[Critical aspects of dengue control in Brazil]

Dengue is now the main reemerging disease in the world. In the absence of an efficacious preventive vaccine and effective etiologic treatment and chemoprophylaxis, the only vulnerable link for reducing dengue transmission is the mosquito Aedes aegypti, its principal vector. There are many difficulties in combating this mosquito in large and medium-sized cities. The complexity of contemporary urban life generates factors that facilitate the mosquito's proliferation and constraints on the reduction of its infestation rates. The objectives of dengue control should be based on available scientific and technical knowledge. Thus, while it is not possible to avoid dengue in areas infested with A. aegypti, it is possible to prevent major epidemics by improving epidemiological surveillance, and it is both possible and feasible to reduce the disease's case fatality from the current 5 to 6% to some 1% in the severe forms. The elaboration and execution of strategic plans for the organization of medical care for suspected dengue cases have proven to be a highly useful instrument to reduce case fatality both in other countries and in some cities of Brazil.