Dengue and dengue hemorrhagic fever, Brazil, 1981-2002

Abstract

In the last 5 years, Brazil has accounted for approximately 70% of reported dengue fever cases in the Americas. We analyzed trends of dengue and dengue hemorrhagic fever (DHF) from the early 1980s to 2002 by using surveillance data from the Brazilian Ministry of Health. Two distinct epidemiologic patterns for dengue were observed: localized epidemics (1986-1993), and endemic and epidemic virus circulation countrywide (1994-2002). Currently, serotypes 1, 2, and 3 cocirculate in 22 of 27 states. Dengue and DHF affected mainly adults; however, an increase in occurrence of DHF among children has been recently detected in northern Brazil, which suggests a shift in the occurrence of severe disease to younger age groups. In 2002, hospitalizations increased, which points out the change in disease severity compared to that seen in the 1990s. We describe the epidemiology of dengue in Brazil, characterizing the changing patterns of it and DHF during the last 20 years.

Figure 1

Number of dengue fever cases reported per month, Brazil. A) 1986–1993, B) 1994–2002. Dark bars represent January.

Figure 2

Number of reported cases and hospitalizations due to dengue and dengue hemorrhagic fever (DHF), Brazil, 1986–2002.

Figure 3

Age distribution of dengue fever (DF) and dengue hemorrhagic fever (DHF) for Brazil and Amazonas State, 1998–2002. Boxes encompass 25th and 75th percentiles. Black lines within boxes, medians. Outliers not shown. Dashed line, 15 years old.

Figure 4

Number of dengue fever–related hospitalizations per state by year, Brazil, 1990–2003. Each dot represents the number of hospitalizations due to dengue/dengue hemorrhagic fever for 1 state by year. Source: Hospitalization Information System–Unified Health System (SIH-SUS).