FGV and Fiocruz monitor the spread of dengue fever in Brazil

The project has established itself as an important tool for the Ministry of Health

According to the World Health Organization (WHO), Brazil is by far the country with the highest number of dengue fever cases in 2024. Around 7.6 million probable cases of the disease have been recorded worldwide. Here, the 6.3 million tests monitored represent more than 82% of the global share, which makes it a threat that requires severe action to combat Aedes aegypti.

The mosquito, as we know, is also the direct transmitter of diseases such as Zika Virus and Chikungunya. It was precisely with the aim of disseminating relevant and detailed information on the numbers of infections caused by these diseases that researchers from the School of Applied Mathematics of the Getulio Vargas Foundation (FGV EMAp) developed InfoDengue, in partnership with the Oswaldo Cruz Foundation (Fiocruz).

Implemented in 2015, the FGV EMAp and Fiocruz initiative is carried out in partnership with the Municipal Health Department of Rio de Janeiro, the Dengue Observatory of the Federal University of Minas Gerais (UFMG), researchers from the Federal University of Paraná (UFPR) and the State University of Western Paraná (Unioeste).

O Aedes aegypti é responsável pela transmissão de diferentes tipos de arboviroses | Foto: Pexels

Aedes aegypti is responsible for transmitting different types of arboviruses | Photo: Pexels

Origin of the platform

InfoDengue monitors data on dengue, Zika virus and chikungunya throughout Brazil in an integrated manner. The platform accesses official government data and transforms this information into graphs, tables and numbers presented in an educational manner, precisely to facilitate the public's understanding of the diseases.

The initiative gained national scope with the full support of the Ministry of Health, starting in 2021.

One of the project coordinators, Flávio Codeço Coelho, reveals that the idea of ​​creating the alert system began in 2013.

“The original proposal was to make the best possible use of the available information on dengue cases that every health system collects. When a person goes to a health center and is diagnosed with dengue, that health center, by law, is required to report the data. This goes into a database and we wanted to provide an analysis of this data on an ongoing basis so that everyone would know, including the Health Departments and all health professionals who were interested, as well as the general public,” he says.

After a decade since its implementation, the FGV EMAp researcher recognizes the evolution of the software, which has become meticulously accurate for any municipality in the country to familiarize itself with the situation of disease outbreaks.

“We can say that InfoDengue is almost like a virtual epidemiology laboratory, because it goes beyond the concept of a research project, since it was born with a research focus, but has become partly a free service for the government. It is funded by the Ministry of Health, so there are sources that help sustain this effort. It is a non-profit initiative to contribute back to the issue of public health”, he analyzes.

How does InfoDengue work?

Official epidemiological data on the diseases are analyzed. The information is provided by the Ministry of Health, which aggregates the numbers from the municipalities.

Mentions of dengue on social media are also used by the system. The goal is to indicate incidences more quickly, making actions to combat the spread of the disease more agile and with continuous interaction with the departments and the Ministry of Health itself.

The results shown on the InfoDengue platform to make projections of the mosquito's incidence focus in each city in Brazil come from the Federal Government. And the details are complete, through analytical reports sent weekly by Coelho's team.

“These notifications have details of where the cases were, whether they are men or women, age, age group. No one's name or exact address is revealed, also to protect their identity, but you end up knowing important variables to do a risk analysis based on this weekly update. So, every week, the graphs are updated and new reports are produced”, explains the School researcher.

O InfoDengue foi implementado em 2015 | Foto: Reprodução

InfoDengue was implemented in 2015 | Photo: Reproduction

To simplify matters, the InfoDengue Coordinator explains that the Ministry has internal divisions for managing the main diseases in Brazil, including arboviruses, which are the set of diseases transmitted by Aedes aegypti. Coelho's team then receives data compiled by the Federal Government and, through a computerized statistical modeling program, transforms them into graphs and analytical maps on a weekly basis.

The synthetic analyses that can be performed from this are numerous, such as the incidence of the disease in Brazil, state or municipality, risk assessments, genera more susceptible to the diseases, climatic aspects that favor the reproduction of the mosquito, among other factors. Finally, InfoDengue returns the most accurate information to the Ministry of Health.

Despite having its own sessions, the Government's health professionals consult the reports produced by the FGV EMAp and Fiocruz software and often require more specific analyses on specific topics. This is the necessary basis for implementing public policies for the respective locations in Brazil.

The InfoDengue team also has an epidemiologist to ensure efficient communication with state and municipal health departments and with the Ministry of Health itself.

“This is an extremely valuable source of information for small cities. There are more than 5,500 cities in Brazil and we continue with our mission. However, we have noticed that capital cities, such as Rio de Janeiro, use epidemiological intelligence centers that can be considered InfoDengue’s own experience. So, this is the impact that the project has had over the last few years and will continue to contribute”, he predicts.

The benefits of the platform are incalculable, but controlling the disease is not a simple process. Although there are awareness campaigns to combat the disease throughout Brazil, these measures are no guarantee that the mosquito will be eliminated.

Firstly, because part of the mosquito population is very likely to be resistant to the insecticides frequently used in the regions where they are found. The second factor is that the extermination of Aedes aegypti breeding sites is a very difficult task to accomplish, since the insect can take advantage of any gap to breed.

The effectiveness of control is limited, so Coelho points out that InfoDengue's work must be accompanied by investment by the municipality and awareness among the population to get vaccinated correctly, if the vaccine is available in their region and for their age group.

“What we recommend is that cities invest in health care so that people with dengue have less chance of developing severe forms of the disease or dying, and improve diagnostic systems so that they receive treatment and recover as quickly as possible”, says the researcher from the School.

But what happens when the municipality has no history of transmission cases?

The FGV EMAp researcher confirms that he has seen cities with excellent awareness-raising efforts and competent health professionals, but the lack of experience with the disease is often what makes it difficult for authorities to act more quickly.

“One of the biggest challenges in a city that has never had dengue and suddenly starts to have cases is that doctors don’t even know how to diagnose it, because they’ve never seen it. In this situation, there needs to be a training campaign for health professionals to quickly identify cases and how to refer them. Because the data is often not visible, the incidence continues and we are unable to stop transmission”, he reports.

InfoDengue’s predictions, although not enough to eradicate the diseases, are valuable elements for reducing morbidity, that is, the harm caused by the diseases to the population.

“We have conducted studies that show the advance of the wave of these diseases to the South of Brazil. With higher temperatures in the region, which previously had virtually no cases of dengue fever, it now houses populations of the mosquito that transmits the disease and the disease is taking hold due to climate change. So, our work was analyzed and alerted to this expansion, which helped professionals to act more promptly”, he explains.

Legacy and evolution of InfoDengue

For Coelho, the legacy of the FGV EMAp and Fiocruz project is enormous in terms of the quality and presentation of information about diseases. Because it is a platform accessible to anyone, even small cities with limited resources can stay up to date on risks and set up efficient campaigns against Aedes aegypti.

“The way such data existed was practically inaccessible. The project, therefore, brought a layer of interpretation, because we collected a ‘truckload’ of data, our software processes all of it, and then we present synthetic numbers, build graphs, color maps with risk scales, where there is a greater focus of disease, and all with continuous updating. This would require a huge team to do manually. Therefore, one of the contributions of our project was to automate this entire process”, he explains.

Flávio Codeço Coelho é um dos coordenadores do projeto | Foto: Reprodução

Flávio Codeço Coelho is one of the project coordinators | Photo: Reproduction

In addition, the ease of access to data through the official InfoDengue website helps authorities to plan awareness campaigns and/or eradication of the mosquito in each location.

“These analytical results from our project serve as input for decisions on the management and control of these diseases, such as planning vaccination, which, in the case of dengue, is just beginning. But also on the issue of controlling the mosquito that carries the disease. All of this is formed by data from our project. Of course, they also have other sources of their own information, but our project has been routinely requested by the Ministry of Health”, reports Coelho.

And who said that the coordination is not working to expand the project's horizons? The InfoDengue collaborator network has grown exponentially and now has partnerships with international research groups that seek solutions for arboviruses in other countries and civil society organizations.

And thinking about contributing more directly to the reduction in cases of arboviruses, especially dengue, scientists from FGV EMAp and Fiocruz have started a new research program aimed at developing innovative technologies for the gradual incorporation and evolution of InfoDengue itself.

The project is called Mosqlimate, a combination of the words ‘mosquito’ and ‘climate’, and aims to address the impact of climate change, which is dangerously influencing the behavior of insects that carry arboviruses.

“Climate change is greatly increasing the area in which these mosquitoes can survive, because traditionally they were unable to live in environments with lower, colder temperatures. Now, with global warming, the area in which these mosquitoes live is expanding, and therefore more disease outbreaks. Places that previously did not have dengue fever now have it”, explains Coelho.

For this reason, one of the project’s main focuses are the models that the team of coordinators call predictive, that is, software that has the ability to project trends for the short, medium and long term of the diseases being studied. It is funded by the British foundation Wellcome Trust, which focuses on creating economic conditions to support research to improve human and animal health.

The information is made available through an API, an automated access interface that delivers data to users, and anyone can collect it to conduct research. FGV EMAp thus monitors forecast models over time in specific regions that serve as a reference for the government.

“The models attempt to capture this variation with some success, because the dynamics of diseases are quite complex and often surprise us. We already have models that we can present with forecasts. We have a specialized dashboard called ‘Forecast’ that aims to show what will actually happen in the future. These forecast maps, in particular, are widely used for planning by the Ministry of Health, which will allocate resources to combat dengue and to care for people with dengue throughout Brazil. They use these projections to anticipate resources for the regions that need them most”, he explains.

Ease of joining the project

Today, all states in the federation can join the InfoDengue system. Members of State Health Departments interested in becoming partners in the project and receiving detailed bulletins for their state can access the ‘Participate’ tab on the official website and send a request to alerta_dengue@fiocruz.br

InfoDengue success stories

In the case of Paraná, which joined the project in 2016, the improvements in combating and raising awareness about arboviruses are evident. Currently, there are 399 municipalities in the state that can monitor the status of the diseases in question on a weekly basis. The system classifies each week into four levels of attention, on a scale that starts at green and goes through yellow and orange to red.

Emanuelle Gemin Pouzato, head of the Vector-Borne Diseases Division of the Health Department (Sesa/PR), praises the long-standing partnership with the weekly availability of the Notifiable Diseases Information System (Sinan) database and classifies the work of FGV EMAp and Fiocruz as impeccable in presenting the graphs produced by the software.

“InfoDengue has contributed to decision-making to anticipate actions in municipalities on alert for epidemic risks, such as: distribution of supplies, financial resources, training, among others. As an online platform, with free public access, the information is available to all municipalities, regardless of their size and technical staff. The data is modeled by highly qualified specialists, ensuring an excellent service in Public Health. The graphic resources presented are easy to understand, without the need for advanced knowledge in statistics to interpret them”, praises Emanuelle.

The new InfoDengue project funded by the United Kingdom can also be of fundamental importance for Coelho's team to make advance predictions of extreme weather phenomena, such as El Niño and its impact on the global scenario in 2024.

“InfoDengue has also contributed to the preparation of projections that take into account climate factors in extreme situations, such as El Niño this year. These projections helped us plan more targeted actions for risk areas and were corroborated with the data presented mainly in non-endemic areas, with no history of epidemics, making it possible to anticipate preventive strategies in these areas. All information is used to plan campaigns and training”, adds the veterinarian and reference in the state department.

High contrast

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