HIV/AIDS

From 1980 to June 2018, 926,742 HIV positive cases were identified in Brazil, with an annual record of 40,000 new cases. In 2012, detection rate was 21.7 cases per 100 thousand inhabitants, whereas in 2017, detection rate was 18.3, representing a decrease of 15.7%. In four years, there was also a decrease of 16.5% in the mortality rate from the disease, from 5.7 per 100 thousand inhabitants in 2014 to 4.8 deaths in 2017.  Around 73% of new HIV infections occur among males, 70% of whom are aged between 15 and 39 years (Brazilian Ministry of Health, 2018f). Such decline might be related to more accessible treatment for all, better diagnosis rates, reduced time between diagnosis and start of treatment, and better access to testing (Brazilian Ministry of Health, 2018f).

Tuberculosis

In 2017, 69,569 new cases of tuberculosis were reported in Brazil. Incidence rate equalled 33.5 cases per 100 thousand inhabitants. From 2008 to 2017, this coefficient showed an annual average decrease of 1.6%. In 2016, 4,426 deaths from tuberculosis were recorded, resulting in a mortality rate equal to 2.1 deaths per 100 thousand inhabitants, reflecting an annual average decrease of 2.0% from 2007 to 2016. The distribution of both indicators was heterogeneous by regions, states, and capitals. However, the tuberculosis situation in the capitals of the country requires attention, since 70.4% of them (19 capitals) had an incidence rate higher than that recorded in the entire country. The highest mortality rates in 2016 were recorded in the north and northeast cities -in Recife (6.4 per 100 thousand inhabitants), Belém (5.3 per 100 thousand inhabitants) and Manaus (4.7 per 100 thousand inhabitants) (Brazilian Ministry of Health, 2018c), possibly given to lower socioeconomic status in these cities. In 2017, 13.347 relapse cases/treatment were registered in the country, equivalent to 16.1% of total cases reported in the period. The states with the highest proportion of retreatments were Rio Grande do Sul (23.3%), Rondônia (19.9%) and Paraíba (19.5%). This result is similar to that observed in the capitals, among which the highest proportion of retreatment was recorded in Porto Alegre (31.2%), Campo Grande (25.8%), João Pessoa (23.8%) and Porto Velho (23.3%) (Brazilian Ministry of Health, 2018c).

Dengue /Zika Virus/ Chikungunya

Brazil faces epidemic levels of mosquitoes-transmissible diseases (e.g. Aedes aegypti), such as dengue, zika virus, yellow fever and chikungunya, all of which take a great proportion of financial and human resources in the primary, secondary and tertiary care sectors in Brazil, in both private and public health services. According to a report published in March 2019 by the Ministry of Health comparing the epidemiological situation of dengue, chikungunya and zika in 2018 and in 2019, the number of cases with such diseases has increased considerably, as per information below (Brazilian Ministry of Health, 2019f).

Dengue: In 2019 (up to week 11), there were 229,064 probable cases of dengue in the country, with an incidence rate of 109.9 cases per 100 thousand inhabitants. In the same period of 2018, there were 62,904 probable cases. The South-Eastern region had the highest number of probable cases (149,804 cases, 65.4%) in relation to the country rates, followed by the Midwest (40,336 cases, 17.6%), the North (15,183 cases, 6.6%), the Northeast (17,137 cases, 7.5%) and the South (6,604 cases, 2.9%). The incidence rate of probable dengue cases (per 100 thousand inhabitants) up to week 11 of 2019 shows that the Centre-West and Southeast regions had the highest incidence rates: 250.8 cases per 100 thousand inhabitants and 170.8 cases per 100 thousand inhabitants, respectively (Brazilian Ministry of Health, 2019f).

Chikungunya: In 2019 (until week 11), there were 12,942 probable cases of chikungunya in the country, with an incidence rate of 6.2 cases per 100 thousand inhabitants. At the same week of 2018, 23,484 probable cases were registered. In 2019, the Southeast region had the highest number of probable cases of chikungunya (8,536 cases, 66.0%) in relation to the total of the country. The North (2,139 cases, 16.5%), the Northeast (1,786 cases, 13.8%), the Central Region (293 cases, 2.3%) and the South (188 cases, 1.5%). The incidence rate of probable cases of chikungunya in 2019 shows that the North and the Southeast regions had the highest incidence rates: 11.8 cases per 100 thousand inhabitants and 9.7 cases per 100,000 inhabitants, respectively (Brazilian Ministry of Health, 2019f).

Zika virus: In 2019 (until September 9), 2,062 probable cases of Zika were registered in the country, representing an incidence rate of 1 case per 100 thousand people. During the same period of 2018, 1,908 probable cases had been registered. In 2019, the northern region has had the highest number of probable cases (912 cases, 44.2%) in relation to the country’s total figures – the Southeast: 584 cases, 28.3%; the Midwest: 176 cases, 8.5%; the Northeast: 343 cases, 16.6%; the South: 47 cases, 2,3 %. The incidence rate of probable Zika cases shows that the Northern region has had the highest incidence rate: 5 cases per 100 thousand inhabitants. Among the UFs, Tocantins (47 cases per 100 thousand inhabitants) and Acre (9.5 cases per 100 thousand inhabitants) have had the highest numbers (Brazilian Ministry of Health, 2019f).

Yellow fever: With regards to yellow fever, between January and May 2019, 68 cases were confirmed in the state of São Paulo, 12 in Paraná and one case in Santa Catarina (total=81 cases). The majority of the cases were among rural workers and/or among people with higher exposure to the mosquitos, of which 72 (88.9%) were males, aged between eight and 87 years. Among the confirmed cases, 14 led to death (17.3%). The total number of human cases recorded in the same period of 2018 was 1,309, showing an important decrease in the number of cases in the country (Brazilian Ministry of Health, 2018d).

Influenza: Brazil has also epidemic periods of influenza, which the country has been trying to control through vaccination and education (e.g. hand washing). It affects mostly vulnerable populations such as babies, pregnant women, older adults, health professionals, carers, bed-bound people, and people with potentially compromised immune systems – HIV, cancer, lupus, etc.). Brazil has a national online system for compulsory registration of Influenza cases (SINAN, 2019).

References:

Brazilian Ministry of Health. (2016b). Panorama da tuberculose no Brasil: A mortalidade em números.

Brazilian Ministry of Health. (2018c). Implantação do Plano Nacional pelo Fim da Tuberculose como Problema de Saúde Pública no Brasil: Primeiros passos rumo ao alcance das metas (Vol. 49).

Brazilian Ministry of Health. (2018d). Monitoramento do Período Sazonal da Febre Amarela Brasil – 2017/2018 (Issue Figura 1).

Brazilian Ministry of Health. (2018f). Pará está entre os estados com redução de óbitos por AIDS. Ministério Da Saúde.

Brazilian Ministry of Health. (2019f). Monitoramento dos casos de arboviroses urbanas transmitidas pelo Aedes (dengue, chikungunya e Zika) até a Semana Epidemiológica 11 de 2019 (Vol. 50, Issue Tabela 1).

SINAN. (2019). Sistema de Informação de Agravos de Notificação. http://www.portalsinan.saude.gov.br/