Dengue continues to be a public health challenge in Brazil, especially in regions with precarious urban infrastructure. The limited provision of services such as sanitation, water supply, and garbage collection in inland areas favors the proliferation of Aedes aegypti. Understanding the relationship between environmental factors and the occurrence of severe cases is fundamental for the development of more effective control strategies. To analyze dengue cases with warning signs reported between 2019 and 2024, correlating them with environmental indicators of municipalities in the XII Health Region/PE. This is an observational, descriptive, and ecological study with secondary data extracted from SINAN, IBGE, and SNIS. The 10 municipalities in the region were included, evaluating clinical variables (sex, age, warning signs, hospitalization, outcome) and environmental variables (garbage collection, water supply, sewage system, and population density). There was a concentration of cases between April and June, coinciding with the rainy period, suggesting seasonality in transmission. The municipalities with reported cases were Timbaúba (n=8), São Vicente Férrer (n=2), Itambé (n=1), and Macaparana (n=1), with annual stability, regardless of outbreaks. All cases occurred in females, with predominance in children (21 days to 10 years) and young adults (18–26 years). The most common warning signs were intense abdominal pain, persistent vomiting, thrombocytopenia, and lethargy. The outcome was favorable, with no deaths and low hospitalization. Environmentally, it was observed that municipalities with higher incidence had worse sanitation indicators. São Vicente Férrer recorded low garbage collection indices (76.69%) and water supply (54.21%); Itambé had only 18.4% sewage coverage. Despite this, other municipalities with equally critical indicators, such as Condado and Itaquitinga, did not present severe cases. The highest incidence rates per 100,000 inhabitants were in Timbaúba (15.5), SVF (10.0), Macaparana (4.0), and Itambé (2.9). The higher incidence of severe cases is related to the precariousness of environmental services. The results reinforce the importance of intersectoral strategies that articulate public health actions, sanitation, and environmental education. The continuous use of LIRAa, allied to epidemiological surveillance and vector control, is essential to reduce the vulnerability of exposed populations.
Barbosa et al. (2026) studied this question.