Amena A. Ferraz

Spatio-temporal tracking and phylodynamics of an urban dengue 3 outbreak in São Paulo, Brazil.

The dengue virus has a single-stranded positive-sense RNA genome of ∼10.700 nucleotides with a single open reading frame that encodes three structural (C, prM, and E) and seven nonstructural (NS1, NS2A, NS2B, NS3, NS4A, NS4B, and NS5) proteins. It possesses four antigenically distinct serotypes (DENV 1–4). Many phylogenetic studies address particularities of the different serotypes using convenience samples that are not conducive to a spatio-temporal analysis in a single urban setting. We describe the pattern of spread of distinct lineages of DENV-3 circulating in São José do Rio Preto, Brazil, during 2006. Blood samples from patients presenting dengue-like symptoms were collected for DENV testing. We performed M-N-PCR using primers based on NS5 for virus detection and identification. The fragments were purified from PCR mixtures and sequenced. The positive dengue cases were geo-coded. To type the sequenced samples, 52 reference sequences were aligned. The dataset generated was used for iterative phylogenetic reconstruction with the maximum likelihood criterion. The best demographic model, the rate of growth, rate of evolutionary change, and Time to Most Recent Common Ancestor (TMRCA) were estimated. The basic reproductive rate during the epidemics was estimated. We obtained sequences from 82 patients among 174 blood samples. We were able to geo-code 46 sequences. The alignment generated a 399-nucleotide-long dataset with 134 taxa. The phylogenetic analysis indicated that all samples were of DENV-3 and related to strains circulating on the isle of Martinique in 2000–2001. Sixty DENV-3 from São José do Rio Preto formed a monophyletic group (lineage 1), closely related to the remaining 22 isolates (lineage 2). We assumed that these lineages appeared before 2006 in different occasions. By transforming the inferred exponential growth rates into the basic reproductive rate, we obtained values for lineage 1 of R0 = 1.53 and values for lineage 2 of R0 = 1.13. Under the exponential model, TMRCA of lineage 1 dated 1 year and lineage 2 dated 3.4 years before the last sampling. The possibility of inferring the spatio-temporal dynamics from genetic data has been generally little explored, and it may shed light on DENV circulation. The use of both geographic and temporally structured phylogenetic data provided a detailed view on the spread of at least two dengue viral strains in a populated urban area.

Avaliação sobre a adesão às práticas preventivas do dengue: o caso de Catanduva, São Paulo, Brasil

This paper presents the results of a qualitative survey on dengue fever prevention in an outlying neighborhood of Catanduva, Sao Paulo, Brazil. The research aimed to identify factors that interfere with on-going preventive practices by local residents. The authors began with a qualitative approach emphasizing preventive work within local womens daily context, mediated by the relationship they establish with vector control agents. The study indicates that to gain greater collaboration in dengue control requires: personalized consideration by both the programs and vector control agents, yet without excluding technical aspects; review of information content and communications methods: and training vector control agents to establish an on-going communications channel between the program and the population. Such factors can influence the populations interest in the prevention programs and minimize community discredit towards vector control activities.

Controle do vetor do dengue e participação da comunidade em Catanduva, São Paulo, Brasil

This study aimed to identify changes in knowledge and practices learned to prevent dengue fever in two areas of Catanduva, São Paulo State, from 1999 to 2001: a study area and a control area. The study included an initial quantitative survey, qualitative research, a preliminary diagnosis presented to the community to launch a discussion aimed at defining future actions, implementation of the actions in the study area with community participation (but without changes in the control area), and a final comparison of the two areas. Changes in the study area included: vector control workers began demonstrating preventive measures without removing potential breeding places or using larvicide; use of educational aids specific to the local reality; activities related to the residents priorities; and activities such as music, theater skits, scavenger hunts, and games to demonstrate the vector cycle. Potential domiciliary breeding sites were significantly reduced; the proportion of houses without breeding sites was significantly increased; and there was an increase in the percentage of individuals who recognized the larval form of the vector in the study area as compared to the control area.

Atividades de controle do dengue na visão de seus agentes e da população atendida, São José do Rio Preto, São Paulo, Brasil

The aim of this article was to identify daily situations experienced by dengue control agents in their relationship to local residents. A cross-sectional study applied questionnaires among vector control agents, community health workers, and a sample of local women. The answers by the dengue control agents and community health workers were grouped in the categories of work, private life, and community. The women were asked about the relationship with the vector control and community health workers. The difficulties cited in the private and work areas by the vector control agents were different from those reported by community health workers. At the community level they coincided and showed that neither group is adequately prepared to deal with these issues. Of the local women interviewed, 87.0% reported that they were well-informed or very well-informed about dengue, 84.0% stated that the work by the vector control agents and community health workers was always helpful, and 54.0% identified inappropriate visiting hours by vector control agents and community health workers as a difficulty. The study identified the need for a new job profile that would recognize and respect the specificities of the areas where their activities are conducted, integrating the communitys socio-environmental issues.

A difícil interface controle de vetores - atenção básica: inserção dos agentes de controle de vetores da dengue junto às equipes de saúde das unidades básicas no município de São José do Rio Preto, SP

This study analyzes the insertion process of vector control agents into the primary health centers (PHCs) in Sao Jose do Rio Preto, Sao Paulo, Brazil, designated health workers (HWs), in order to improve the effectiveness of the dengue fever control program. This is a case study, based on direct observation and recording of participants’ speeches in forums held by the municipal Secretary of Health with these professionals. These records underwent content analysis, and five categories were identified: social insertion; comprehensiveness of care; intersectoriality; appreciation of HW; and continuing education. The professionals expressed the need for permanent discussion forums; the difficulties to take intersectoral actions; and the feeling of professional appreciation for participating in teams from PHCs and collaborating to community participation. The study allowed us to understand how the insertion of HWs took place in municipal primary care and the complexity of dengue fever control, at this level of care, which involves socio-environmental issues and intersectoral action. The study revealed the various possibilities of action for HWs and the relevance of their insertion into primary care.

O controle da dengue com o auxílio de carroceiros

ampliar o acesso ao diagnostico precoce, viabilizando o encaminhamento das pessoas com resultados positivos para o tratamento com mais agilidade. O objetivo deste trabalho foi tracar o perfil dos usuarios atendidos pelo CTA, desde o periodo da implantacao ate dezembro de 2007. Houve um aumento significativo pela procura dos testes: 645 (39%) por metodologia convencional, 1624 (71%) por teste rapido, representando um acres-cimo percentual de 12,7% em relacao a 2005.