CHALLENGES OF DENGUE EPIDEMIOLOGICAL SURVEILLANCE IN THE AMAZONAS HEALTH SYSTEM

Abstract

Dengue fever is one of the major arboviral diseases of global importance and represents a significant public health problem in tropical and subtropical countries, such as Brazil. The disease is transmitted by the Aedes aegypti mosquito, whose proliferation is favored by environmental, climatic, and socioeconomic factors. In the state of Amazonas, the scenario becomes more complex due to the large territorial extension, high rainfall, high temperatures, and difficulties in accessing health services, especially in inland municipalities and vulnerable communities. Since the first recorded epidemic in 1998, dengue has become endemic in the region, initially with the circulation of serotypes DENV-1 and DENV-2, followed by the introduction of serotypes DENV-3 and DENV-4, increasing the risk of severe forms of the disease. Studies also point to the occurrence of co-infections between serotypes, highlighting the epidemiological complexity of dengue in Amazonas. In this context, epidemiological surveillance plays a fundamental role in the early detection of outbreaks, viral monitoring, and implementation of control measures, although it faces challenges such as underreporting, a shortage of qualified professionals, logistical difficulties, and fragmentation of information systems. Climatic factors, such as high temperatures, high humidity, and intense rainfall, favor the accelerated reproduction of the vector and amplify its dissemination, especially in densely populated urban areas. Furthermore, research demonstrates that low rates of basic sanitation and sewage collection contribute significantly to the increase in dengue cases in Amazonian municipalities. Problems such as inadequate water storage, the accumulation of solid waste, and disordered urbanization are factors that contribute to the formation of mosquito breeding grounds, highlighting the disease's relationship with social and environmental inequalities. Another relevant challenge is the low engagement of the population in preventive actions, compromising strategies such as the Rapid Survey of Aedes aegypti Indices (LIRAa). Studies conducted in southern Amazonas show that, although part of the population is aware of the symptoms and prevention methods of the disease, there is still a need to expand continuous health education and public awareness campaigns. In this sense, Digital Information and Communication Technologies (DICTs) have proven to be important tools for strengthening educational practices aimed at dengue prevention. The COVID-19 pandemic exacerbated the weaknesses of epidemiological surveillance in Amazonas, reducing vector control and epidemiological monitoring actions, resulting in an increase in cases and possible underreporting. Given this scenario, the adoption of integrated strategies involving epidemiological surveillance, environmental management, improved basic sanitation, health education, and strengthening primary care becomes essential. It is concluded that the challenges of dengue surveillance in Amazonas are related to socio-environmental conditions, the structural limitations of the health system, and the need to strengthen integrated public policies, associated with community participation, to reduce the incidence of the disease and promote sustainable improvements in public health.