A pandemia da covid-19 e seus efeitos no programa de vigilância da dengue em município da região metropolitana de Belo Horizonte, Minas Gerais, Brasil

Abstract

Public Health Emergencies of International Concern (PHEIC) are extraordinary and worrying events regarding public health, for their impact in mortality and morbidity rates and possible secondary consequences on local endemics. The COVID-19 PHEIC had more than 460 million confirmed cases and more than 6 million deaths, since its inception until March 17, 2022, in the six regions where the World Health Organization operates. It is necessary to consider the COVID-19 effects on national efforts in the fight against dengue, considered an important public health problem in Brazil and the urban arbovirus of greatest epidemiological relevance in Latin America. Thus, a systematic literature review on the effects of all PHEIC on the control and surveillance of notifiable diseases and an ecological study of the effects of COVID-19 on dengue control were conducted. Through the electronic databases of the Virtual Health Library of the Ministry of Health (BVS), Latin American and Caribbean Literature on Health Sciences (LILACS,) PubMed (Medical Literature Analysis and Retrieval System Online - Medline), Scientific Electronic Library Online (SciELO) and gray literature (Google Scholar), 3,209 studies were selected, of which 31 met the inclusion criteria and were described in the present review. The studies addressed the impacts of H1N1, Ebola, Zika virus associated with congenital malformations and COVID-19 on indicators of local endemics and health services, such as malaria, HIV/AIDS, congenital neuropathies, dengue, polio, and measles. In general, local populations suffered from the decrease in coverage and access of health systems, impacting various aspects of public health. The main factors related to the results were the closing of facilities, difficulties in transportation and laboratory logistics, low stocks and distrust of the population. In addition, an ecological study was carried out using secondary data provided by the Health Department of the Municipality of Contagem, located in the Metropolitan Region of Belo Horizonte, Minas Gerais. The year of 2020 had an atypical start, with dengue notifications above the threshold of non-epidemic years, however, there was an early drop in the 11th epidemiological week, coinciding with the increase in COVID-19 cases (r = -0.4743; 95%CI -0.6646 to -0.2263; p = 0.0003). In addition, there was a reduction in vector control in 2020, due to the Aedes aegypti Rapid Infestation Index Survey suspension, along with a significant decrease (p < 0.05) in the installation of ovitraps, as well as focal treatment and application of larvicide. The population’s refusal to receive municipal agents of endemics increased. Despite the obvious need of controlling a PHEIC, the overload of resources and attention from health authorities can lead, over time, to a weakening of health systems, causing the population to lose years of healthy life. The observed results corroborate to the hypothesis of weakening of control and surveillance programs and possible underreporting of dengue cases as a result of the COVID-19 emergency. It is hoped that understanding the consequences of dealing with a health crisis amidst a scenario of endemicity for other infectious diseases can be applied to different realities that present similar contexts.