1.3.3 Dengue

Inventory of R&D&I needs

According to the specialist invited to point out the needs of research in the area, there are three types of virus circulating in Brazil, along with more aggressive genotypes, and which carry the most recurrent development in serious forms of the disease. The researcher in this area pointed out two priorities, as important contributions for public policies on the control of dengue are studies on atypical ways of disease manifestation and the development of the fast diagnosis method. The vaccine elaboration for fighting against the endemics is also subject to great investigation.

The Ministry of Health's technical area highlighted the following studies as priorities for the area:

• Development of methodology for evaluation of the density of the infestation that functions in other development phases that are not larval: pupa, adult, eggs in order to have correlations among the methods and determine levels of the transmission risk.
• Development of an operational model of the stratified field, that considers different degrees of transmission (infestation levels, notifications, socio-environmental conditions, preferential deposits, among others) risk in large urban centers.
• Improvement of the current dengue system (field operations) information, in a way to make it more agile, generating reports compatible with the systems now used that could be analyzed at any level.
• Development of new fast monitoring strategies for integrated analyses of clinician-epidemic data, entomologic and virological.
• Development of prediction models for the transmission risk of infection in dengue viruses.
• Development and application of an evaluation methodology for the Municipal Programs activities of control of the dengue in relative aspects, to the integrated administration of their components (control of vectors, epidemics surveillance, attendance, communication and mobilization).
• Study development for the risk perception of the population in relation to dengue.
• Development of a fast serological test for use in field conditions, as a support tool in the prevention activities and control of the dengue.
  

Methodology

The group adopted the proposed methodology; it went through the stages and answered the questions presented by the script. They dedicated part of the time to discuss and incorporate the recommendations from the Ministry of Health’s technical area as well as from experts about the inventory of R&D&I needs for the area. In some cases, they had fully contemplated the recommendations.

Setting Priority Research in Health - Results

1. What is the nature and size of the disease burden and which are the epidemic trends?

The model that estimates the disease burden is not adequate to evaluate acute diseases, such as dengue (for instance: the DALY does not take into account to which extent dengue overburdens the health system in a short time).

2. What are the interventions and control strategies of the disease currently available?

Control of the vector.

3. Which are the major problems and challenges in controlling the disease?

Inexistence of vaccines; extensive areas of the mosquito spreading; insufficient scientific knowledge for reducing vector populations; problems in the detection and early notification of disease cases; weak integration between entomological surveillance and epidemic surveillance, making an opportune intervention unfeasible.

Recommendations

• Projects of a great, medium or small size? Preferably a medium size.
• Individual support or in networks? Preferably in networks but depending on the proposal, individual projects should also be addressed. In relation to projects with clinical studies, only networked projects should be addressed.
• Multi-centric? Support in multi-centric studies, depending on the nature of the project.
• Support for emerging groups? The support for emerging groups should be conditioned to networked projects, for expanding the scientific-technical capacity building.
• How 30% of the resources of the call for bid should be invested as a priority, and which obligatorily have to be applied in the North, Northeast and Central-West areas? Besides the scientific merit of the proposal, priority should be given to networked projects, mainly in the case of groups that are not fully qualified.
  

Nature of the intended innovations

Priority Lines

1.Vectors

• Development of new technologies for the construction of non-larval entomologic indicators, operationally viable in its field, to be used as risk indicators of dengue occurrence, and of infestation density, so as to improve the control programs.
• Studies on the resistance mechanisms of Aedes to insecticides, vectorial capacity and relationship between resistance and vectorial capacity.
• Evaluations on the vectorial capacity of Aedes albopictus in relation to dengue in the country.
• Studies about the interaction between dengue virus and the vector.
• Evaluation of entomological factors and socio-environmental determinants on the geographical stratification in what concerns the degree of dengue transmission risk in great urban centers.
  

2 . Epidemiology, surveillance and control

Improvement of the current collection system and information processing about field operations developed by the National Program of Dengue Control (Programa Nacional de Controle da Dengue – PNCD), in a way to make it more agile, generating reports compatible with the systems currently in use and that allows analysis at all levels of the health system.

• Development of new fast monitoring strategies for integrated analyses of clinical-epidemiological data, entomologic and virological data to subsidize the decision-making process/ dengue epidemiological surveillance initiatives.
• Development of predictive models for the risk of infection transmission through means of dengue virus.
• Development and application of methodologies for assessing processes, results, epidemiological impact, as well as health economy concerning actions on dengue control.
• Development of study to assess the population’s knowledge, risk perception and practices in relation to dengue with views to provide subsidies to improve the communication and social mobilization component of the PNCD.
• Development of new technologies and vector control strategies for dengue virus to improve the PNCD.
• Research on potential vaccines for dengue, already in development.
• Study of predictive factors of risk of occurrence in serious forms of dengue.
  

3. Clinical-Laboratorial

• Clinical-epidemiological studies of unusual dengue manifestations.
• Development of new methodologies of fast diagnosis for dengue, economically feasible for application on large scale, to be used in field conditions.
• Studies about the interaction of the dengue virus with human host.
• Molecular study of the dengue virus and its relationship to the epidemiological patterns of the disease in the country.
• Development of laboratorial diagnosis methodologies, with special attention to effective methods to differentiate the dengue virus and other flavivirus.
• Development and evaluation of animal models for dengue.
  

Recommendations of Work Group Dengue for the Ministry of Health.

• Development of field operational strategies, stratified, complementary or alternative, which consider different degrees of transmission risk (infestation levels, notifications, socio-environmental conditions, preferential deposits, among others) in large urban centers (original proposal of Ministry of Health for the call for bid) – the group suggested that this item should not be part of the call for bid. The Work Group suggests that the Ministry of Health should look for partners to accomplish this project, jointly with research institutions and State and/or Municipal Health Secretariats.
• Stimulus to laboratories willing to collaborate with the monitoring of the populations’ resistance to Aedes aegypti to insecticides used in PNCD (MoReNAa) – draft recommendation to Decit.
• Training of units for large-scale production of insecticides in the country – draft recommendation to Decit and other health institutions endowed with production units.
• Recommendation for larger integration among different programs of vectors control.
• To include PNCD technicians in the projects evaluation commission for this call for bid.
• The Ministry of Health should support the Brazilian research groups working in the development of a vaccine against the dengue virus.
• Support to projects of insectaries and infectors infrastructure.
  

Workgroup