is important – added Rezza – because people with the infection can be identified and disinfested around their homes”.
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The “hot” risk
The possible local reproduction of the mosquito as the Italian summer approaches would in fact be the greatest risk. For this reason, for the Italian government the watchword is not to let the insect enter the country. And for this reason, since last February, the Ministry of Health has introduced extraordinary checks at airports, so as to prevent dangerous specimens of mosquitoes from disembarking together with passengers traveling from tropical regions. Finally, the new circular also provided for checks on goods arriving by sea, also requiring a certificate of disinfestation at the time of shipment for potential “water containers capable of supporting the survival of insects, such as flowers, used tires or wood”. .
Lopalco: “Moderate alert, but the risk is there”
Faced with this situation, and the hot season that is about to arrive, how should Italians behave? For the epidemiologist Pier Luigi Lopalco “The Dengue emergency in Latin America raises a serious question about the level of risk for our country”. And he explains: “I feel like stating that at the moment the Dengue risk in Italy stands at moderate alert levels. For two reasons: the first is linked to the current absence of the mosquito in our territory Temples of the Egyptians, which is the optimal vector of the Dengue virus. However, this element does not eliminate the risk, given that it is widely present in Italy Aedes albopictus (tiger mosquito), which is capable of transmitting the disease anyway. In any case, for the disease to spread to the levels we observe in Brazil and Argentina it is necessary to reach a very large critical mass of infected people who can sustain the contagion.”
“The way to minimize infections”
“These considerations, however, show us the path to follow to minimize the risk of importation – continues Lopalco -. There are two main actions: the control of mosquitoes, for all species, and not only through checks at the borders, but with containment on our territory; the close surveillance of human cases: Dengue fever, if not actively sought with specific tests, can go unnoticed and be mistaken for any other fever syndrome. Ultimately, even if today we can consider the risk of spread of this disease, now is the time to implement preventive actions.”
“Other diseases such as Dengue have already become endemic in Italy. Let’s not forget the hundreds of cases of West Nile fever that we record every year in the Po Valley area – concludes Lopalco -. The West Nile virus is very similar to the Dengue virus. And climate change exponentially favors the spread of these diseases. I remember that recently Japanese encephalitis, another disease caused by a similar virus also transmitted by mosquitoes, became endemic for the first time in Australia. So don’t panic, but be alert high”.
How to control the disease: the vaccine
That said, is there a way for the disease to not spread further than it already has? There is the vaccine. The first against Dengue was developed by the Japanese pharmaceutical company Takeda. It has been available since last year, and could offer a solution to disease control now limited only to the vector. For Andreoni it is not necessary in Europe, but in Brazil it is. But, despite the availability of the first doses, the start of the vaccination campaign was greeted with little enthusiasm, recording low participation. Only 35% of parents brought their children between the ages of 10 and 14 (the age set as a priority by the ministry) to be vaccinated. A delay that could worsen the already complicated situation in the country, also because the peak of infections has not yet been reached. The authorities confirm that the peak will occur in May and if the advance of the disease is confirmed it will be able to exceed the projections of 4.2 million cases by the end of the year. Will the prediction come true?