Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil.
Lancet. 2011 May 28;377(9780):1877-89. doi: 10.1016/S0140-6736(11)60202-X. Epub 2011 May 9.
Despite pronounced reductions in the number of deaths due to infectious diseases over the past six decades, infectious diseases are still a public health problem in Brazil. In this report, we discuss the major successes and failures in the control of infectious diseases in Brazil, and identify research needs and policies to further improve control or interrupt transmission. Control of diseases such as cholera, Chagas disease, and those preventable by vaccination has been successful through efficient public policies and concerted efforts from different levels of government and civil society. For these diseases, policies dealt with key determinants (eg, the quality of water and basic sanitation, vector control), provided access to preventive resources (such as vaccines), and successfully integrated health policies with broader social policies. Diseases for which control has failed (such as dengue fever and visceral leishmaniasis) are vector-borne diseases with changing epidemiological profiles and major difficulties in treatment (in the case of dengue fever, no treatment is available). Diseases for which control has been partly successful have complex transmission patterns related to adverse environmental, social, economic, or unknown determinants; are sometimes transmitted by insect vectors that are difficult to control; and are mostly chronic diseases with long infectious periods that require lengthy periods of treatment.
尽管在过去的六十年中，由于传染病导致的死亡人数明显减少，但传染病仍然是巴西的一个公共卫生问题。在本报告中，我们讨论了巴西在控制传染病方面的主要成功和失败，并确定了研究需求和政策，以进一步改善控制或中断传播。通过有效的公共政策和各级政府及民间社会的协调努力，霍乱、恰加斯病和可通过疫苗预防的疾病等的控制已经取得成功。对于这些疾病，政策涉及关键决定因素（例如，水和基本卫生条件的质量、病媒控制），提供了预防资源（如疫苗）的获取途径，并成功地将卫生政策与更广泛的社会政策相结合。控制失败的疾病（例如登革热和内脏利什曼病）是具有变化的流行病学特征且治疗难度大的虫媒传染病（在登革热的情况下，尚无治疗方法）。控制部分成功的疾病具有与不良环境、社会、经济或未知决定因素有关的复杂传播模式；有时由难以控制的昆虫媒介传播；并且主要是慢性疾病，具有较长的传染性，需要长时间的治疗。
