5. The role of Fiocruz

In Brazil, dengue has a seasonal pattern, with a higher incidence of cases in the first 5 months of the year, a warmer and wetter period, typical of tropical climates. In the second half of the twentieth century, from 1986, dengue became epidemiologically important, when the epidemic broke out in the State of Rio de Janeiro and the circulation of serotype 1, which soon reached the Northeast Region. Thus, dengue became endemic in Brazil, interspersed with epidemics, usually associated with the introduction of new serotypes, in areas previously indene [14, 55–58].

Aedes aegypti: The Main Enemy of Public Health in Brazil - Challenges… DOI: http://dx.doi.org/10.5772/intechopen.79780

The Oswaldo Cruz Foundation (Fiocruz), under the Ministry of Health have a mission to produce, disseminate and share knowledge and technologies aimed at the strengthening and consolidation of the Unified Health System (SUS) and contribute to the promotion of health and quality of life of the population [59].

Since 2003, in order to promote dengue control actions, Fiocruz has established the Fiocruz Dengue Network, through the allocation of resources to the Program for Development and Technological Innovation in Public Health in the field of research.

With the epidemiological cycles of the disease continuing, repeating itself and spreading throughout the country, more than 30,000 cases of dengue fever were reported in the city of Rio de Janeiro in 2008. Due to this epidemic, Fiocruz was called to assist the state and municipality in actions to combat the disease.

Thus, from 2009, Fiocruz redirected an integral focus to the issue with coverage in these three areas, without excluding the research. The Network Health Care of Integrated Actions for Health Care in Dengue Control originated from 2015 onwards and began to include in its scope the issues related to two emerging viruses in Brazil: chikungunya and Zika.

Aiming to reduce or even block the transmission of Zika, dengue and chikungunya Fiocruz has set up a factory for the large-scale release of Aedes aegypti Wolbachia bacterium in Rio de Janeiro. The plant has the capacity to produce 10 million eggs of the mosquito per week.

The initiative, officially called "Eliminating Dengue: Brazil Challenge," began in 2016 as a pilot project focused on the city of Niterói and the Tubiacanga neighborhood of Rio. According to the project's schedule, it will expand to North and South zones of Rio de Janeiro. The release of mosquitoes will be finalized by the end of 2018, at which time the project's coverage will have increased to a total area occupied by approximately 2.5 million people.

The Oswaldo Cruz Foundation (Fiocruz) developed a new test that will help drive public policies to fight the health emergency caused by the three infection diseases. The kit uses molecular diagnostics to detect and differentiate simultaneous RNA of the three viruses through real-time PCR technology, and the result is released on the same day. The kit can be used for laboratory diagnosis of all three viruses, two of them or each separately. The test allows diagnosis in the critical phase of the disease, at the beginning of clinical symptoms and an accurate laboratory diagnosis is essential. The opportunity or earlier diagnosis can also aid for epidemiological surveillance and prevention of new cases.

Fiocruz maintains investment in research, development and innovation because this is the only way to seek and find answers to the challenges due to triple Zikadengue-chikungunya epidemic. Therefore, the goal is to search for cooperation with other institutions in Brazil and internationally to build projects that could offer new possibilities to generate knowledge and developing technologies.

#### 6. Conclusion

Aedes aegypti is still a worldwide threat, since more than half of the world's population live in areas where these mosquitoes species are present. However, many efforts have been undertaken to combat and to control these mosquitoes and the diseases transmitted by them, such as vaccination, repellents and larvicides and the biological control of mosquitoes. Brazil has been continuously developing public policies to health education, alerting the population on the risks which can be avoided, with the purpose of decreasing the dengue, Zika and chikungunya diseases. The Brazilian government plays a role in continuing investment in research,

environmentally benign sterile insect technique (SIT). The RIDL involves the insertion of a lethal gene into male mosquitoes that prevents them from being able to reproduce successfully. The insects are considered sterile because the vast majority dies before maturing. These genetically modified males will seek out females to mate with and the ensuing progeny will contain the lethal gene [50–52]. If an appropriate number of mosquitoes are released, the females will be more likely to find a modified male, and a substantial drop in population can be achieved in a remarkably short period. To control populations with this technique as "zones" of release should be established to ensure sufficient area coverage. The preliminary results in Brazil showed that successful approach achieved a 95% reduction in local

Another alternative approach to A. aegypti control is the use of mosquitoes with the Wolbachia pipientis an endosymbiotic bacterium to prevent arboviruses replicating within the mosquito. The bacteria can hinder the fertility of their hosts and influence the sex of offspring. Besides, it can block viruses from reproducing in infected fruit flies and mosquitoes [50, 52, 53]. Mosquito control is an effective

FIOCRUZ's initiative to produce, create and release adult mosquitoes infected by bacterium of Wolbachia genus in several districts of the city of Rio de Janeiro has been shown to be very effective in controlling the diseases transmitted by Aedes

Other mosquitoes genetically modified (Moscamed™, created in 2005) are produced in large scale and released in different cities of Bahia states, reducing the mosquito population in 95% during 6 months. These strategies are being expanded

• Monthly/bimonthly inspection of households/population orientation by

• Smoke dispersion containing neurotoxic agent to adult mosquitoes at

• Biological control through the use of a bacterium naturally found in the

• Application of larvicides in the houses (more than 300,000 nonmilitary health agents +220,000 soldiers fighting against potential mosquitoes breeding sites);

environment, Wolbachia, which when present in Aedes, is able to prevent the transmission of the disease by the mosquitoes, and this characteristic is passed

In Brazil, dengue has a seasonal pattern, with a higher incidence of cases in the first 5 months of the year, a warmer and wetter period, typical of tropical climates. In the second half of the twentieth century, from 1986, dengue became epidemiologically important, when the epidemic broke out in the State of Rio de Janeiro and the circulation of serotype 1, which soon reached the Northeast Region. Thus, dengue became endemic in Brazil, interspersed with epidemics, usually associated with the introduction of new serotypes, in areas previously indene

throughout the Brazilian territory to combat Aedes aegypti [55, 56].

4.4 Control of mosquitoes by the Brazilian government

mosquito populations [53].

health agents;

epidemic locals;

5. The role of Fiocruz

[14, 55–58].

114

through on to their larvae.

aegypti.

Malaria

measure to prevent a dengue outbreak [54].

development and innovation to find new ways with national and international cooperation to combat Aedes aegypti.

References

60537

2017-12-12]

[1] Patterson J, Sammon M, Dengue GM. Zika and chikungunya: Emerging arboviruses in the new world. Western Journal of Emergency Medicine. 2016;

DOI: http://dx.doi.org/10.5772/intechopen.79780

Aedes aegypti: The Main Enemy of Public Health in Brazil - Challenges…

[8] Dye C. The analysis of parasite transmission by bloodsuccking insects. Annual Review of Entomology. 1992;37: 1-19. DOI: 10.1146/annurev.en.37.

[9] Scott WT, Clark GG, Lorenz LH, Amerasinghe PH, Reiter P, Edman J. Detection of multiple blood feeding in Aedes aegypti (Diptera: culicidae) during a single gonotrophic cycle using a histologique technique. Journal of Medical Entomology. 1993;30(1):94-99.

DOI: 10.1093/jmedent/30.1.94

the 21st century. Trends in

S1518-8787.2017051006889

[13] Mustafa MS, Rasotgi V, Jain S, Gupta V. Discovery of fifth serotype of dengue virus (DENV-5): A new public health dilemma in dengue control. Medical Journal Armed Forces India. 2015;71(1):67-70. DOI: 10.1016/j.

[14] Braga IA, Valle D. Aedes aegypti: Histórico do controle no Brasil. Epidemiologia e Serviços de Saúde. 2007;16(2):113-118. DOI: 10.5123/ S1679-49742007000200006

[15] Dick GW, Kitchen SF, Haddow AJ. Zika virus. I. Isolations and serological

SUS. 1999;8:5-33

mjafi.2014.09.011

[10] Gubler DJ. Epidemic dengue/ dengue hemorrhagic fever as a public health, social and economic problem in

Microbiology. 2002;10(2):100-103. DOI: 10.1016/S0966-842X(01)02288-0

[11] Teixeira MG, Barreto ML, Guerra A. Epidemiologia e medidas de prevenção do Degue. Informe Epidemiológico do

[12] Donalisio MR, Freitas ARR, Zuben V APB. Arboviruses emerging in Brazil: Challenges for clinic and implications for public health. Revista de Saúde Pública. 2017;51:30-36. DOI: 10.1590/

010192.000245

[2] Cavalcanti LPG, Freitas ARR, Brasil P, Da Cunha RV. Surveillance of deaths caused by arboviruses in Brazil: From dengue to chikungunya. Memórias do Instituto Oswaldo Cruz. 2017;112(8): 583-585. DOI: 10.1590/0074-027601

[3] Shoukry NM, Elwan NA, Morsy TA. Aedes aegypti (Linnaeus) re-emerging in southern Egypt. Journal of the Egyptian Society of Parasitology. 2012;42(1): 41-50. DOI: 10.12816/0006293

[4] World Health Organization (WHO). What is dengue? [Internet] 2017. Available from: http://www.who.int/de nguecontrol/disease/en/ [Accessed:

[5] Centers for Disease Control and Prevention (CDC). Dengue and the Aedes aegypti mosquito. [Internet]. 2015. Available from: https://www.cdc.gov/de ngue/resources/factSheets/factsheet\_de ngue-what-you-need-to-know.pdf

[6] Rodhain F, Rosen L. Mosquito vectors and dengue virus-vector relations ships. In: Gubler DJ, Kuno G,

[7] Silva AM, Dittus WPJ, Amerasinghe

editors. Dengue and Dengue Hemorragic Fever. New York: CAB International; 1997. pp. 45-60

PH, Amerasinghe FP. Serologic evidence for an epizootic dengue virus infecting toque macaques (Macaca Sinica) at Polonnaruwa, Sri Lanka. The American Journal of Tropical Medicine and Hygiene. 1999;60(2):300-306. DOI:

10.1002/ajp.10105

117

[Accessed: 2017-12-12]

17(6):671-679. DOI: 10.5811/ westjem.2016.9.30904
