Novos pressupostos para o saneamento no controle de arboviroses no Brasil

Abstract

Cad. Saúde Pública 2020; 36(4):e00233719 Arbovirus infections such as dengue, Zika, and chikungunya cause pain and suffering in the population and overload the health systems. Recent outbreaks have exposed the vulnerability of prevention and control measures for these arbovirus infections. Thus, the complexity of arboviruses has increased as susceptible population groups emerge in different geographic areas 1,2,3,4,5. In 2019, a total of 1,544,987 cases of dengue, 132,205 of chikungunya, and 10,768 of Zika were reported in Brazil. There were 782 confirmed deaths from dengue, 92 from chikungunya, and three from Zika 6. The high incidence rates of arbovirus infections transmitted by Aedes mosquitoes in recent years in Brazil may be associated with deficiencies in the water supply 7 , whether caused by extreme droughts, inadequate management of water utilities, or deficient public policies, and probably by the combination of these factors. The high rates may also be related to inadequate access to other components of sanitation, such as sewage disposal, solid waste disposal, and storm drainage. Although Brazil has legislation on processes providing for universalization of sanitation services, notably the National Plan for Basic Sanitation (PLANSAB), coverage of running water supply and sewage disposal is still incipient. If planning takes the premises of the Human Right to Water and Sanitation (HRWS) into account in the elaboration and implementation of public policies, such policies become more egalitarian and contribute to the promotion of health for vulnerable populations. Importantly, the way the territory is organized defines relations with the environment and thus influences the emergence of diseases. It is thus necessary to observe each territory with its specifici-ties and to locate, as precisely as possible, where and how the diseases are occurring, which services the population needs, the areas of potential health and environmental risks, and the areas where the vulnerable social situations are located 8. In this context, sanitation services can be an important determinant of the incidence and prevalence of arbovirus infections, while such services have been neglected in disease control strategies. The implementation of services has not been oriented from the HRWS perspective, which provides for important instruments to analyze the territory's real situation, pointing to guidelines for planning. We thus present three premises for debate on the relationship between arbovirus infections and the supply of sanitation services, considering the inclusion of HRWS premises as an important element for the control of these diseases.