Amid an increase of more than 100% in probable dengue cases in Brazil in the first two weeks of 2024 compared to 2023, the federal government announced the arrival of 750,000 vaccines to start an immunization campaign in the country.
The Ministry of Health announced this Thursday (25) that it will begin applications in 521 municipalities in 16 states and the Federal District from February.
The ministry’s forecast is that, by the end of 2024, the government will receive a quantity of vaccines capable of immunizing 3.2 million Brazilians aged 10 to 14 with the two doses necessary for the complete cycle – respecting an interval of three months between them.
The government does not yet have a forecast of when it will begin immunizing other age groups of the population.
The federal government based itself on three criteria to define vaccination points: cities with more than 100,000 inhabitants, with high dengue transmission in 2023 and 2024 and with a greater predominance of the DENV-2 serotype, or dengue subtype 2.
This serotype is one of four in circulation in the country and against which the vaccine had the best result.
But can people with health insurance get vaccinated at a private clinic and request reimbursement? And what is the forecast for vaccinating adults?
The National Supplementary Health Agency (ANS) reported this Wednesday (24) that Brazil has 51,081,018 health plan users.
In a note, the ANS stated that health plans are not obliged to cover vaccines, but that some contracts include immunizations.
“If the beneficiary has a health plan with coverage of additional services that includes vaccines, they must check with their operator whether there is coverage for dengue immunization,” says the text.
Explosion of dengue cases
The number of probable dengue cases more than doubled in the first two weeks of 2024, compared to the same period in 2023.
55,859 probable cases of dengue were registered in the first half of 2024 compared to 26,801 in the previous period. There was a drop, however, in the number of deaths: there were six this year and 17 last year.
The report found several clinics that already offer the Qdenga vaccine, manufactured by the Takeda laboratory, even before the federal government began using it. The values, identified by the report per dose applied in the city of São Paulo, range from R$349 to R$428.
When contacted, the Consumer Protection and Defense Foundation (Procon-SP) reinforced that health plans are not obliged to cover the application of vaccines. For this reason, says the agency, it is generally not possible to request reimbursement for this type of procedure.
The agency warns, however, that consumers should be aware of exceptions, as some contracts provide for this type of reimbursement.
“Agreements can choose whether or not to offer the service”, says Procon.
Marcos Novais, executive superintendent of the Brazilian Association of Health Plans (Abramge), says that most health plans choose not to reimburse or offer the vaccine because this is a universal need.
“If the health plan were to cover the vaccine, in practice, it is the same as paying for it. If I am covering the vaccine, I am charging you. And I would still be charging you more than once because there is an annual turnover of 30% of beneficiaries. So you would be vaccinating people who enter and leave the agreement all the time”, he explains.
He states that, when there is an expense that 100% of the population will need to have access to, such as vaccines, the health plan loses its functionality.
“Hospitalization for dengue is not 100% certain that it will happen. The vaccine is 100% certain that you will use it. In practice, you will charge everyone. [Nos planos de saúde]everything goes through statistics and probability”, he says.
Novais explains that some operators cover vaccines because many companies decide to pay more for this service to prevent their employees from being absent for medical reasons.
The Abramge superintendent also says that vaccines cost more in the private network because their negotiating power with manufacturers is lower than that of the government.
“The government has a lot of negotiating power. The clinics pay much more and, due to the turnover in their portfolios, they will vaccinate a lot of people.”
“And those who are in this supplementary health system will pay this bill several times. This is a type of coverage that does not make sense to be covered by health plans”, says Novais.
Who can take it?
The dengue vaccine, known as Qdenga, was incorporated into the National Immunization Program (PNI) by the Ministry of Health, and is expected to begin being offered free of charge from February.
Doses can be taken by people aged 4 to 60 – there are no studies to evaluate the effectiveness and safety of the vaccine outside this age group.
Both those who have already had dengue and those who have never been infected can receive the vaccine.
Pregnant women, breastfeeding women, people allergic to any of the components present in the vaccine, anyone with a compromised immune system or any immunosuppressive condition cannot be vaccinated.
What level of protection does the dengue vaccine offer?
The vaccine contains live attenuated dengue viruses, which have been weakened in a controlled manner.
This technique allows you to trigger an effective immune response without causing full-blown disease. In the future, this allows the body to react more quickly in cases of actual exposure to the disease.
Dengue has four serotypes, and when someone is infected by one of them, they acquire immunity against that specific type – but are still susceptible to the others.
Although the company responsible for the vaccine has announced an overall efficacy of 80%, this percentage encompasses the results of all serotypes.
When analyzing them individually, the effectiveness of the immunizer varied for each serotype.
18 months after the second dose, for type 1, the rate was 69.8%. For dengue 2, there was the best result, 95.1%, and for subtype 3, the least satisfactory, 48.9%.
Regarding subtype 4, Takeda told BBC News Brasil that the number of cases tested was not high enough to reach a conclusion.
Felipe Naveca, public health researcher at Fiocruz, highlights that the reduced effectiveness against subtype 3 and the lack of data for subtype 4 are challenges for the immunizer administered to a large number of people.
As a backdrop, there is the resurgence of both variants of dengue in Brazil after a prolonged period without new cases in the country – 15 years without cases of dengue 3 and five years without cases of dengue 4.
“We have a significant portion of the population aged up to 15 who have not been exposed, mainly to dengue 3, which last appeared in 2008. This makes them susceptible to infection by this virus”, says Naveca, who coordinates arbovirus and emerging virus laboratories. from Fiocruz.
Serotypes 3 and 4 do not necessarily cause more serious conditions.
In dengue, the severity of the disease is associated with secondary infection – that is, a person who has had dengue for the first time, of any serotype, runs a greater risk of developing a more severe form when infected again.
Therefore, for those who are getting vaccinated, it is important to consider the lesser protection when the secondary infection is due to dengue 3 or 4. The experts interviewed by the report say that, even so, the vaccine is essential to avoid serious cases and reduce the risk of death. when contracting the disease.
The researcher highlights the good efficacy of the new vaccine against dengue 1 and 2 and the possibility of it reducing the risks of a second infection with the disease, especially for populations living in endemic areas.
How to prevent dengue?
The vaccine is one of the most effective ways to prevent infection with the disease, but as the doses are not sufficient for the entire population and not all groups will be able to take the vaccine, prevention remains.
To achieve this, the infestation of mosquitoes that transmit dengue fever must be reduced by eliminating breeding sites: avoid stagnant water and keep reservoirs or any place that can accumulate water covered with screens or lids.
Additionally, there are forms of individual protection such as using repellent.