Dengue: Bauru tem metade dos agentes recomendados pelo Ministério da Saúde

Dos 121 Agentes de Combate a Endemias na cidade, 45 trabalham para controlar a epidemia de dengue; repasse federal cobre até 219 profissionais

Reportagem publicada em 18 de janeiro de 2019

No Jardim Carolina, terrenos baldios acumulam lixo e água parada (Foto: Bibiana Garrido/JORNALDOIS | Edição: Henrique Nakandakare/JORNALDOIS)
Por Bibiana Garrido

São 18 dias em 2019 e 241 casos de dengue confirmados. O número é o mesmo dos 241 casos registrados durante todo o ano de 2018. “A gente tá acima da incidência para a época, e isso já é indício de quadro epidêmico. Estamos há quatro semanas sem interrupção de crescimento nesses casos”, alerta Roldão Neto, chefe de Seção de Ações de Meio Ambiente no Centro de Controle de Zoonoses (CCZ).

Uma epidemia acontece a partir do momento em que o número de ocorrências de uma doença supera o esperado para determinada época do ano em uma região. Até setembro do ano passado, o Departamento de Saúde Coletiva de Bauru tinha divulgado 28 casos de dengue.

Entre as últimas semanas de 2018 e os primeiros dias de 2019, a taxa de infestação marcada pelo Levantamento Rápido de Índice para Aedes aegypti (LIRAa) apresentou estado de alerta e risco de surto na cidade.

Faltou pessoal para tanto trabalho. A prefeitura tem 121 Agentes de Combate a Endemias (ACEs) em ação – 45 deles estão trabalhando no controle da dengue. Outros, se dividem na prevenção de outras doenças como a leishmaniose e a doença de Chagas.

Eduardo Fogolin, responsável da Secretaria Municipal de Saúde, afirma que está em processo a entrada de mais 28 funcionários. “Dentro do Limite de Responsabilidade Fiscal, nós vamos contratar. Tem que ampliar também os médicos, enfermeiros, técnicos, atendentes. Então a gente faz uma divisão dentro das prioridades”, explica.

Os ACEs são responsáveis por bater nas casas de porta em porta para falar dos riscos da dengue e eliminar focos de proliferação do mosquito que transmite a doença. Também conferem escolas, hospitais e terrenos baldios.

Bauru pode contratar até 219 agentes com auxílio financeiro do Ministério da Saúde. O repasse federal cobre 95% do salário de cada funcionário: pela Lei n° 12.994, a maior parte do gasto com os ACEs não sai dos cofres municipais. O número atual de agentes na cidade representa 55% dessa quantia

“A Secretaria de Saúde tem a intenção de chegar nesse número do ministério, e podemos até superar”, arrisca o secretário de Saúde. “E aí vamos pleitear com base no nosso histórico epidemiológico, apresentando o cenário local. Tendo essa justificativa, pretendemos ampliar”, finaliza Fogolin.

Incidência de casos é maior na região noroeste da cidade (Foto: Bibiana Garrido/JORNAL DOIS | Edição: Henrique Nakandakare/JORNALDOIS)

Parque Jaraguá, Santa Edwiges e Vânia Maria são os bairros mais afetados. Roldão Neto, do CCZ, faz parte da coordenação das equipes de agentes e calcula que 90% dos casos estão concentrados na região noroeste da cidade.

“Tá feio o negócio”, opina Heloísa Romado, que trabalha como diarista no Jardim Carolina. Assim como a Vila Ipiranga, Redentor, Chapadão e Mary Dota, o bairro tem apresentado elevação nos números de casos de dengue detectados. “Trabalho em outras casas e procuro deixar tudo em ordem. Assim como eu não quero na minha casa, não quero na dos outros”, diz ela.

A concentração populacional contribui com o aumento da doença nessas áreas. “Nós temos diversos fatores de vulnerabilidade social, então acaba sendo diferenciado nesse sentido. Tem pessoas que vivem de material reciclável, então isso interfere na proliferação do mosquito se não armazenar corretamente”, pondera Roldão.

“Pro nosso lado lá, no Bela Vista, tá tendo muito pernilongo” conta Heloísa. “Achei incrível que esses dias tava passando na minha rua o carro da nebulização”. A aplicação de inseticida para matar mosquitos em fase adulta começou no dia 15.

Vírus diferente. E não é só por aqui. A picada da fêmea do mosquito Aedes aegypti pode transmitir quatro sorotipos do vírus. O DEN2 é o que está em maior circulação no estado de São Paulo.

Por ser um tipo que não é de comum circulação, o vírus DEN2 tem menos pessoas imunes a sua estrutura e por isso se espalha mais rápido. Quem já teve dengue pode contrair de novo a doença – só fica imune quem já foi infectado com o mesmo tipo de vírus.

Andradina e Araraquara são as cidades que fecharam o ano passado com o maior número de casos: 1.621 e 942, respectivamente. No estado inteiro, em 2018, a média foi de 38,9 casos para cada 100 mil habitantes. A informação é do Boletim Epidemiológico do Ministério da Saúde.

O Jornal Dois fez a conta para ver como Bauru se encaixa nesse cenário: em 2018 foram detectados 38,4 casos para cada 100 mil habitantes da cidade. A média para os 18 dias de 2019 é de 70,2 casos para cada 100 mil habitantes.

“A dengue é uma doença cíclica”, afirma o chefe de Seção de Ações no Meio Ambiente do CCZ. “Em média, a cada três anos, a gente tem uma elevação dos casos aqui na cidade. Já estávamos esperando uma incidência maior, principalmente pela reintrodução desse vírus tipo dois. A gente tá super infestado de Aedes aegypti”.

A fiscalização na rua, prédios e residências é tarefa dos Agentes de Combate a Endemias; hoje são 45 trabalhando no setor da dengue, e mais 28 estão em processo de contratação (Foto: Bibiana Garrido/JORNALDOIS | Edição: Henrique Nakandakare/JORNALDOIS)

Como resolver o problema. O combate à dengue tem lugar em qualquer espaço que possa acumular água parada – que é onde o mosquito se reproduz. A Secretaria Municipal de Saúde tem uma página informativa sobre o combate à doença.

As residências são o foco de atuação dos 45 Agentes de Combate a Endemias (ACEs) que se dividem em 7 equipes para trabalhar nos bairros. Isso porque 80% dos criadouros da dengue estão dentro de casa, de acordo com Roldão. Fiscalizar a limpeza de terrenos baldios também é trabalho dos agentes.

O Centro de Controle de Zoonoses (CCZ) relata que 45% dos moradores se nega a receber os funcionários da prefeitura.

Mário Ramos é chefe do Departamento de Saúde Coletiva e avaliou em entrevista que os poucos casos de dengue no começo de 2018 tinham feito com que os moradores afrouxassem “no trabalho de prevenção aos focos do mosquito Aedes aegypti”.

“Se a gente dá condições para o mosquito se proliferar, a culpa é nossa”, julga Roldão. “O papel do poder público é de passar orientação, fazer o controle e aplicar medidas emergenciais. Pode até jogar inseticida, mas se a população não fizer a parte dela, a transmissão vai continuar”.


Reportagem atualizada às 16 horas do dia 18 de janeiro de 2018, depois de recebida uma atualização da Secretaria Municipal de Saúde de Bauru. O órgão havia contabilizado 62 casos de dengue desde o começo de 2019, número que passou para 241.

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