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Article: What kills in dengue fever?


Rivaldo Venâncio da Cunha, Lucia Teresa Côrtes da Silveira and André Machado de Siqueira*


During dengue epidemics, the resulting deaths, with rare exceptions, are avoidable. Dengue does not kill. What kills is the lack of care and attention to the signs of worsening that can appear, especially when the fever disappears. This neglected moment leads to avoidable serious cases and deaths.

Most of the avoidable deaths from dengue are the result of several errors, three of which stand out. The first is when patients or their families underestimate the potential seriousness of the illness, so they do not seek care at a health facility in time.

The second is when patients or their families are aware of the seriousness of the disease, and seek care at a health facility but, unfortunately, are not seen. When they arrive, they find the unit disorganized, with improvised reception and risk classification, thus causing long queues and delays in the service.

Due to the long hours of waiting, often without success in obtaining care, patients give up and return home. A situation that represents a loss of opportunity for proper guidance or intervention, which could save lives.

Many states facing epidemics in 2024 also recorded high incidence rates in 2023, indicating there was enough time to organize the healthcare network.

The third, and probably most common, type of error is that in which patients or their families are aware of the potential seriousness of the illness, seek out a health facility and, with greater or lesser delay, are seen. However, the presence of clinical signs of alarm or severity is not noticed by the team seeing them, so advise them to go home. A day or two later, they will return to the health facility with their clinical condition already deteriorated, often irreversibly. The outcome would have been different if the patient had been better assessed and kept in an observation bed or hospitalized, with ongoing intravenous hydration until the clinical signs of severity were overcome.

Investigating deaths and defining which of the three factors are involved is essential to correct and adapt local strategies so that we no longer have avoidable deaths.

When the health care network is disorganized, frontline professionals lack the structure or training to properly classify or stage the risk of patients who come to the facility. It is essential to organize the entry points well in advance.

In this initial care, timely classification according to the severity of the dengue clinical condition is fundamental to identify patients with signs of alarm or severity, special clinical conditions, social risk, or comorbidities, which can increase the severity of the disease or signal the need for differentiated care.

In the organization of entry points, multi-professional action is decisive in changing this situation. Nurses have an essential role in the first stages of patient care, when they can carry out timely risk staging, request a blood count and start intravenous hydration immediately when indicated.

Contingency plans and response actions to dengue epidemics lie under the governance of the states and municipalities, which, knowing their territories and the specificities of their healthcare network, can more efficiently and safely organize the care.


*Rivaldo Venâncio da Cunha is an infectious disease physician and researcher at Fiocruz; Lucia Teresa Côrtes da Silveira is a physician and researcher at the Teaching and Research Group on Emergency and Health in Disasters (Gepesed/UFRJ); André Machado de Siqueira is an infectious disease physician and researcher at the Evandro Chagas National Institute of Infectious Diseases (INI/Fiocruz).

** This article was originally published at O Globo.

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