Dengue: 30 years of cases in an endemic area

Daniela Cristina Sensato Monteiro Natália Vasconcelos de Souza Jane Cavalcante Amaral Kaynan Bezerra de Lima Fernanda Montenegro Carvalho de Araújo Izabel Letícia Cavalcante Ramalho Victor Emanuel Pessoa Martins Jeová Keny Baima Colares Luciano Pamplona de Góes Cavalcanti Danielle Malta Lima About the authors

Abstract

The present study aimed to review literature on studies of dengue cases conducted over 30 years in the state of Ceará.

Between November 2015 and January 2016, articles published in Portuguese and English in 7 databases were searched using keywords and a Boolean operator. A total of 191 articles were identified in the databases; 133 were excluded according to the exclusion criteria, and 58 were included in the study.

Of the 58 articles analyzed, 6 reported data from Brazil; including the Northeast region and the state of Ceará; 41 reported data for only the city of Fortaleza; 7 reported data for the state of Ceará; 4 reported data for cities in the interior of the state; and 3 included only children. The studies adopted different approaches and focused on different aspects of the disease. Study outcomes included the identification of serological, epidemiological, clinical, and laboratory characteristics; potential larvicides and biological predators of mosquitoes; potential antiviral agents; vector density characteristics; and educational dengue prevention and control strategies. Additionally, one vaccine trial was included.

Although studies on dengue in the state of Ceará are scarce, they are encompassing, including several lines of research, and the number of studies and reports on dengue in the state of Ceará continues to increase.

Dengue; Aedes Aegypti; Aedes Albopictus; Virus


INTRODUCTION

The first dengue epidemic in Brazil is believed to have occurred between 1846 and 1853 in the cities of São Paulo and Rio de Janeiro (RJ) (11. Teixeira MG, Barreto ML, Guerra Z. Epidemiologia e medidas de prevenção do dengue. Inf Epidemiol SUS. 1999;8(4):5-33. Apud Meire R. “Urucubaca” Gripe ou Dengue? In: Clínica Médica. Gráfica O Estado de São Paulo. 1916;273-85. https://doi.org/10.5123/S0104-16731999000400002.
https://doi.org/10.5123/S0104-1673199900...
,22. Barreto ML, Teixeira MG. Dengue no Brasil: situação epidemiológica e contribuições para uma agenda de pesquisa. Estudos Avançados. 2008;22(64):53-72. Apud Pedro A. O dengue em Nictheroy. Bras Med. 1923;1:173-7. https://doi.org/10.1136/bmj.1.3239.173.
https://doi.org/10.1136/bmj.1.3239.173...
). At that time, the disease was known by other names, such as polka (a fashionable dance at the time), polka fever, and break-bone fever (33. Henchal EA, Putnak JR. The dengue viruses. Clin Microbiol Rev. 1990;3(4):376-96. Apud Sabin AB. Dengue, In T. Rivers and F. Horsfall (ed.). 1959. Viral and rickettsial infections of man. J. B. Lippincott Co. Philadelphia. p361-73. https://doi.org/10.1128/CMR.3.4.376.
https://doi.org/10.1128/CMR.3.4.376...
). However, dengue cases were first reported in medical literature in 1916 in the city of São Paulo and in 1923 in Niterói (11. Teixeira MG, Barreto ML, Guerra Z. Epidemiologia e medidas de prevenção do dengue. Inf Epidemiol SUS. 1999;8(4):5-33. Apud Meire R. “Urucubaca” Gripe ou Dengue? In: Clínica Médica. Gráfica O Estado de São Paulo. 1916;273-85. https://doi.org/10.5123/S0104-16731999000400002.
https://doi.org/10.5123/S0104-1673199900...
,22. Barreto ML, Teixeira MG. Dengue no Brasil: situação epidemiológica e contribuições para uma agenda de pesquisa. Estudos Avançados. 2008;22(64):53-72. Apud Pedro A. O dengue em Nictheroy. Bras Med. 1923;1:173-7. https://doi.org/10.1136/bmj.1.3239.173.
https://doi.org/10.1136/bmj.1.3239.173...
). The first epidemic documented from a clinical and laboratory viewpoint occurred in late 1981 and early 1982 in Boa Vista, Roraima; this epidemic was caused by the dengue-1 (DENV-1) and dengue-4 (DENV-4) serotypes (44. Osanai CH, Travassos da Rosa AP, Tang AT, do Amaral RS, Passos AD, Tauil PL. [Dengue outbreak in Boa Vista, Roraima. Preliminary report]. Rev lnst Med Trop Sao Paulo. 1983;25(1):53-4.). In 1955, Brazil succeeded in eradicating Aedes aegypti (A. aegypti), eliminating the last mosquito source on the 2nd of April in a rural area in the municipality of Santa Terezinha, Bahia (55. Braga IA, Vale D. Aedes aegypti: histórico do controle no Brasil. Epidemiol Serv Saúde. 2007;16(2):113-8. Apud Franco O. Reinfestação do Pará por Aedes aegypti. Rev Bras Malariol Doenças Trop. 1969;21(4):729-31. https://doi.org/10.5123/S1679-49742007000200006.
https://doi.org/10.5123/S1679-4974200700...
).

The first cases of A. aegypti reinfestation following eradication occurred in 1967 in Belém (Pará) and in 1968 in São Luiz (Maranhão); the source populations were finally eliminated in 1973. A. aegypti was again detected in 1976 in Salvador (Bahia) and in 1977 in RJ and then spread to other states (66. Tauil PL. [Critical aspects of yellow fever control in Brazil]. Rev Saude Publica. 2010;44(3):555-8. Apud Franco O. Reinfestação do Pará por Aedes aegypti. Rev Bras Malariol Doenças Trop. 1969;21(4):729-31. https://doi.org/10.1590/S0034-89102010005000014.
https://doi.org/10.1590/S0034-8910201000...
,77. Nogueira RM, Schatzmayr HG, Miagostovich MP, Farias MF, Farias Filho JD. Virological study of a dengue type 1 epidemic at Rio de Janeiro. Mem Inst Oswaldo Cruz. 1988;83(2):219-25. https://doi.org/10.1590/S0074-02761988000200012.
https://doi.org/10.1590/S0074-0276198800...
). In 1986, a dengue epidemic (DENV-1 serotype) circulated in the state of RJ and quickly reached Northeast Brazil (77. Nogueira RM, Schatzmayr HG, Miagostovich MP, Farias MF, Farias Filho JD. Virological study of a dengue type 1 epidemic at Rio de Janeiro. Mem Inst Oswaldo Cruz. 1988;83(2):219-25. https://doi.org/10.1590/S0074-02761988000200012.
https://doi.org/10.1590/S0074-0276198800...
,88. Pontes RJ, Ruffino-Netto A. [Dengue in a urban locality of southeastern Brazil: epidemiological aspects]. Rev Saude Publica. 1994;28(3):218-27. https://doi.org/10.1590/S0034-89101994000300010.
https://doi.org/10.1590/S0034-8910199400...
). From 1986 to 1990, dengue epidemics were limited to some Brazilian states in the Southeast (RJ, São Paulo and Minas Gerais) and Northeast regions (Alagoas, Bahia, Ceará and Pernambuco) (99. Fundação Nacional de Saúde. Evolução temporal das doenças de notificação compulsória no Brasil 1980-1998. Boletim Epidemiológico Edição Especial. Brasília. 1999; Available from: http://bvsms.saude.gov.br/bvs/periodicos/boletim_epi_edicao_especial.pdf.
http://bvsms.saude.gov.br/bvs/periodicos...
).

A. aegypti was reintroduced in the Ceará cities of Aquiraz, Beberibe and Fortaleza in the mid-1980s (1010. Lima JT. Risco de reurbanização de febre amarela no Brasil. Cad Saude Publica. 1985;1(3):377-84. https://doi.org/10.1590/S0102-311X1985000300010.
https://doi.org/10.1590/S0102-311X198500...
). The first dengue cases occurred in August 1986, originating from tourists from RJ, where a dengue epidemic (DENV-1) was occurring, who were visiting the cities of Fortaleza and Canoa Quebrada (1111. Vilar MC, Rouquayrol MZ, Timbo MJ, Gomes IL. Epidemia de dengue no Ceará 1986-1988. https://doi.org/Rev Bras Prom Saude. 1989;5(1):60-5..
https://doi.org/Rev Bras Prom Saude. 198...
).

For the dengue cases reported in the state of Ceará over 30 years, seven epidemics were recorded (1987, 1994, 2001, 2008, 2011, 2012 and 2015) (1212. Secretaria da Saúde do Estado do Ceará. Boletim epidemiológico dengue, chikungunya e zika. Coordenadoria de Promoção e Proteção è Saúde Núcleo de Vigilância Epidemiológica. [cited December 8th, 2017]. Available from: https://www.saude.ce.gov.br/wp-content/uploads/sites/9/2018/06/boletim_arboviroses_se48_08_12_2017.pdf
https://www.saude.ce.gov.br/wp-content/u...
,1313. Cavalcanti LPG, Barreto FKA, Oliveira RMAB, Canuto IFP, Lima AAB, Lima JWO, et al. Trinta anos de dengue no Ceará: história, contribuições para ciência e desafios no cenário atual com tripla circulação de arbovírus. J Health Biol Sci. 2018;6(1):65-82. https://doi.org/10.12662/2317-3076jhbs.v6i1.1415.p65-82.2018.
https://doi.org/10.12662/2317-3076jhbs.v...
). Ceará has 184 municipalities, 167 of which reported DENV transmission in 2015. From 1986 until 2016, 302,015 dengue cases were reported in the state (1414. Secretaria Municipal de Saúde (SMS). Prefeitura de Fortaleza. Boletim Semanal da Dengue. Célula de Vigilância Epidemiológica. Ano de 2017. 36° Semana Epidemiológica. [Internet] [cited January 25th, 2019]. Available from: https://saude.fortaleza.ce.gov.br/images/Boletins/Dengue/2017/36_Boletim-dengue--Boletim-Epidemiolgico-36_2017.pdf.
https://saude.fortaleza.ce.gov.br/images...
). Dengue has therefore been endemic to Ceará for 30 years, resulting in high incidence rates caused by four circulating serotypes. The present study aimed to review literature on studies involving dengue cases in the state of Ceará conducted during these 30 years.

METHODOLOGY

Between November 2015 and January 2016, articles in the Portal of CAPES Journals, Biblioteca virtual em saúde (BVS), Ebsco Host, Scientific Electronic Library Online (SciELO), PubMed, Science Direct and Google Scholar databases were searched. Scientific reports about dengue in Ceará from 1986 until 2016 were identified. The search was performed in both Portuguese and English using the Boolean operator “and” and the following keywords: “Dengue and Ceará”, “Dengue and Fortaleza”, “Dengue virus and Ceará”, “Dengue virus and Fortaleza”, “Dengue virus Ceará” and “Dengue virus Fortaleza”. To organize the information contained in the scientific articles identified with the descriptors, the articles were fully read, and the objectives, study type, location, period, methods, importance and results were identified. Published scientific reports such as letters, original articles and brief communications to national and international journals were included in the search according to the descriptors and peer reviewed. After preanalysis, scientific literature identified in more than one database that was accounted for as a single work, congress abstracts, theses, dissertations and articles that included no data for the state of Ceará were excluded. A total of 191 articles were identified in the databases; 133 articles were excluded according to the exclusion criteria, and 58 articles were included in the study (Figure 1).

Figure 1
Flow chart - Selection of articles. Notes: Biblioteca virtual em saúde (BVS).

RESULTS AND DISCUSSION

Of the 7 databases analyzed, only Google Scholar did not contain articles related to the descriptors of the present work.

Of the 58 reports analyzed, 6 (10.3%) reported data from Brazil, including the Northeast region and the state of Ceará; 41 (70.6%) reported data for only the city of Fortaleza; seven (12%) reported data for the state of Ceará; and four (6.8%) reported data for cities in the interior of the state (one in Icaraí (Caucaia); one in Juazeiro do Norte, Crato and Barbalha; one in Tauá and one in Pacoti) (Tables 1 and 2). Of the reports analyzed, 39 (67.2%) included only adults, 16 (27.5%) included children and adults, and 3 (5.2%) included only children (1515. Pires Neto Rda J, de Sá SL, Pinho SC, Pucci FH, Teofilo CR, Evangelista PD, et al. Dengue infection in children and adolescents: clinical profile in a reference hospital in northeast Brazil. Rev Soc Bras Med Trop. 2013;46(6):765-8. https://doi.org/10.1590/0037-8682-1716-2013.
https://doi.org/10.1590/0037-8682-1716-2...

16. Dayan G, Arredondo JL, Carrasquilla G, Deseda CC, Dietze R, Luz K, et al. Prospective cohort study with active surveillance for fever in four dengue endemic countries in Latin America. Am J Trop Med Hyg. 2015;93(1):18-23. https://doi.org/10.4269/ajtmh.13-0663.
https://doi.org/10.4269/ajtmh.13-0663...
-1717. Sacramento RH, de Melo Braga DN, Sacramento FF, de Carvalho Araújo FM, Lima AA, de Lima Pompeu MM, et al. Death by dengue fever in a Brazilian child: a case report. BMC Res Notes. 2014;7:855. https://doi.org/10.1186/1756-0500-7-855.
https://doi.org/10.1186/1756-0500-7-855...
).

Table 1
Main characteristics of the stratified studies with clinical and laboratory characteristics.
Table 2
Main results of published studies on biological predators, larvicides, antiviral drugs and vectors.

Epidemiological aspects

A literature study about dengue and the control of A. aegypti in Ceará, based on epidemiological bulletins, found that five dengue epidemics, with high incidence rates, occurred in Ceará between 1986 and 2011, and children were most affected from 2008 to 2010. Annually, during the studied period, an average of 120 municipalities reported infestation with A. aegypti, and 84 reported dengue transmission (1818. Lima EP, Goulart MO, Albuquerque MR, Victor FM, Pinto NB. Série histórica da dengue e do Aedes aegypti no Ceará. Rev Bras Prom Saude. 2013;26(3):340-8. https://doi.org/10.5020/18061230.2013.p340.
https://doi.org/10.5020/18061230.2013.p3...
).

In 2014, the city of Fortaleza was a World Cup host city, and a study was performed to investigate the potential for a dengue epidemic in the 12 World Cup host cities (1919. Lowe R, Barcellos C, Coelho CA, Bailey TC, Coelho GE, Graham R, et al. Dengue outlook for the World Cup in Brazil: an early warning model framework driven by real-time seasonal climate forecasts. Lancet Infect Dis. 2014;14(7):619-26. https://doi.org/10.1016/S1473-3099(14)70781-9.
https://doi.org/10.1016/S1473-3099(14)70...
20. Vasconcelos PF, de Menezes DB, Melo LP, Pesso ET, Rodrigues SG, da Rosa ES, et al. A large epidemic of dengue fever with dengue hemorrhagic cases in Ceará State, Brazil, 1994. Rev Inst Med Trop Sao Paulo. 1995;37(3):253-5. https://doi.org/10.1590/S0036-46651995000300012.
https://doi.org/10.1590/S0036-4665199500...
21. Vasconcelos PF, Lima JW, da Rosa AP, Timbó MJ, da Rosa ES, Lima HR, et al. Dengue epidemic in a Northeastern Brazil: random epidemiological serum survey. Rev Saude Publica. 1998;32(5):447-54. https://doi.org/10.1590/S0034-89101998000500007.
https://doi.org/10.1590/S0034-8910199800...
22. Da Cunha RV, Miagostovich MP, Petrola Z, De Araújo ESM, Cortez D, Pombo V, et al. Retrospective Study on Dengue in Fortaleza, State of Ceará, Brazil. Mem Inst Oswaldo Cruz. 1998;93(2):155-9. https://doi.org/10.1590/S0074-02761998000200003.
https://doi.org/10.1590/S0074-0276199800...
23. Araújo FM, Nogueira RM, de Araújo JM, Ramalho IL, Roriz ML, de Melo ME, et al. Concurrent infection with dengue virus type-2 and DENV-3 in a patient from Ceará, Brazil. Mem Inst Oswaldo Cruz. 2006;101(8):925-8. https://doi.org/10.1590/S0074-02762006000800017.
https://doi.org/10.1590/S0074-0276200600...
24. Albuquerque PL, Silva Júnior GB, Diógenes SS, Silva HF. Dengue and aplastic anemia-a rare association. Travel Med Infect Dis. 2009;7(2):118-20. https://doi.org/10.1016/j.tmaid.2009.01.001.
https://doi.org/10.1016/j.tmaid.2009.01....
25. Aragão RE, Barreira IM, Lima LN, Rabelo LP, Pereira FB. [Bilateral optic neuritis after dengue viral infection: case report]. Arq Bras Oftalmol. 2010;73(2):175-8. https://doi.org/10.1590/S0004-27492010000200015.
https://doi.org/10.1590/S0004-2749201000...
26. Ponte HJ, Pucci FH, Moreira Filho HF, Teófilo CR, Pires Neto RJ. Evaluation of pain manifestations in patients admitted to a reference hospital with presumptive dengue fever diagnosis. Rev Dor. 2011;12(2):104-7. https://doi.org/10.1590/S1806-00132011000200005.
https://doi.org/10.1590/S1806-0013201100...
27. Lima DM, Sabino-Santos Junior G, Oliveira AC, Fontes RM, Colares JK, Araújo FM, et al. Hantavirus infection in suspected dengue cases from State of Ceará, Brazil. Rev Soc Bras Med Trop. 2011;44(6):795-6. https://doi.org/10.1590/S0037-86822011000600031.
https://doi.org/10.1590/S0037-8682201100...
28. Azin FR, Gonçalves RP, Pitombeira MH, Lima DM, Branco IC. Dengue: profile of hematological and biochemical dynamics. Rev Bras Hematol Hemoter. 2012;34(1):36-41. https://doi.org/10.5581/1516-8484.20120012.
https://doi.org/10.5581/1516-8484.201200...
29. Araújo FM, Araújo MS, Nogueira RM, Brilhante RS, Oliveira DN, Rocha MF, et al. Central nervous system involvement in dengue: a study in fatal cases from a dengue endemic area. Neurology. 2012;78(10):736-42. https://doi.org/10.1212/WNL.0b013e31824b94e9.
https://doi.org/10.1212/WNL.0b013e31824b...
30. Araújo F, Nogueira R, Araújo Mde S, Perdigão A, Cavalcanti L, Brilhante R, et al. Dengue in patients with central nervous system manifestations, Brazil. Emerg Infect Dis. 2012;18(4):677-9. https://doi.org/10.3201/eid1804.111522.
https://doi.org/10.3201/eid1804.111522...
31. Macedo RN, Rocha FA, Rolim DB, Vilar DC, Araújo FM, Vieira NN, et al. Severe coinfection of melioidosis and dengue fever in Northeastern Brazil: first case report. Rev Soc Bras Med Trop. 2012;45(1):132-3. https://doi.org/10.1590/S0037-86822012000100028.
https://doi.org/10.1590/S0037-8682201200...
32. Torres AF, Braga DN, Muniz F, Mendonça C, Oliveira DN, de Souza ET, et al. Lymphocytic myocarditis at autopsy in patients with dengue fever. Braz J Infect Dis. 2013;17(5):619-21. https://doi.org/10.1016/j.bjid.2013.03.009.
https://doi.org/10.1016/j.bjid.2013.03.0...
33. Cavalcanti LP, Mota LA, Lustosa GP, Fortes MC, Mota DA, Lima AA, et al. Evaluation of the WHO classification of dengue disease severity during an epidemic in 2011 in the state of Ceará, Brazil. Mem Inst Oswaldo Cruz. 2014;109(1):93-8. https://doi.org/10.1590/0074-0276140384.
https://doi.org/10.1590/0074-0276140384...
34. Teixeira MG, Paixão ES, Costa Mda C, Cunha RV, Pamplona L, Dias JP, et al. Arterial hypertension and skin allergy are risk factors for progression from dengue to dengue hemorrhagic fever: a case control study. PLoS Negl Trop Dis. 2015;9(5):e0003812. https://doi.org/10.1371/journal.pntd.0003812.
https://doi.org/10.1371/journal.pntd.000...
35. Costa SD, da Silva GB Jr, Jacinto CN, Martiniano LV, Amaral YS, Paes FJ, et al. Dengue Fever Among Renal Transplant Recipients: A Series of 10 Cases in a Tropical Country. Am J Trop Med Hyg. 2015;93(2):394-6. https://doi.org/10.4269/ajtmh.15-0038.
https://doi.org/10.4269/ajtmh.15-0038...
36. Fontes RM, Cavalcanti LP, Oliveira AC, Bezerra LF, Gomes AM, Colares JK, et al. A new possibility for surveillance: do we identify all cases of leptospirosis? Rev Inst Med Trop Sao Paulo. 2015;57(5):443-6. https://doi.org/10.1590/S0036-46652015000500014.
https://doi.org/10.1590/S0036-4665201500...
37. Maia SH, Brasil IR, Esmeraldo Rde M, Ponte CN, Costa RC, Lira RA. Severe dengue in the early postoperative period after kidney transplantation: two case reports from Hospital Geral de Fortaleza. Rev Soc Bras Med Trop. 2015;48(6):783-5. https://doi.org/10.1590/0037-8682-0205-2015.
https://doi.org/10.1590/0037-8682-0205-2...
38. de Melo Bezerra LF, Fontes RM, Gomes AM, da Silva DA, Colares JK, Lima, DM. Serological evidence of leptospirosis in patients with a clinical suspicion of dengue in the State of8 Ceará, Brazil. Biomedica. 2015;35(4):557-62. 39. Cavalcanti LP, Braga DN, da Silva LM, Aguiar MG, Castiglioni M, Silva-Junior JU, et al. Postmortem Diagnosis of Dengue as an Epidemiological Surveillance Tool. Am J Trop Med Hyg. 2016;94(1):187-92. https://doi.org/10.4269/ajtmh.15-0392.
https://doi.org/10.4269/ajtmh.15-0392...
). Real-time seasonal climate forecasts were performed based on several international sources, and epidemiological predictions for dengue in Brazil were analyzed. The results showed reduced risks of dengue in the cities of Brasília, Cuiabá, Porto Alegre and São Paulo. Some cities were considered to have moderate risk (Belo Horizonte, Salvador and Manaus), and some cities, such as Recife, Natal and Fortaleza, located in Northeast Brazil, were considered to have high risk (1919. Lowe R, Barcellos C, Coelho CA, Bailey TC, Coelho GE, Graham R, et al. Dengue outlook for the World Cup in Brazil: an early warning model framework driven by real-time seasonal climate forecasts. Lancet Infect Dis. 2014;14(7):619-26. https://doi.org/10.1016/S1473-3099(14)70781-9.
https://doi.org/10.1016/S1473-3099(14)70...
).

Clinical and laboratory aspects

For the period analyzed (1986-2016), we selected manuscripts that described the clinical and laboratory aspects of the disease in Ceará (Table 1).

Larvicides and biological predators/antiviral drugs/vectors

Larvicides and biological predators are used as methods to fight the spread of mosquitoes. In the present review, following stratification of the 58 selected reports, 13 (22.4%) were found to address the use of larvicides and biological predators against A. aegypti (4040. Pamplona Lde G, Alencar CH, Lima JW, Heukelbach J. Reduced oviposition of Aedes aegypti gravid females in domestic containers with predatory fish. Trop Med Int Health. 2009;14(11):1347-50. https://doi.org/10.1111/j.1365-3156.2009.02377.x.
https://doi.org/10.1111/j.1365-3156.2009...

41. de Oliveira Lima JW, de Góes Cavalcanti LP, Pontes RJ, Heukelbach J. Survival of Betta splendens fish (Regan, 1910) in domestic water containers and its effectiveness in controlling Aedes aegypti larvae (Linnaeus, 1762) in Northeast Brazil. Trop Med Int Health. 2010;15(12):1525-32. https://doi.org/10.1111/j.1365-3156.2010.02658.x.
https://doi.org/10.1111/j.1365-3156.2010...

42. Cavalcanti LP, Pontes R, Regazzi AC, de Paula Júnior FJ, Frutuoso RL, Sousa EP, et al. [Efficacy of fish as predators of Aedes aegypti larvae, under laboratory conditions]. Rev Saude Publica. 2007;41(4):638-44. https://doi.org/10.1590/S0034-89102006005000041.
https://doi.org/10.1590/S0034-8910200600...

43. Pamplona Lde G, Lima JW, Cunha JC, Santana EW. [Evaluation of the impact on Aedes aegypti infestation in cement tanks of the municipal district of Canindé, Ceará, Brazil after using the Betta splendens fish as an alternative biological control]. Rev Soc Bras Med Trop. 2004;37(5):400-4. https://doi.org/10.1590/S0037-86822004000500006.
https://doi.org/10.1590/S0037-8682200400...

44. Paiva CN, Lima JW, Camelo SS, Lima Cde F, Cavalcanti LP. Survival of larvivorous fish used for biological control of Aedes aegypti (Diptera: Culicidae) combined with different larvicides. Trop Med Int Health. 2014;19(9):1082-6. https://doi.org/10.1111/tmi.12341.
https://doi.org/10.1111/tmi.12341...

45. Oliveira MS, Morais SM, Magalhães DV, Batista WP, Vieira IG, Craveiro AA, et al. Antioxidant, larvicidal and antiacetylcholinesterase activities of cashew nut shell liquid constituents. Acta Trop. 2011;117(3):165-70. https://doi.org/10.1016/j.actatropica.2010.08.003.
https://doi.org/10.1016/j.actatropica.20...

46. Farias DF, Cavalheiro MG, Viana SM, De Lima GPG, da Rocha-Bezerra LC, Ricardo NM, et al. Insecticidal action of sodium anacardate from Brazilian cashew nut shell liquid against Aedes aegypti. J Am Mosq Control Assoc. 2009;25(3):386-9. https://doi.org/10.2987/08-5851.1.
https://doi.org/10.2987/08-5851.1...

47. Cavalcanti ES, Morais SM, Lima MA, Santana EW. Larvicidal activity of essential oils from Brazilian plants against Aedes aegypti L. Mem Inst Oswaldo Cruz. 2004;99(5):541-4. https://doi.org/10.1590/S0074-02762004000500015.
https://doi.org/10.1590/S0074-0276200400...

48. Souza LG, Almeida MC, Monte FJ, Santiago GM, Braz-Filho R, Lemos TL. Constituintes químicos de Capraria biflora (Scrophulariaceae) e atividade larvicida de seu óleo essencial. Quim Nova. 2012;35(11):2258-62. https://doi.org/10.1590/S0100-40422012001100032.
https://doi.org/10.1590/S0100-4042201200...

49. Araújo EC, Silveira ER, Lima MA, Neto MA, de Andrade IL, Lima MA, et al. Insecticidal activity and chemical composition of volatile oils from Hyptis martiusii Benth. J Agric Food Chem. 2003;51(13):3760-2. https://doi.org/10.1021/jf021074s.
https://doi.org/10.1021/jf021074s...

50. Souza TM, Cunha AP, Farias DF, Machado LK, Morais SM, Ricardo NM, et al. Insecticidal activity against Aedes aegypti of m-pentadecadienyl-phenol isolated from Myracrodruon urundeuva seeds. Pest Manag Sci. 2012;68(10):1380-4. https://doi.org/10.1002/ps.3316.
https://doi.org/10.1002/ps.3316...

51. Lima EP, de Oliveira Filho AM, de Oliveira Lima JW, Ramos Júnior AN, de Góes Cavalcanti LP, Pontes RJ. [Aedes aegypti resistance to temefos in counties of Ceará State]. Rev Soc Bras Med Trop. 2006;39(3):259-63. https://doi.org/10.1590/S0037-86822006000300006.
https://doi.org/10.1590/S0037-8682200600...
-5252. Lima EP, Paiva MH, de Araújo AP, da Silva EV, da Silva UM, de Oliveira LN, et al. Insecticide resistance in Aedes aegypti populations from Ceará, Brazil. Parasit Vectors. 2011;4:5. https://doi.org/10.1186/1756-3305-4-5.
https://doi.org/10.1186/1756-3305-4-5...
) (Table 2). Other studies examined the vectors A. aegypti and Aedes albopictus (A. albopictus) (5353. Martins VE, Martins MG, de Araújo JM, Silva LO, Monteiro HA, Castro FC, et al. [First report of Aedes (Stegomyia) albopictus in the state of Ceará, Brazil]. Rev Saude Publica. 2006;40(4):737-9. https://doi.org/10.1590/S0034-89102006000500027.
https://doi.org/10.1590/S0034-8910200600...

54. Martins VE, Alencar CH, Facó PE, Dutra RF, Alves CR, Pontes RJ, et al. [Spatial distribution and breeding site characteristics of Aedes albopictus and Aedes aegypti in Fortaleza, State of Ceará]. Rev Soc Bras Med Trop. 2010;43(1):73-7. https://doi.org/10.1590/S0037-86822010000100016.
https://doi.org/10.1590/S0037-8682201000...

55. Degallier N, Servain J, Lucio PS, Hannart A, Durand B, de Souza RN, et al. The influence of local environment on the aging and mortality of Aedes aegypti (L.): case study in Fortaleza-CE, Brazil. J Vector Ecol. 2012;37(2):428-41. https://doi.org/10.1111/j.1948-7134.2012.00247.x.
https://doi.org/10.1111/j.1948-7134.2012...
-5656. Lucio PS, Degallier N, Servain J, Hannart A, Durand B, de Souza RN, et al. A case study of the influence of local weather on Aedes aegypti (L.) aging and mortality. J Vector Ecol. 2013;38(1):20-37. https://doi.org/10.1111/j.1948-7134.2013.12005.x.
https://doi.org/10.1111/j.1948-7134.2013...
57. Martins VE, Alencar CH, Kamimura MT, de Carvalho Araújo FM, De Simone SG, Dutra RF, et al. Occurrence of natural vertical transmission of dengue-2 and dengue-3 viruses in Aedes aegypti and Aedes albopictus in Fortaleza, Ceará, Brazil. PLoS One. 2012;7(7):e41386. https://doi.org/10.1371/journal.pone.0041386.
https://doi.org/10.1371/journal.pone.004...
58. Pontes RJ, Freeman J, Oliveira-Lima JW, Hodgson JC, Spielman A. Vector densities that potentiate dengue outbreaks in a Brazilian city. Am J Trop Med Hyg. 2000;62(3):378-83. https://doi.org/10.4269/ajtmh.2000.62.378.
https://doi.org/10.4269/ajtmh.2000.62.37...
) or investigated antiviral drugs against dengue (5959. Silva ARA, Morais SM, Marques MMM, Lima DM, Santos SCC, Almeida RR et al. Antiviral activities of extracts and phenolic components of two Spondias species against dengue virus. J Venom Anim Toxins incl Trop Dis. 2011;17(4):406-13. https://doi.org/10.1590/S1678-91992011000400018.
https://doi.org/10.1590/S1678-9199201100...
,6060. Marques MM, de Morais SM, da Silva AR, Barroso ND, Pontes Filho TR, Araújo FM, et al. Antiviral and Antioxidant Activities of Sulfated Galactomannans from Plants of Caatinga Biome. Evid Based Complement Alternat Med. 2015;2015:591214.). The main findings of these studies are listed below (Table 2).

Educational actions

After stratification, two reports about educational actions were found. The first was performed in Icaraí (Caucaia) and concerned dengue prevention and control actions, evaluating the limitations and difficulties found. The seventeen individuals who participated in the study were distributed into three groups: eight were users of a Basic Health Unit, four were endemic disease control agents, and five were health care professionals. Data were collected by participant observation and professional/user interactions that occurred throughout the study. The study concluded that actions that strengthened the power and responsibility of individuals over their own history and their local citizenship were needed (6161. Sales FM. [Health education actions for the prevention and control of dengue fever: a study at Icaraí, Caucaia, Ceará State, Brazil]. Cien Saude Colet. 2008;13(1):175-84. https://doi.org/10.1590/S1413-81232008000100022.
https://doi.org/10.1590/S1413-8123200800...
). The second report was a case study involving six blocks, with each block corresponding to 40 houses in Fortaleza. The aim of the study was to evaluate the implementation of an intervention strategy to decrease the amount of A. aegypti. Fortaleza is divided into six administrative regions (SERs), and in this study, one block in each of the six SERs was selected to understand the ecological, biological, and social complexity and diversity in Fortaleza. The results showed a complex interaction between socioenvironmental inequalities and dengue control. The ethnographic data and interviews of those in the studied SERs reflected the environmental and socioeconomic complexity of a large city in a developing country such as Brazil, which has struggled with the serious public health problem of dengue (6262. Caprara A, Lima JW, Marinho AC, Calvasina PG, Landim LP, Sommerfeld J. Irregular water supply, household usage and dengue: a bio-social study in the Brazilian Northeast. Cad Saude Publica. 2009;25 Suppl 1:S125-36. https://doi.org/10.1590/S0102-311X2009001300012.
https://doi.org/10.1590/S0102-311X200900...
).

Two reports concerning risk factors associated with dengue were included. One case-control study analyzed low-income housing development on the coast of Fortaleza with the aim of increasing the efficacy of control measures against dengue during a dengue outbreak. A total of 211 households were investigated using a questionnaire to collect socioeconomic, behavioral, and environmental risk data for cases and controls. Cases were defined according to the national guidelines for the control of dengue based on the detection of dengue IgM antibodies; 34 cases and 34 controls were investigated. An analysis of the epidemic in a low-income housing development showed the presence of several known risk factors because human behavioral components are difficult to manipulate. However, other factors, such as the frequency of visits by vector control agents, could be solved by making simple changes within municipal services (6363. Heukelbach J, de Oliveira FA, Kerr-Pontes LR, Feldmeier H. Risk factors associated with an outbreak of dengue fever in a favela in Fortaleza, north-east Brazil. Trop Med Int Health. 2001;6(8):635-42. https://doi.org/10.1046/j.1365-3156.2001.00762.x.
https://doi.org/10.1046/j.1365-3156.2001...
).

Another study evaluated the implementation of an intervention strategy to decrease the amount of A. aegypti in 2012 and 2013. Participants were divided into 10 intervention groups and 10 control groups, and activities such as workshops, cleaning campaigns, and student and older inhabitant mobilization were conducted. Differences in social participation, commitment and leadership were observed between the groups, and a higher efficacy was observed in the intervention group than in the control group. Social participation and environmental management are viable and promising alternatives to vector measures for dengue vector control (6464. Caprara A, Lima JW, Peixoto AC, Motta CM, Nobre JM, Sommerfeld J, et al. Entomological impact and social participation in dengue control: a cluster randomized trial in Fortaleza, Brazil. Trans R Soc Trop Med Hyg. 2015;109(2):99-105. https://doi.org/10.1093/trstmh/tru187.
https://doi.org/10.1093/trstmh/tru187...
).

CONCLUSION

Dengue remains a serious public health problem and constitutes a threat to the Brazilian population. The tropical climate of Brazil favors the proliferation of dengue and the four serotypes (DENV-1 to DENV-4) that circulate in Brazil. Vector control is still the most effective means of protection against the spread of the disease but remains ineffective against the numerous epidemics occurring every year in Brazilian cities. Serological diagnostic tests also need to be improved because cross-reactions with other arboviruses often occur.

From the present review, we conclude that although studies on dengue in the state of Ceará are scarce, they are encompassing, including several lines of research, and the number of studies and reports on dengue in the state of Ceará continues to increase.

ACKNOWLEDGMENTS

The authors would like to thank the Medical Sciences Graduate Program of the University of Fortaleza, the Edson Queiroz Foundation, the Cearense Foundation for Scientific and Technological Development Support (FUNCAP), and the National Council for Scientific and Technological Development (CNPq). Grant holders: Danielle Malta Lima (PQ-2 CNPQ), Jane Cavalcante Amaral (PIBIC/CNPq) and Daniela Cristina Sensato Monteiro (FUNCAP).

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Publication Dates

  • Publication in this collection
    9 Sept 2019
  • Date of issue
    2019

History

  • Received
    24 Sept 2018
  • Accepted
    10 Apr 2019
Creative Common - by 4.0
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