Brasil Destaques

Brasil está sentado em ‘bomba-relógio’, diz especialista sobre febre amarela

Após alta em número de casos suspeitos notificados no interior de Minas Gerais, que levaram a 14 mortes desde o início do ano, pesquisadores temem risco de doença chegar a centros urbanos.


A bióloga Marcia Chame explica que macacos são uma espécie de 'sentinela', cujas mortes avisam humanos sobre a proximidade de um surto (Foto: Aquivo pessoal)A bióloga Marcia Chame explica que macacos são uma espécie de 'sentinela', cujas mortes avisam humanos sobre a proximidade de um surto (Foto: Aquivo pessoal)

A bióloga Marcia Chame explica que macacos são uma espécie de ‘sentinela’, cujas mortes avisam humanos sobre a proximidade de um surto (Foto: Aquivo pessoal)

O aumento de casos de febre amarela silvestre (transmitida em regiões rurais e de mata) em Minas Gerais pode ser um surto cíclico da doença, como o já observado em 2009. Mesmo assim, o país corre risco de ver um retorno dela às áreas urbanas, avaliam pesquisadores.

Desde o início de janeiro, 23 casos suspeitos foram notificados no interior de Minas Gerais – 14 deles levaram à morte dos pacientes. Segundo a Secretaria de Saúde do Estado, 16 deles são considerados prováveis, após exames apontarem a presença do vírus, mas ainda estão sendo investigados.

No interior de São Paulo, uma morte foi confirmada como causada pela febre amarela silvestre em dezembro, a primeira desde 2009.

“Já esperávamos um surto maior da febre amarela silvestre, mas devemos nos preocupar, sim. Estamos sentados em uma bomba-relógio”, disse à BBC Brasil o epidemiologista Eduardo Massad, da USP.

“Precisamos entender o risco de reintrodução de febre amarela urbana, o que seria uma enorme tragédia, talvez maior do que zika, dengue e chikungunya juntas – porque ela mata quase 50% das pessoas que não são tratadas.”

Especialistas temem que vírus chegue às cidades, onde poderia ser espalhado pelo Aedes aegypti, também transmissor de doenças como a dengue e a zika (Foto: Paulo Whitaker/Reuters)Especialistas temem que vírus chegue às cidades, onde poderia ser espalhado pelo Aedes aegypti, também transmissor de doenças como a dengue e a zika (Foto: Paulo Whitaker/Reuters)

Especialistas temem que vírus chegue às cidades, onde poderia ser espalhado pelo Aedes aegypti, também transmissor de doenças como a dengue e a zika (Foto: Paulo Whitaker/Reuters)

A febre amarela é considerada endêmica nas regiões rurais e de mata do Brasil, onde é transmitida por mosquitos de espécies diferentes, como o Haemagogus e o Sabethes, para macacos e, ocasionalmente, para humanos não vacinados. Mas não há registro de casos em áreas urbanas – onde o vetor é o mosquito Aedes aegypti – desde 1942.

O Ministério da Saúde notificou a OMS (Organização Mundial da Saúde) dos casos, seguindo recomendação do Regulamento Sanitário Internacional de informar à organização ocorrências importantes de saúde pública.

Em 2016, o Brasil teve seis casos da doença confirmados, segundo o governo. O último surto da febre amarela silvestre ocorreu entre 2008 e 2009, quando 51 ocorrências foram confirmadas.

A pasta também afirmou que enviou duas equipes e cerca de 285 mil doses de vacina contra a febre amarela para Minas Gerais para controlar a doença. Pessoas nas áreas onde há registro de casos serão vacinadas, e, em seguida, moradores de municípios vizinhos.

Em sua fase inicial, que dura de três a cinco dias, a febre amarela causa calafrios, febre, dores de cabeça e no corpo, cansaço, perda de apetite, náuseas e vômitos. Em sua fase mais grave, a doença provoca hemorragias e insuficiência nos rins e no fígado, o que pode levar à morte.

Macacos

Atualmente, 15 municípios mineiros estão em situação de alerta para a febre amarela. Também estão sendo monitoradas cidades onde ainda não houve casos em humanos, mas que registraram mortes de macacos possivelmente causadas pela doença.

O monitoramento ocorre normalmente no Brasil todos os anos, especialmente entre dezembro e maio, considerado o período de maior probabilidade de transmissão da febre amarela.

A bióloga Marcia Chame, coordenadora da Plataforma Institucional de Biodiversidade e Saúde Silvestre na Fiocruz Rio, diz que as autoridades de saúde no Brasil já haviam percebido que os surtos extravasam o ambiente das florestas aproximadamente a cada sete anos e atingem mais seres humanos no interior do país.

MG registra 14 mortes por febre amarela

“Este surto maior é cíclico e, por isso, já há atenção sobre isso. Isso tem relação com todas as atividades humanas que invadem a floresta. E no Brasil também temos um processo importante de perda de ambientes naturais”, disse à BBC Brasil.

Segundo ela, o aumento das mortes de macacos – principais hospedeiros do vírus no ciclo de transmissão silvestre – é o principal indicativo de que o surto pode estar se aproximando das populações humanas.

“Desde 1940 não temos ciclos, no Brasil, de transmissão deste vírus pelo Aedes aegypti, só pelo Haemagogus. A morte de macacos perto de pessoas mostra que um ciclo que deveria estar limitado ao ambiente das matas está mais perto das áreas onde vivem humanos. E quando eles estão próximos, é mais fácil para o mosquito passar o vírus para uma pessoa”, explica.

“Em 2009, no Rio Grande do Sul, as pessoas chegaram a matar os macacos, achando que eles transmitiam a doença, mas ele nos presta um serviço, porque é o sentinela. É importante notificar as autoridades dessas mortes.”

Na Fiocruz, a equipe liderada por Chame tenta entender o que causa esses surtos de maior proporção na tentativa de evitar, também, que o vírus volte às cidades.

“Estamos modelando a ocorrência de febre amarela contra 7,2 mil parâmetros ambientais, climatológicos e outros, para tentarmos identificar que variáveis que causam isso, mas é muito complexo”, explica.

“Elas acontecem em ambientes diferentes, com espécies de macacos e de mosquitos vetores diferentes. Precisamos que a população nos ajude a identificar esses animais e o que está ao redor dos locais onde são encontrados – empreendimentos imobiliários, construções.”

O receio, diz ela, é que com a diminuição das áreas florestais, animais que foram infectados frequentem cada vez mais os centros urbanos em busca de alimento e abrigo. Lá, eles também poderiam ser picados pelo Aedes aegypti, abundante nas cidades brasileiras.

Retorno

Atualmente, o Ministério da Saúde recomenda que todas as pessoas que moram ou têm viagem planejada para áreas silvestres, rurais ou de mata verifiquem se estão vacinadas contra a febre amarela. Em geral, a vacina passa a fazer efeito após um período de dez dias.

O risco de que moradores de áreas endêmicas e até ecoturistas contraiam o vírus e o levem para cidades maiores é a principal preocupação dos especialistas. Na verdade, eles ainda tentam descobrir por que isso não ocorreu até agora.

“Ainda é um desafio entender como a febre amarela não voltou para os centros urbanos, já que temos um grande número de pessoas que vão a áreas endêmicas para turismo ou a trabalho e voltam para cidades infestadas de Aedes aegypti”, diz Eduardo Massad.

O médico e pesquisador Carlos Brito, da Universidade Federal de Pernambuco (UFPE), concorda. “Dizemos que a febre amarela só não voltou ainda às cidades porque Deus é brasileiro. É uma preocupação real.”

Os pesquisadores tentam compreender se o Aedes aegypti teria, por exemplo, menos competência como vetor da febre amarela do que da dengue, da chikungunya e da zika, outros vírus da mesma família.

“Hoje os deslocamentos de pessoas pelo país são muito mais rápidos. Por isso, estes vírus se disseminam com mais facilidade. O fato de a febre amarela ainda não ter se disseminado no país todo é um alento, que dá expectativa de que não aconteça o mesmo que ocorreu com zika e chikungunya nos últimos dois anos”, afirma Brito.

“Mas uma coisa é fato: se em 30 anos de dengue batemos recordes de números de casos em 2015 e em 2016, não é porque a população brasileira cresceu. Isso mostra que perdemos o controle do mosquito.”

Vacina

O Ministério recomenda a vacina para pessoas a partir de nove meses de idade que vivem nas áreas endêmicas ou viajarão para lá e a partir dos seis meses, em situações de surto.

Segundo a pasta, todos os Estados estão abastecidos com a vacina e o país tem estoque suficiente para atender a todas as pessoas nestas condições.

Para Massad, no entanto, o governo deveria elaborar uma estratégia para ampliar a vacinação contra a febre amarela em todo o país, incluindo as zonas costeiras, onde estão alguns dos maiores centros urbanos, que não são consideradas endêmicas.

De acordo com o ministério, apenas os Estados de Ceará, Rio Grande do Norte, Paraíba, Pernambuco, Alagoas, Sergipe, Espírito Santo e Rio de Janeiro estão fora da Área com Recomendação para Vacinação (ACRV) de febre amarela.

Mas enquanto ainda não se explica como o vírus se manteve fora das cidades durante os últimos 75 anos – mesmo com o aumento da infestação pelo Aedes aegypti – o pesquisador continua preocupado.

“A probabilidade de levar uma picada de Aedes aegypti no Rio durante o Carnaval é 99,9%. É inescapável. As pessoas ficaram preocupadas com Olimpíada, Copa do Mundo. Isso é besteira. Imagine se chega alguém com febre amarela no Rio no Carnaval.”

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