Luc<strong>en</strong>a LT, et al. D<strong>en</strong>gue <strong>en</strong> la Amazonía: <strong>aspectos</strong> epi<strong>de</strong>miológicos <strong>en</strong> <strong>el</strong> <strong>Estado</strong> <strong>de</strong> Rondônia, <strong>Brasil</strong>, <strong>de</strong> 1999 a 2010d<strong>el</strong> D<strong>en</strong>gue <strong>en</strong> 2008: Ariquemes, Cabixi, Cacoal, Espigãod’Oeste, Guajará-mirim, Ji-Paraná, Ouro Preto do Oeste,7Porto V<strong>el</strong>ho, Presid<strong>en</strong>te Médici y Vilh<strong>en</strong>a .A pesar <strong>de</strong> las medidas tomadas, la tasa <strong>de</strong> incid<strong>en</strong>ciasufrió nuevo aum<strong>en</strong>to y, una vez más, la tasa estadualultrapasa las tasas nacional y regional. Los númerosmáximos se alcanzaron <strong>el</strong> año <strong>de</strong> 2010, tanto <strong>en</strong> <strong>el</strong> paíscomo <strong>en</strong> <strong>el</strong> <strong>Estado</strong>. En Rondônia, la tasa <strong>de</strong> incid<strong>en</strong>ciallegó a ser aproximadam<strong>en</strong>te 16 veces superior a la d<strong>el</strong>inicio <strong>de</strong> las notificaciones. Los casos <strong>de</strong> FHD, DCC yóbitos pres<strong>en</strong>tan también los mayores números <strong>de</strong>s<strong>de</strong>1999, probablem<strong>en</strong>te <strong>de</strong>bido a la reintroducción <strong>de</strong> los10,9serotipos DENV-1 y DENV-2 <strong>en</strong> <strong>el</strong> <strong>Estado</strong> .La introducción <strong>de</strong> una nueva forma viral repres<strong>en</strong>ta unimportante riesgo <strong>de</strong> nuevas epi<strong>de</strong>mias y <strong>de</strong> formas graves,ya que gran parte <strong>de</strong> la población no ti<strong>en</strong>e anticuerpos2,13para, al m<strong>en</strong>os, un serotipo d<strong>el</strong> d<strong>en</strong>gue . Sin embargo, <strong>el</strong><strong>Estado</strong> no posee un sistema <strong>de</strong> vigilancia activoresponsable por la id<strong>en</strong>tificación <strong>de</strong> los serotipos virales.Con r<strong>el</strong>ación a la tasa <strong>de</strong> letalidad, la mayor sucedió <strong>el</strong>año <strong>de</strong> 2001 (100%), con notificación <strong>de</strong> ap<strong>en</strong>as 2 casos<strong>de</strong> DCC y evolución <strong>de</strong> todos a óbito. El año <strong>de</strong> 2007,hubo 16 casos complicados <strong>de</strong> d<strong>en</strong>gue sin ningún óbitoregistrado. En contrapartida, <strong>el</strong> año <strong>de</strong> 2010 se notificaron428 casos complicados <strong>de</strong> la <strong>en</strong>fermedad, con 24 óbitos,resultando <strong>en</strong> una tasa <strong>de</strong> letalidad <strong>de</strong> 5%. De formag<strong>en</strong>eral, la tasa <strong>de</strong> letalidad se ha mostrado alta y variable<strong>en</strong> <strong>el</strong> <strong>Estado</strong>. De acuerdo con <strong>el</strong> Programa Nacional <strong>de</strong>Control d<strong>el</strong> D<strong>en</strong>gue, d<strong>el</strong> Ministerio <strong>de</strong> Salud, la reducción<strong>de</strong> la tasa <strong>de</strong> letalidad es una meta a ser alcanzada, con14niv<strong>el</strong>es esperados m<strong>en</strong>ores a 1% .CONCLUSIONESEn <strong>el</strong> <strong>Estado</strong> <strong>de</strong> Rondônia, la situaciónepi<strong>de</strong>miológica d<strong>el</strong> d<strong>en</strong>gue alerta hacia la necesida<strong>de</strong>merg<strong>en</strong>te <strong>de</strong> inversiones satisfactorias <strong>en</strong> acciones quepuedan combatir esa epi<strong>de</strong>mia. Tales acciones <strong>de</strong>b<strong>en</strong>realizarse a través <strong>de</strong> un mod<strong>el</strong>o <strong>de</strong>sc<strong>en</strong>tralizado, con <strong>el</strong>objetivo <strong>de</strong> un abordaje multisectorial <strong>de</strong> mayor4,3impacto <strong>en</strong> la población . A<strong>de</strong>más, es necesarioperfeccionar <strong>el</strong> sistema <strong>de</strong> notificaciones estadual, con<strong>el</strong> objetivo <strong>de</strong> reducir la subnotificación y posibilitar, así,mejorar <strong>el</strong> conocimi<strong>en</strong>to sobre la realidad <strong>de</strong> la saludlocal.Debido al aum<strong>en</strong>to expon<strong>en</strong>cial <strong>de</strong> los casos <strong>de</strong>d<strong>en</strong>gue <strong>en</strong> Rondônia, a partir <strong>de</strong> 2009, <strong>el</strong> Ministerio <strong>de</strong>Salud inició la adopción <strong>de</strong> medidas <strong>de</strong> apoyo <strong>en</strong> <strong>el</strong><strong>Estado</strong>. Estas medidas incluy<strong>en</strong> aporte financieroadicional; acciones <strong>de</strong> vigilancia y control <strong>de</strong> vectores, pormedio <strong>de</strong> visitas a las unida<strong>de</strong>s, con búsqueda activa <strong>de</strong>casos; y <strong>el</strong>aboración <strong>de</strong> planes <strong>de</strong> acción para <strong>el</strong> combate9al mosquito d<strong>el</strong> d<strong>en</strong>gue . Sin embargo, aún con estasacciones, la capital, Porto V<strong>el</strong>ho, estaba <strong>en</strong>tre los 24municipios brasileños con mayor riesgo <strong>de</strong> brote <strong>de</strong>d<strong>en</strong>gue <strong>en</strong> 2011, <strong>de</strong> acuerdo con <strong>el</strong> Riesgo D<strong>en</strong>gue.A pesar <strong>de</strong> la difícil solución, es necesario modificar <strong>el</strong>actual esc<strong>en</strong>ario <strong>de</strong>bido a la constante am<strong>en</strong>aza <strong>de</strong>brotes <strong>de</strong> la <strong>en</strong>fermedad cada vez mayores <strong>en</strong> lapoblación. Se <strong>de</strong>staca la importancia <strong>de</strong> la prev<strong>en</strong>ción <strong>de</strong>una nueva onda epidémica <strong>de</strong> d<strong>en</strong>gue <strong>en</strong> <strong>el</strong> <strong>Estado</strong> <strong>de</strong>Rondônia, a fin <strong>de</strong> evitar mayor ocurr<strong>en</strong>cia <strong>de</strong> formasgraves <strong>de</strong> la <strong>en</strong>fermedad y, consecu<strong>en</strong>tem<strong>en</strong>te, unaum<strong>en</strong>to <strong>en</strong> <strong>el</strong> número <strong>de</strong> óbitos.D<strong>en</strong>gue na Amazônia: <strong>aspectos</strong> epi<strong>de</strong>miológicos no <strong>Estado</strong> <strong>de</strong> Rondônia, <strong>Brasil</strong>, <strong>de</strong> 1999a 2010RESUMOA d<strong>en</strong>gue é uma do<strong>en</strong>ça viral, aguda e sistêmica, que é transmitida principalm<strong>en</strong>te p<strong>el</strong>o mosquito Ae<strong>de</strong>s aegypti. Estápres<strong>en</strong>te em todos os 26 <strong>Estado</strong>s da Fe<strong>de</strong>ração <strong>Brasil</strong>eira e no Distrito Fe<strong>de</strong>ral e no país registram-se, aproximadam<strong>en</strong>te,70% das notificações mundiais. O objetivo <strong>de</strong>ste estudo é analisar a epi<strong>de</strong>miologia da d<strong>en</strong>gue <strong>en</strong>tre os anos 1999 e 2010no <strong>Estado</strong> <strong>de</strong> Rondônia, comparando os dados obtidos com a situação do país no período equival<strong>en</strong>te. Utilizaram-secomo fonte <strong>de</strong> informações os registros oficiais do Sistema Nacional <strong>de</strong> Agravos <strong>de</strong> Notificação, da Agência Estadual <strong>de</strong>Vigilância Sanitária e do Departam<strong>en</strong>to <strong>de</strong> Informática do SUS. Os dados são refer<strong>en</strong>tes ao período <strong>de</strong> 1999, início dasnotificações, a 2010, último ano com números completos. Foram coletadas informações refer<strong>en</strong>tes aos casos notificadose confirmados, formas graves da do<strong>en</strong>ça, taxa <strong>de</strong> incidência, número <strong>de</strong> óbitos, <strong>en</strong>tre outros. Des<strong>de</strong> o início dasdocum<strong>en</strong>tações, ocorreu um aum<strong>en</strong>to expon<strong>en</strong>cial nos casos <strong>de</strong> d<strong>en</strong>gue no <strong>Estado</strong>, que passaram <strong>de</strong> 969 casosnotificados em 1999 para 27.910 casos em 2010, um increm<strong>en</strong>to <strong>de</strong> 2.880% nas notificações, principalm<strong>en</strong>te na capital,Porto V<strong>el</strong>ho. Observou-se também crescim<strong>en</strong>to da taxa <strong>de</strong> incidência, que subiu <strong>de</strong> 7,63 para 365,9 por 100 milhabitantes. Em r<strong>el</strong>ação à notificação <strong>de</strong> casos graves, ocorreu increm<strong>en</strong>to no número <strong>de</strong> casos <strong>de</strong> todos os tipos <strong>de</strong>manifestação e na ocorrência <strong>de</strong> óbitos. É necessário o <strong>de</strong>s<strong>en</strong>volvim<strong>en</strong>to <strong>de</strong> políticas públicas para a prev<strong>en</strong>ção <strong>de</strong> futurasepi<strong>de</strong>mias, a fim <strong>de</strong> evitar maior ocorrência <strong>de</strong> formas graves da do<strong>en</strong>ça e, consequ<strong>en</strong>tem<strong>en</strong>te, aum<strong>en</strong>to no número <strong>de</strong>óbitos.Palavras-Chaves: D<strong>en</strong>gue; Vigilância Epi<strong>de</strong>miológica; Incidência; Amazônia.24Rev Pan-Amaz Sau<strong>de</strong> 2011; 2(3):19-25
Luc<strong>en</strong>a LT, et al. D<strong>en</strong>gue <strong>en</strong> la Amazonía: <strong>aspectos</strong> epi<strong>de</strong>miológicos <strong>en</strong> <strong>el</strong> <strong>Estado</strong> <strong>de</strong> Rondônia, <strong>Brasil</strong>, <strong>de</strong> 1999 a 2010D<strong>en</strong>gue in the Amazon: epi<strong>de</strong>miological aspects in Rondônia State, Brazil, from 1999to 2010ABSTRACTD<strong>en</strong>gue is a viral, acute, and systemic disease that is mainly transmitted by the mosquito Ae<strong>de</strong>s aegypti. It is spread throughall 26 states of the Brazilian Fe<strong>de</strong>ration and in the Fe<strong>de</strong>ral District, and approximat<strong>el</strong>y 70% of all the world’s notifications ofd<strong>en</strong>gue are recor<strong>de</strong>d in Brazil. The objective of the pres<strong>en</strong>t study is to analyze the epi<strong>de</strong>miology of d<strong>en</strong>gue betwe<strong>en</strong> 1999and 2010 in Rondônia State, comparing the data obtained with that of the country as a whole during this period. Asinformation sources, we used the official records from the National System for Notifiable Diseases (Sistema Nacional <strong>de</strong>Agravos <strong>de</strong> Notificação), the State Ag<strong>en</strong>cy of Sanitary Surveillance (Agência Estadual <strong>de</strong> Vigilância Sanitária), and theDepartm<strong>en</strong>t of Informatics (Departam<strong>en</strong>to <strong>de</strong> Informática) of the Brazilian Unified Health System (DATASUS). The data referto the period from 1999 (the beginning of the notifications) to 2010 (the last year with complete data). Information wascollected regarding the notified and confirmed cases, severe forms of the disease, the incid<strong>en</strong>ce rate, and the number of<strong>de</strong>aths. From the beginning of docum<strong>en</strong>tation, there was an expon<strong>en</strong>tial increase in the cases of d<strong>en</strong>gue in the state. Th<strong>en</strong>umber of reported cases increased from 969 in 1999 to 27,910 in 2010, which repres<strong>en</strong>ts a 2,880% increase innotifications. The notifications were conc<strong>en</strong>trated mainly in the capital, Porto V<strong>el</strong>ho. In addition, the incid<strong>en</strong>ce rateincreased from 7.63 to 365.9 per 100,000 inhabitants. Regarding the reporting of severe cases, there were increases in th<strong>en</strong>umber of all types of severe case expression and in the occurr<strong>en</strong>ce of <strong>de</strong>aths. It is necessary to <strong>de</strong>v<strong>el</strong>op public policies thatprev<strong>en</strong>t future epi<strong>de</strong>mics to avoid a greater occurr<strong>en</strong>ce of the severe forms of the disease and, consequ<strong>en</strong>tly, an increase inthe number of <strong>de</strong>aths.Keywords: D<strong>en</strong>gue; Epi<strong>de</strong>miological Surveillance; Incidência; Amazônia.REFERENCIAS1 Cruz ACR, Galler R, Silva EVP, Silva MO, Carneiro AR,Travassos da Rosa ES, et al. Epi<strong>de</strong>miologia moleculardos sorotipos 2 e 3 do vírus d<strong>en</strong>gue isolados no <strong>Brasil</strong><strong>de</strong> 1991 a 2008. Rev Pan-Amaz Sau<strong>de</strong>. 2010mar;1(3):25-34.2 Teixeira MG, Costa MCN, Barreto F, Barreto ML.D<strong>en</strong>gue: tw<strong>en</strong>ty-five years since reemerg<strong>en</strong>ce in Brazil.Cad Sau<strong>de</strong> Publica. 2009;25 Suppl 1:S7-8.3 Maci<strong>el</strong> IJ, Siqueira Jr JB, Mart<strong>el</strong>li CMT. Epi<strong>de</strong>miologia e<strong>de</strong>safios no controle do d<strong>en</strong>gue. Rev Patol Trop. 2008maio - jun;37(2):111-30.4 Ministério da Saú<strong>de</strong> (BR). Aspectos clínicos dainfecção p<strong>el</strong>o vírus da d<strong>en</strong>gue. Brasília: Ministério daSaú<strong>de</strong>; 2011.5 Ministério da Saú<strong>de</strong> (BR). Secretaria <strong>de</strong> Vigilância emSaú<strong>de</strong>. Informe epi<strong>de</strong>miológico da d<strong>en</strong>gue - semanas<strong>de</strong> 1 a 52 <strong>de</strong> 2009. Brasília: Ministério da Saú<strong>de</strong>;2009.28 p.6 Instituto <strong>Brasil</strong>eiro <strong>de</strong> Geografia e Estatística.Cida<strong>de</strong>s [Internet]. Rondônia: IBGE; 2011. [citado2 0 1 1 j a n 3 ] . D i s p o n í v e l e m :http://www.ibge.gov.br/estadosat/perfil.php?sigla=ro.7 Ministério da Saú<strong>de</strong> (BR). Sistema Nacional <strong>de</strong>Vigilância em Saú<strong>de</strong>. R<strong>el</strong>atório <strong>de</strong> situação. Rondônia.Brasília: Ministério da Saú<strong>de</strong>; 2009.8 Ministério da Saú<strong>de</strong> (BR). Secretaria <strong>de</strong> Vigilância emSaú<strong>de</strong>. Informe epi<strong>de</strong>miológico da d<strong>en</strong>gue – janeiro anovembro <strong>de</strong> 2008. Brasília: Ministério da Saú<strong>de</strong>;2008.9 Ministério da Saú<strong>de</strong> (BR). Secretaria <strong>de</strong> Vigilância emSaú<strong>de</strong>. Informe epi<strong>de</strong>miológico da d<strong>en</strong>gue: análise <strong>de</strong>situação e t<strong>en</strong>dências - 2010. Brasília: Ministério daSaú<strong>de</strong>; 2010.10 Ministério da Saú<strong>de</strong> (BR). Re<strong>de</strong> Internacional parainformação para a Saú<strong>de</strong>. Indicadores <strong>de</strong> morbida<strong>de</strong>[Internet]. Brasília: Ministério da Saú<strong>de</strong>; 2011. [citado2 0 1 1 f e v 1 5 ] . D i s p o n í v e l e m :http://tabnet.datasus.gov.br/cgi/tabcgi.exe?idb2009/d0203.ddf.11 Lima VLC, Figueiredo LTM, Correa FHR, Leite OF,Rang<strong>el</strong> O, Vido AA, et al. D<strong>en</strong>gue: inquéritosorológico pós epi<strong>de</strong>miológico em zona urbana doestado <strong>de</strong> São Paulo, <strong>Brasil</strong>. Rev Sau<strong>de</strong> Publica. 1999<strong>de</strong>z;33(6):566-74.12 Câmara FP, Theophilo RLG, Santos GT, Pereira SRFG,Câmara DCP, Matos RRC. Estudo retrospectivo(histórico) da d<strong>en</strong>gue no <strong>Brasil</strong>: característicasregionais e dinâmicas. Rev Soc Bras Med Trop. 2007mar-abr;40(2):192-96.13 Medronho RA. D<strong>en</strong>gue no <strong>Brasil</strong>: <strong>de</strong>safios para o seucontrole. Cad <strong>de</strong> Sau<strong>de</strong> Publica. 2008maio;24(5):948-49.14 Ministério da Saú<strong>de</strong> (BR). Fundação Nacional daSaú<strong>de</strong>. Programa nacional <strong>de</strong> controle da d<strong>en</strong>gue:instituído em 24 <strong>de</strong> julho <strong>de</strong> 2002. Brasília: Ministérioda Saú<strong>de</strong>; 2002. 32 p.Recibido <strong>en</strong> / Recebido em / Received: 20/9/2011Aceito <strong>en</strong> / Aceito em / Accepted: 22/3/2012Rev Pan-Amaz Sau<strong>de</strong> 2011; 2(3):19-2525