A second infection tends to be more severe
Em meio a uma epidemia que já ceifou mais de mil vidas em um único ano, o Brasil enfrenta uma questão que transcende a medicina: a proteção contra a dengue chegou, mas não chegou para todos. A vacina Qdenga, eficaz e aprovada, divide o país entre quem pode pagar entre 780 e 980 reais pelo esquema completo em clínicas privadas e quem aguarda uma campanha pública restrita a faixas etárias e municípios específicos. É o retrato de uma nação que encontrou a ferramenta, mas ainda negocia com quem ela pertence.
- O Brasil registrou 243.720 casos de dengue nas primeiras quatro semanas de 2024 — um aumento de 273% em relação ao mesmo período do ano anterior, sinalizando uma crise sem precedentes.
- A vacina Qdenga existe, funciona com 80,2% de eficácia contra infecção e 90,4% contra casos graves, mas seu custo integral em clínicas privadas ultrapassa o salário mínimo, tornando-a inacessível para a maioria dos brasileiros.
- O Ministério da Saúde lançou a primeira campanha pública com Qdenga do mundo, mas a escassez de doses limita o atendimento a jovens de 10 a 14 anos em apenas 521 municípios com alta transmissão.
- Regiões historicamente poupadas, como o Sul do país, enfrentam sua primeira epidemia de dengue, com sistemas de saúde despreparados para absorver o impacto.
- Uma saída doméstica está no horizonte: a vacina de dose única do Instituto Butantan, com 79,6% de eficácia, deve pedir aprovação ainda em 2024, com previsão de disponibilidade em 2025.
O Brasil ganhou uma arma contra a dengue, mas o acesso a ela depende do endereço e do saldo bancário de cada cidadão. A Qdenga, desenvolvida pela farmacêutica japonesa Takeda, chegou às clínicas privadas em julho do ano passado como a primeira vacina capaz de proteger pessoas de 4 a 60 anos — com ou sem infecção prévia. O esquema completo, de duas doses aplicadas com três meses de intervalo, custa entre 780 e 980 reais, valor proibitivo para a maior parte da população. Redes como Fleury, Richet e Labi cobram entre 390 e 490 reais por dose, refletindo não apenas o teto regulatório da Anvisa, mas também taxas de triagem e acompanhamento médico.
A especialista Rosana Richtmann, da Sociedade Brasileira de Infectologia, ressalta que quem já teve dengue tem razão especial para se vacinar: uma segunda infecção — possível porque o vírus circula em quatro sorotipos distintos — costuma ser mais grave. Ela também alerta para a expansão geográfica da doença: o Centro-Oeste registrou surto expressivo no ano passado, e o Sul vive sua primeira epidemia, sem estrutura preparada para enfrentá-la.
No sistema público, o Ministério da Saúde anunciou a primeira campanha mundial com a Qdenga, mas a limitação de doses restringiu o público-alvo a jovens de 10 a 14 anos em 521 municípios com alta transmissão e mais de 100 mil habitantes. A faixa etária foi escolhida por apresentar a segunda maior taxa de hospitalização por dengue, atrás apenas dos idosos — que, paradoxalmente, não puderam ser incluídos por falta de estudos clínicos nessa população.
O contexto é de emergência: nas primeiras quatro semanas de 2024, o país contabilizou 243.720 casos, alta de 273% sobre o mesmo período de 2023, ano em que 1.094 pessoas morreram pela doença. Uma perspectiva de alívio vem do Instituto Butantan, que desenvolve uma vacina nacional de dose única, com 79,6% de eficácia, e pretende solicitar aprovação regulatória ainda este ano para disponibilizá-la em 2025. Até lá, o Brasil convive com a tensão entre a escassez pública e o privilégio privado.
Brazil has a new weapon against dengue, but access depends on where you live and how much you can spend. The Qdenga vaccine, made by Japanese pharmaceutical company Takeda, arrived in private clinics last July as the first shot capable of protecting people aged 4 to 60—whether they've never had dengue or have been infected before. Seven months later, a survey found doses selling for between 390 and 490 reais each. Since the vaccine requires two shots spaced three months apart, the full course costs between 780 and 980 reais, putting it out of reach for most Brazilians.
In clinical trials, the two-dose regimen showed 80.2 percent effectiveness at preventing dengue infection and 90.4 percent effectiveness at preventing severe cases. Medical societies recommend it for anyone in the approved age range, regardless of prior infection history. Rosana Richtmann, director of the immunization committee at the Brazilian Society of Infectology, notes that people who have already had dengue benefit especially from vaccination, since a second infection—possible because the virus has four distinct strains—tends to be more severe. She emphasizes that vaccination decisions should also consider where someone lives. The Center-West region saw a significant surge in cases last year, and the South, traditionally dengue-free, is now experiencing its first epidemic, with health systems unprepared to manage the virus.
Private clinics across the country stock the vaccine at varying prices. Fleury clinics, which operate under brands including Labs a+, Clínica Felippe Mattoso, and LAFE across 12 states and the Federal District, charge between 400 and 490 reais per dose depending on location. Richet Medicina offers it for 450 reais at four Rio de Janeiro locations plus home visits. Labi clinics in Rio and São Paulo charge 390 reais. The Dasa health network, which encompasses 30 brands including Sérgio Franco, Bronstein, and Delboni across 12 states, also carries the vaccine but did not disclose pricing. The higher private prices reflect not just the base cost regulated by Brazil's drug pricing authority—which caps the maximum consumer price between 346.66 and 390.90 reais per dose—but also clinic fees for medical screening, vaccination record review, and pre- and post-vaccination counseling.
Meanwhile, the public health system is moving forward with a far more limited rollout. The Health Ministry announced that 521 municipalities will receive Qdenga doses for a 2024 public campaign, the first such effort anywhere in the world. But production constraints mean the initial phase targets only young people aged 10 to 14 living in cities with more than 100,000 residents and high dengue transmission. This age group was chosen because it experiences the second-highest hospitalization rate from dengue after elderly people, and the selection aligns with guidance from the World Health Organization and independent experts advising the ministry. The campaign was set to begin in February. Because the vaccine has not been studied in people over 60, the ministry cannot include them despite their vulnerability.
The timing reflects a crisis. In the first four weeks of 2024 alone, Brazil recorded 243,720 dengue cases—a 273 percent increase compared to the same period the previous year. Last year, the country suffered 1,094 confirmed dengue deaths, surpassing 2022's toll of 1,053. The disease has become a recurring catastrophe, with each year bringing new records. Relief may eventually come from a second source: the Instituto Butantan, a Brazilian research institute, is developing its own dengue vaccine that requires only a single dose and showed 79.6 percent effectiveness over two years in trials. The institute plans to submit its approval request to Brazil's drug regulator this year, with hopes of making the vaccine available by 2025. If approved, domestic production could expand access far beyond the current constraints, though for now, the choice between private expense and public scarcity remains.
Citas Notables
The South is now experiencing its first epidemic, with health systems unprepared to manage the virus— Rosana Richtmann, director of immunization committee, Brazilian Society of Infectology
La Conversación del Hearth Otra perspectiva de la historia
Why did the government choose 10-to-14-year-olds for the public campaign instead of older people, who seem more vulnerable?
The data actually shows that age group has the second-highest hospitalization rate after elderly people. But there's a harder reason too—the vaccine hasn't been tested in people over 60, so regulators won't approve it for them. The government is working within the evidence it has.
So someone over 60 who's terrified of dengue has to pay 800 reais out of pocket?
If they can afford it and find a clinic nearby, yes. But most can't. That's the gap the public campaign is supposed to close eventually, once supply increases and they can expand beyond the 521 cities they're starting with.
Why is production so limited? It's been available for seven months.
Takeda is the only manufacturer right now, and dengue vaccines are complex to produce. That's partly why the Butantan vaccine matters—if it gets approved, Brazil could make it domestically and scale up much faster.
The numbers are staggering. 273 percent more cases in just four weeks?
And that's early 2024. Last year was already a record for deaths. The South is particularly alarming because dengue is new there—health systems don't know how to handle it yet. The vaccine can't come fast enough.
If someone already had dengue once, should they definitely get vaccinated?
Doctors say yes, especially them. A second infection is usually worse because of how the virus works. The vaccine is actually more valuable for people with prior infection than for those who've never had it.