The greatest Dengue epidemic in Brazil: Surveillance, Prevention, and Control

Abstract

In this review, we discuss dengue surveillance, prevention, and control measures in Brazil. Data on dengue epidemics between 2000 and 2024 indicates an increase in the number of dengue cases and deaths. Global climate change is a key driver of this growth. Over the past 25 years, nearly 18 million Brazilians have been infected with the dengue virus, and the highest number of dengue cases in Brazil's history is projected to reach 2024. Dengue mortality in Brazil increased geographically over time. As of June, there were approximately 6 million probable cases and 4,000 confirmed deaths in Brazil, which represents the greatest dengue epidemic to date. Several technologies have been developed to control Aedes aegypti, including the deployment of Wolbachia-infected mosquitoes, indoor residual spraying, sterile insect techniques, and mosquito-disseminated insecticides. The Ministry of Health recommends integrating these technologies into health services. Brazil is the first country to incorporate the Takeda vaccine into its public health system, and the Butantan vaccine is currently undergoing Phase 3 clinical trials. Increasing the vaccination coverage and implementing novel Ae. aegypti control technologies could reduce the number of dengue cases in Brazil in the coming years. Community activities such as home cleaning and elimination of potential mosquito breeding sites, facilitated by social media and health education initiatives, must continue to achieve this reduction. Ultimately, a multisectoral approach encompassing sanitary improvements, mosquito control, vaccination, and community mobilization is crucial in the fight against dengue epidemics.

FIGURE 1:. Dengue epidemics in Brazil between 2000 and 2024. The historical series shows probable cases of dengue/100,000 (gray) and probable deaths of dengue/1000,000 inhabitants (red) recorded by month in each year. The small black bars indicate the probable cases of dengue/100,000 in January for each year. The longer black bar indicates the decades. The vertical dotted lines mark the first 4.5 years of each decade.

FIGURE 2:. Number of severe/shock syndrome (black bars) and dengue with warning signs and other complications (gray bars) reported in Brazil between 2000 and 2024.

FIGURE 3:. Number of dengue deaths under investigation (gray) and confirmed death from dengue (red)/1,000,000 inhabitants in Brazil between 2000 and 2024. The longer black bar indicates the decades. The vertical dotted lines mark the first 4.5 years of each decade.

FIGURE 4:. Dengue incidence rate reported in Brazil in 2024, until June. The bars represent the number of deaths by age/1,000,000 inhabitants and the color represents the sex (male: black, female: red). Source: Notifiable Diseases Information System (SINAN).

FIGURE 5:. Mapping dengue mortality in Brazil. Maps show the mortality rates (/1 million inhabitants) of each Brazilian municipality (by health region) in four periods (2000, 2010, 2020 and 2024). The color gradient represents the variation in the mortality rate. These maps were created using QGIS (version 3.36.1) and SINAN mortality data until June 2024.