3. Epidemiology

The Brazilian regions with the highest incidence and prevalence of these diseases (northeast and southeast region) present a favorable climate for the development of the Aedes aegypti (Figure 4) and the use of lighter clothes, which cover smaller areas of the body, favoring their exposure.

The number of suspected or confirmed dengue cases reported to the World Health Organization (WHO) is showed in Figure 5 as well its distribution in the world.

In 2015, the incidence of probable cases of dengue fever (number of cases/ 100,000 inhabitants), according to Brazilian geographic regions, shows that the

Figure 4. Brazilian demographic density and latitude at geographic regions.

methods for establishing a laboratory diagnosis of these arboviruses are as follows: (1) detection of the virus for example, cell culture or viral RNA real-time detection; (2) antibody detection for example, IgM or IgG detection and (3) antigen/antibody

DENV CHIKV ZIKV

Mild Moderate Intense

Itch Mild Mild From moderate to intense

Rare From moderate to intense Mild

Conjunctivitis Rare 30% cases 50–90% cases Joint pain Mild From moderate to intense Moderate Muscles pain Intense Intense Moderate

Moderate Mild —

Appear from 2nd and 5th days (50% cases)

Rare Rare More frequently that DENV and

Appear from 1st or 2th day (90–100% cases)

(1–2 days of subfebrile)

Above 38°C (2–3 days) without febrile and subfebrile 38

CHIKV

Headache Intense Moderate Moderate

From the 4th day (30–50% cases)

\*Adapted from: http://combateaedes.saude.gov.br/pt/sintomas

The main symptoms of dengue, Zika and chikungunya.

These diseases are usually self-limiting with no need for hospitalization except warning signs are observed, especially severe dengue. There are no specific treatments available. Only symptomatic treatment with nonsalicylic analgesics and nonsteroid anti-inflammatories drugs are administrated when dengue infection is discovered. Patients should be advised to drink plenty of fluids to replace fluid lost

combined detection for example, NS1 and IgM/IgG [27, 28].

from sweating, vomiting and others.

Symptoms\* Arboviruses

Fever Above 38°C (4– 7 days)

Ganglionar hypertrophy

Malaria

Cutaneous rash (exantema)

Articulation swelling

Neurological events

Hemorrhage events

Table 1.

108

Midwest and Southeast regions had the highest incidence: 1451.9 cases/100,000 inhabitants and 1205.7 cases/100,000 inhabitants, respectively. Among the states, Goiás (2500.6 cases/100,000 inhabitants) and São Paulo (1665.7 cases/100,000 inhabitants) have presented the most incidence numbers [34].

The analysis of the incidence rate of probable cases of chikungunya fever (number of cases/100,000 inhabitants), according to geographic regions, shows that the Northeast presents the highest incidence rate: 249.7 cases/100,000 inhabitants. Among the Brazilian states, we highlight Ceará (1271.0 cases/100,000 inhabitants), Roraima (795.0 cases/100,000 inhabitants) and Tocantins (207.1 cases/100,000

The general objective of the Zika surveillance is to describe the epidemiology of

Due to this epidemiological situation of Zika viruses and its consequences, this

disease is considered an Emergency in Public Health of National Importance (ESPIN). From week 45/2015 and until week 52/2017,there were 15,298 cases notified of suspected changes in growth and possibly related to infection with the Zika virus and other infectious etiologies, of which 2869 (18.8%) remained research until 2017, December. Of the total cases, 3071 (20.1%) were confirmed, 339 (2.2%) were classified as likely to be related to infection during pregnancy and 230 (1.5%) as inconclusive. The majority of cases reported is concentrated in the Northeast region of the country (60.6%), followed by the Southeast (23.9%) and Midwest region (7.3%). The five Brazilian states with the greatest number of reported cases are Pernambuco (16.8%), Bahia (16.3%), São Paulo (9.0%), Paraíba (7.3%) and Rio de

the occurrence of microcephaly related to congenital infections in the national territory. Thus, from week 45/2015 until week 06/2016, there were 5280 registered cases of microcephaly occurrence, considering newborns, stillbirths, abortion and fetuses. Considering the year of notification, 60.1% (3174/5280) were recorded in 2015 and 39.9% (2106/5280) in 2016. [37]. Thus 3174 are confirmed, being 508 confirmed and 203 of these cases distributed in 13 Brazilian states, mainly in Northeast region (93.6%). Southeast region presented only five microcephaly notified cases. At least 27 of the confirmed cases evolved to death after birth or during pregnancy. At the end of 2016, the number of reported cases of the microcephaly increased to 10,867. Of these, 3183 (29.3%) remain under investigation and 7684 (70.7%) cases were investigated and classified, being 2366 confirmed, 49 probable and 5269 discarded. According to the geographical distribution, confirmed cases of the 10,867 reported are distributed in 751 Brazilian cities of the 27 Brazilian states, mainly in Northeast region (75.3%). The southeast region showed a large increase in

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

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

the number of confirmed cases of microcephaly: 74 cases [38].

Cases of dengue, chikungunya and Zika fever in Brazil during 2015, 2016 and 2017.

inhabitants) [36].

Janeiro (7.3%) [39].

Figure 7.

111

The dengue fever incidence rate was about 733.4 cases/100,000 inhabitants in all Brazilian States at 2016. During this year, the midwest (1322.0/100,000 inhabitants) and the southeast (1001.2/100,000 inhabitants) regions have presented bigger incidence numbers than the other geographic Brazilian regions [35].

In 2017, the midwest region had an incidence of 502.7 cases/100,000 inhabitants and the northeast region had 151.8 cases/100,000 inhabitants, most notably the states of Goiás with 947.3 cases/100.00 inhabitants, Ceará with 453.4/100,000 inhabitants and Tocantins with 331.2/100,000 inhabitants [36].

Figure 6 shows the total number cases of dengue in Brazilian regions during 2015–2017, mainly in the Southeast and Northeast regions, due to their characteristic climate aspects.

In 2015, 38,499 suspected chikungunya fever cases were registered in Brazil (Figure 6) which caused an incidence rate of 18.8 cases/100,000 inhabitants. These cases were distributed by 704 cities and 17,971 (46.7%) of them and 14 deaths were confirmed: 05 in Bahia, 02 in Sergipe and 07 in Pernambuco Brazilian states [35].

In 2016, the registered cases number increased significantly to 271,824 and the incidence rate was 133.0 cases/100,000 inhabitants. These cases were distributed in 2829 cities and 151,318 (55.7%) were confirmed. Once again, the northeast region had the highest incidence rate. Among the states were: Rio Grande do Norte (723.1 cases/100,000 inhabitants), Ceará (537.7 cases/100,000 inhabitants), Alagoas (514.8 cases/100,000 inhabitants) and Paraíba (503.0 cases/100,000 inhabitants). At the same year, 196 deaths caused by Chikungunya fever were confirmed [35].

In 2017, the registered cases number had a slight decrease with 185,737, and the incidence rate was 90.1 cases/100,000 inhabitants. However, there are 52,285 cases discarded. During this year, the Northeast region had the highest number of probable chikungunya fever cases (142,131 cases, 76.5%) in relation to the total of the country. Followed by the Southeast (22,984 cases, 12.4%), North (16,570 cases, 8.9%), Midwest (3679 cases, 2.0%) and South (373 cases, 0.2%) [36].

Figure 6.

Total dengue cases within Brazilian regions at the last 3 years.

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

The analysis of the incidence rate of probable cases of chikungunya fever (number of cases/100,000 inhabitants), according to geographic regions, shows that the Northeast presents the highest incidence rate: 249.7 cases/100,000 inhabitants. Among the Brazilian states, we highlight Ceará (1271.0 cases/100,000 inhabitants), Roraima (795.0 cases/100,000 inhabitants) and Tocantins (207.1 cases/100,000 inhabitants) [36].

The general objective of the Zika surveillance is to describe the epidemiology of the occurrence of microcephaly related to congenital infections in the national territory. Thus, from week 45/2015 until week 06/2016, there were 5280 registered cases of microcephaly occurrence, considering newborns, stillbirths, abortion and fetuses. Considering the year of notification, 60.1% (3174/5280) were recorded in 2015 and 39.9% (2106/5280) in 2016. [37]. Thus 3174 are confirmed, being 508 confirmed and 203 of these cases distributed in 13 Brazilian states, mainly in Northeast region (93.6%). Southeast region presented only five microcephaly notified cases. At least 27 of the confirmed cases evolved to death after birth or during pregnancy. At the end of 2016, the number of reported cases of the microcephaly increased to 10,867. Of these, 3183 (29.3%) remain under investigation and 7684 (70.7%) cases were investigated and classified, being 2366 confirmed, 49 probable and 5269 discarded. According to the geographical distribution, confirmed cases of the 10,867 reported are distributed in 751 Brazilian cities of the 27 Brazilian states, mainly in Northeast region (75.3%). The southeast region showed a large increase in the number of confirmed cases of microcephaly: 74 cases [38].

Due to this epidemiological situation of Zika viruses and its consequences, this disease is considered an Emergency in Public Health of National Importance (ESPIN). From week 45/2015 and until week 52/2017,there were 15,298 cases notified of suspected changes in growth and possibly related to infection with the Zika virus and other infectious etiologies, of which 2869 (18.8%) remained research until 2017, December. Of the total cases, 3071 (20.1%) were confirmed, 339 (2.2%) were classified as likely to be related to infection during pregnancy and 230 (1.5%) as inconclusive. The majority of cases reported is concentrated in the Northeast region of the country (60.6%), followed by the Southeast (23.9%) and Midwest region (7.3%). The five Brazilian states with the greatest number of reported cases are Pernambuco (16.8%), Bahia (16.3%), São Paulo (9.0%), Paraíba (7.3%) and Rio de Janeiro (7.3%) [39].

Figure 7. Cases of dengue, chikungunya and Zika fever in Brazil during 2015, 2016 and 2017.

Midwest and Southeast regions had the highest incidence: 1451.9 cases/100,000 inhabitants and 1205.7 cases/100,000 inhabitants, respectively. Among the states, Goiás (2500.6 cases/100,000 inhabitants) and São Paulo (1665.7 cases/100,000

The dengue fever incidence rate was about 733.4 cases/100,000 inhabitants in all Brazilian States at 2016. During this year, the midwest (1322.0/100,000 inhabitants) and the southeast (1001.2/100,000 inhabitants) regions have presented big-

In 2017, the midwest region had an incidence of 502.7 cases/100,000 inhabitants and the northeast region had 151.8 cases/100,000 inhabitants, most notably the states of Goiás with 947.3 cases/100.00 inhabitants, Ceará with 453.4/100,000

Figure 6 shows the total number cases of dengue in Brazilian regions during 2015–2017, mainly in the Southeast and Northeast regions, due to their characteris-

In 2015, 38,499 suspected chikungunya fever cases were registered in Brazil (Figure 6) which caused an incidence rate of 18.8 cases/100,000 inhabitants. These cases were distributed by 704 cities and 17,971 (46.7%) of them and 14 deaths were confirmed: 05 in Bahia, 02 in Sergipe and 07 in Pernambuco Brazilian states [35]. In 2016, the registered cases number increased significantly to 271,824 and the incidence rate was 133.0 cases/100,000 inhabitants. These cases were distributed in 2829 cities and 151,318 (55.7%) were confirmed. Once again, the northeast region had the highest incidence rate. Among the states were: Rio Grande do Norte (723.1 cases/100,000 inhabitants), Ceará (537.7 cases/100,000 inhabitants), Alagoas (514.8 cases/100,000 inhabitants) and Paraíba (503.0 cases/100,000 inhabitants). At the same year, 196 deaths caused by Chikungunya fever were confirmed [35]. In 2017, the registered cases number had a slight decrease with 185,737, and the incidence rate was 90.1 cases/100,000 inhabitants. However, there are 52,285 cases discarded. During this year, the Northeast region had the highest number of probable chikungunya fever cases (142,131 cases, 76.5%) in relation to the total of the country. Followed by the Southeast (22,984 cases, 12.4%), North (16,570 cases,

inhabitants) have presented the most incidence numbers [34].

inhabitants and Tocantins with 331.2/100,000 inhabitants [36].

8.9%), Midwest (3679 cases, 2.0%) and South (373 cases, 0.2%) [36].

tic climate aspects.

Malaria

Figure 6.

110

Total dengue cases within Brazilian regions at the last 3 years.

ger incidence numbers than the other geographic Brazilian regions [35].

Nowadays, the 542 microcephaly cases confirmed in Brazil between weeks 1 and 52/2017, 204 (37.6%) received care in childcare. The confirmed children were concentrated in the Southeast (183 cases). Attending in precocious stimulation was performed in 100 of the 542 (18.5%) of confirmed cases, while care in specialized care occurred in 184 of the 542 (33.9%) confirmed cases [39].

of dengue virus. In addition, it reduces severe cases—those that lead to death, such

Pending vaccine development, the measures recommended to prevent against mosquito bites and vector control consist of individual protection or action. Mosquito control is the best available method for preventing arboviruses infection. Breeding sites must be removed, destroyed, cleaned and treated with insecticides.

About the intervention against mosquitoes, mainly Aedes aegypti, the use of new

nanoparticles containing plant extracts and the essential oils from Zingiber officinale, Curcuma longa, Ocimum basilicum, and Mentha piperita which variety of types and levels of their actives constituents could be responsible for their potential to combat mosquitoes and have been shown to be promising and low-cost mosquitoes control

Other intervention, could be done such as using repellents with DEET, wear cloth which minimizes skin exposure to the day-biting vectors, stay in places with air conditioning, use domestic insecticides in aerosol form or in vaporizers within

The conventional methods such as insecticides and larval biological used until now revealed that control have proven ineffective at halting disease spreading [46, 47]. A successful system controlling a broad spectrum of approaches should be mutually compatible and encompass including the development of novel insecticides, transgenic disease-resistant mosquitoes, the release of sterile insects to suppress vector populations and equipment for preventing mosquito bites is to be

In Brazil, some new approaches to control mosquito have shown considerable promise in latest years are the biolarvicide Bti, the genetic control of A. aegypti mosquitoes and the development of mosquitoes that are resistant to arbovirus

Brazil was among the pioneers in adopting Bti to control mosquitoes and black flies. Developed by research groups in Brazilian institutions, this bacterial larvicide is highly toxic at very low doses to target organisms (mosquito and black flies larvae) and safe to other nontarget organisms. Larvicidal activity is due to large amounts of crystal proteins produced during sporulation and transformed into toxins under specific conditions after ingestion by larvae. The structure of the proteins made by the bacterium strain and the presence of proteolytic enzymes and receptor in the host larvae midgut determined the selectivity observed. Brazilian product showed some advantages such as reduction in the number of applications, formulation with high storage stability, no environmental impact and high persis-

tence in the environment and especially efficient in tropical climates [49].

One way to control mosquitoes is the genetic control strategy known as release of insects carrying dominant lethal genes (RIDL) which is an advancement of the

repellents and insecticides agents are investigated. Due to the development of resistance, biological magnification of toxic substances through the food chain, and others adverse effects on the environment and human health caused by the synthetic insecticides, eco-friendly agents control of mosquitoes vectors have a great importance to avoid dengue, Zika and chikungunya and others diseases transmitted by A. aegypti. By this way, so many natural products as plant extracts and essential

oils have been evaluated against larval and pupal stages of A. aegypti as

as hemorrhagic dengue—by 93% and hospitalization rates by 80%.

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

4.2 Repellents and larvicides

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

strategies [42–45].

the home.

developed [48].

infection [47].

113

4.3 Biological control of mosquitoes

Figure 7 shows the behavior of these three diseases in relation to the number of registered cases for the period 2015–2017.

These epidemiology data have demonstrated the incidence rates of the three arboviruses among 2015–2017. In 2016, the incidence of dengue cases has slightly decreased. In 2017, although the numbers of dengue have decreased, the cases of Zika and chikungunya increased, consequently the occurrence of accompany Zika diseases increases during the same period, mainly the microcephaly cases [35–39].

#### 4. Control and prevention

For residents in areas populated by the Aedes aegypti species, the most important preventative measure they can take is to remove standing water wherever possible to eliminate breeding sites. This species can breed in as little as one tablespoon of water, so every effort should be made to eliminate standing water in buckets, old tires, gutters, birdbaths, flower pots and more. Additionally, residents should protect themselves indoors with the use of air conditioning and properly maintained window screens and outdoors with the use of mosquito repellents containing DEET (N,N-diethyl-meta-toluamide) and loose fitting clothing [40]. At present, the control of dengue disease is mainly hampered by the absence of antivirals or a vaccine, which results in an estimated half worldwide population at risk of infection.

Currently, antiviral treatment against dengue is available, and the development of an effective anti-dengue vaccine would represent a cornerstone in public health. An important aspect of dengue is that an effective immunity can be potentially impaired during heterologous infections (refers to the immunity that can develop to one pathogen after a host has had exposure to nonidentical pathogens), which may lead to severe manifestations of dengue and represents a great burden in the development of a vaccine against this pathogen.

Due to the absence of an effective vaccine for these arboviruses, the control is still accomplished through the prevention and elimination of potential mosquitobreeding habitats. Thus, the use of chemical insecticides is yet the main vector control component. Alternative products, with potential to be used in the control of A. aegypti, including the biolarvicide Bti (Bacillus thuringiensis var. israelensis) and some insect growth regulators are also being used recently [41].

#### 4.1 Vaccination

It is widely recognized that passive vaccination is the most appropriate preventive and therapeutic option but till now no vaccine is available for Zika and chikungunya although some initiative to the development of a vaccine have been tested. Several vaccine approaches have been used such as inactivated viral vaccines, live-attenuated viruses, recombinant subunit vaccines, DNA vaccination and others. In Brazil, a live-attenuated viruses vaccine developed by Sanofi Pasteur laboratory has been available since 2016. It is sold in private clinics and is part of vaccination pilot public programs in Paraná state. The product requires three applications with an interval of 6 months between them. In the early studies, the efficacy in the population above 9 years old is approximately 66% against the four serotypes

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

of dengue virus. In addition, it reduces severe cases—those that lead to death, such as hemorrhagic dengue—by 93% and hospitalization rates by 80%.

Pending vaccine development, the measures recommended to prevent against mosquito bites and vector control consist of individual protection or action. Mosquito control is the best available method for preventing arboviruses infection. Breeding sites must be removed, destroyed, cleaned and treated with insecticides.

#### 4.2 Repellents and larvicides

Nowadays, the 542 microcephaly cases confirmed in Brazil between weeks 1 and

Figure 7 shows the behavior of these three diseases in relation to the number of

For residents in areas populated by the Aedes aegypti species, the most important preventative measure they can take is to remove standing water wherever possible to eliminate breeding sites. This species can breed in as little as one tablespoon of water, so every effort should be made to eliminate standing water in buckets, old tires, gutters, birdbaths, flower pots and more. Additionally, residents should protect themselves indoors with the use of air conditioning and properly maintained window screens and outdoors with the use of mosquito repellents containing DEET (N,N-diethyl-meta-toluamide) and loose fitting clothing [40]. At present, the control of dengue disease is mainly hampered by the absence of antivirals or a vaccine, which results in an estimated half worldwide population at risk of infection.

Currently, antiviral treatment against dengue is available, and the development of an effective anti-dengue vaccine would represent a cornerstone in public health. An important aspect of dengue is that an effective immunity can be potentially impaired during heterologous infections (refers to the immunity that can develop to one pathogen after a host has had exposure to nonidentical pathogens), which may lead to severe manifestations of dengue and represents a great burden in the devel-

Due to the absence of an effective vaccine for these arboviruses, the control is still accomplished through the prevention and elimination of potential mosquitobreeding habitats. Thus, the use of chemical insecticides is yet the main vector control component. Alternative products, with potential to be used in the control of A. aegypti, including the biolarvicide Bti (Bacillus thuringiensis var. israelensis) and

It is widely recognized that passive vaccination is the most appropriate preven-

tive and therapeutic option but till now no vaccine is available for Zika and chikungunya although some initiative to the development of a vaccine have been tested. Several vaccine approaches have been used such as inactivated viral vaccines, live-attenuated viruses, recombinant subunit vaccines, DNA vaccination and others. In Brazil, a live-attenuated viruses vaccine developed by Sanofi Pasteur laboratory has been available since 2016. It is sold in private clinics and is part of vaccination pilot public programs in Paraná state. The product requires three applications with an interval of 6 months between them. In the early studies, the efficacy in the population above 9 years old is approximately 66% against the four serotypes

some insect growth regulators are also being used recently [41].

These epidemiology data have demonstrated the incidence rates of the three arboviruses among 2015–2017. In 2016, the incidence of dengue cases has slightly decreased. In 2017, although the numbers of dengue have decreased, the cases of Zika and chikungunya increased, consequently the occurrence of accompany Zika diseases increases during the same period, mainly the microcephaly cases [35–39].

52/2017, 204 (37.6%) received care in childcare. The confirmed children were concentrated in the Southeast (183 cases). Attending in precocious stimulation was performed in 100 of the 542 (18.5%) of confirmed cases, while care in specialized

care occurred in 184 of the 542 (33.9%) confirmed cases [39].

registered cases for the period 2015–2017.

opment of a vaccine against this pathogen.

4.1 Vaccination

112

4. Control and prevention

Malaria

About the intervention against mosquitoes, mainly Aedes aegypti, the use of new repellents and insecticides agents are investigated. Due to the development of resistance, biological magnification of toxic substances through the food chain, and others adverse effects on the environment and human health caused by the synthetic insecticides, eco-friendly agents control of mosquitoes vectors have a great importance to avoid dengue, Zika and chikungunya and others diseases transmitted by A. aegypti. By this way, so many natural products as plant extracts and essential oils have been evaluated against larval and pupal stages of A. aegypti as nanoparticles containing plant extracts and the essential oils from Zingiber officinale, Curcuma longa, Ocimum basilicum, and Mentha piperita which variety of types and levels of their actives constituents could be responsible for their potential to combat mosquitoes and have been shown to be promising and low-cost mosquitoes control strategies [42–45].

Other intervention, could be done such as using repellents with DEET, wear cloth which minimizes skin exposure to the day-biting vectors, stay in places with air conditioning, use domestic insecticides in aerosol form or in vaporizers within the home.

The conventional methods such as insecticides and larval biological used until now revealed that control have proven ineffective at halting disease spreading [46, 47]. A successful system controlling a broad spectrum of approaches should be mutually compatible and encompass including the development of novel insecticides, transgenic disease-resistant mosquitoes, the release of sterile insects to suppress vector populations and equipment for preventing mosquito bites is to be developed [48].

In Brazil, some new approaches to control mosquito have shown considerable promise in latest years are the biolarvicide Bti, the genetic control of A. aegypti mosquitoes and the development of mosquitoes that are resistant to arbovirus infection [47].

Brazil was among the pioneers in adopting Bti to control mosquitoes and black flies. Developed by research groups in Brazilian institutions, this bacterial larvicide is highly toxic at very low doses to target organisms (mosquito and black flies larvae) and safe to other nontarget organisms. Larvicidal activity is due to large amounts of crystal proteins produced during sporulation and transformed into toxins under specific conditions after ingestion by larvae. The structure of the proteins made by the bacterium strain and the presence of proteolytic enzymes and receptor in the host larvae midgut determined the selectivity observed. Brazilian product showed some advantages such as reduction in the number of applications, formulation with high storage stability, no environmental impact and high persistence in the environment and especially efficient in tropical climates [49].

#### 4.3 Biological control of mosquitoes

One way to control mosquitoes is the genetic control strategy known as release of insects carrying dominant lethal genes (RIDL) which is an advancement of the

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 mosquito populations [53].

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

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

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

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 occu-

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

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

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,

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

to the promotion of health and quality of life of the population [59].

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

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

of research.

6. Conclusion

115

in Brazil: chikungunya and Zika.

10 million eggs of the mosquito per week.

pied by approximately 2.5 million people.

epidemiological surveillance and prevention of new cases.

possibilities to generate knowledge and developing technologies.

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 measure to prevent a dengue outbreak [54].

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 aegypti.

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