Dr. Pedro Fernando da Costa Vasconcelos is elected president of the BSTM

Considered one of the worlds leading arbovirus experts and pioneer in the study of Zika virus in Brazil, virologist Dr. Pedro Fernando da Costa Vasconcelos warns that at least three wild viruses, now restricted to rural areas, threaten to spread throughout the country

In almost four decades, Dr. Pedro Fernando da Costa Vasconcelos participated in the identification and de ion of more than 100 different virus species. In 2014, the Pará doctor diagnosed the first Brazilian case of West Nile fever and described for the first time in Brazil the Chikungunya epidemics in Amapá and Bahia. He also coordinated the research group that clarified the action of the Yellow Fever virus in monkeys, facilitating the understanding of the phenomena found in people affected by the disease. In 2015, his research group at the Evandro Chagas Institute (IEC), isolated the Zika virus from the brain of a baby with microcephaly, son of a woman from Ceara infected during pregnancy. Based on this work, the Ministry of Health (MoH) issued a statement establishing the association between Zika infection and microcephaly. In 2016, the epidemic spread throughout the Americas and Dr. Pedro Vasconcelos represented Brazil on the emergency committee of the World Health Organization (WHO) that accompanied the subject.

Find below the full interview with the president-elect:

BSTM: Which arboviruses have been described as potentially dangerous and threatening to spread throughout Brazil?

Dr. Pedro Fernando da Costa Vasconcelos: There are several arboviruses with potential to spread and cause epidemics in Brazil. Among the long-standing native arboviruses, certainly the Mayaro alphavirus and the Oropouche orthobunyavirus that cause Mayaro and Oropouche fevers respectively, represent the greatest threats as they have caused outbreaks or epidemics in the Amazon for decades and there is evidence of the expansion of their circulation to other areas outside the Amazon and to other countries. Furthermore, experimental studies have showed that the vectors Aedes aegypti and Aedes albopictus were susceptible to them. The Saint Louis encephalitis virus has also shown signs of distribution expansion and caused small outbreaks in Argentina and Brazil. Here in our country there was an outbreak in Sao Jose do Rio Preto that was simultaneous with an epidemic of dengue fever. The so-called exotic arboviruses that can occur in epidemic form and that already occur in Brazil are certainly the West Nile virus is the strongest candidate. Transmitted by Culex pipiens mosquitoes in the US, WNV was possibly introduced in Brazil by migratory birds. There is serological evidence of WNV circulation in the Pantanal and the Amazon, but WNV was confirmed causing encephalitis in the Piaui sertão, the Brazilian backlands. In 2017, it caused an epizootic in horses in the Espírito Santo State. The transmitter is not yet known in Brazil, but bets are on Culex quinquefasciatus, a nocturnal mosquito that is widely distributed in the country. As for exotic viruses that do not occur in Brazil, the most likely are the Ross River (from Australia) and Onyongnyong alphaviruses which circulates in Africa and also in Asia, and the Japanese encephalitis flavivirus that is originally from Asia. The first two are transmitted by Aedes aegypti, while the third by Culex mosquitoes. Good quality and continuous surveillance are needed for early detection and to attempt preventing the spread of these arboviruses if introduced into Brazil.

BSTM: Eradicated diseases once again threaten the country. Tell us a little about the challenges Brazil faces and what must be done to control the epidemics

Dr. Pedro Fernando da Costa Vasconcelos: Well, a systematic surveillance should be implemented to prevent air-borne diseases like measles and rubella. Look what happened to measles. There were multiple introductions of the virus from Roraima, whose cases are associated with the migration of Venezuelans to this and other Amazonian states, but also in São Paulo, from cases imported from Europe. It is difficult to eliminate – or to remain eliminated – a respiratory transmission virus if vaccination coverage is very low, as has been announced in Brazil. It is necessary to strengthen the NIP (National Immunization Program) so that Brazil can once more be an example in vaccination coverage. Incidentally, low vaccination coverage has been found in virtually all immunopreventable diseases. You cant relax, you have to be incisive and charge the state and municipal health departments to increase immunization coverage at all levels and for all immunopreventable diseases, to link school enrollment with the good standing vaccination card, meaning we have to encourage increased immunization coverage. Without improvement in vaccine coverage there is no way to control or prevent epidemics of these diseases.

BSTM: Your group was the first to isolate the Zika virus. Is care for children born with microcephaly still a problem? Why?

Dr. Pedro Fernando da Costa Vasconcelos: Yes, it is true, I remember that in 2015 when the cases of microcephaly among newborns in the Northeast increased, several hypotheses were raised about causality. Of course, there was already a suspicion that ZIKV was responsible, but no one could show it. We at IEC made it from one case from Ceará and then from several cases from Paraíba, Rio Grande do Norte and Maranhão. Based on our findings, MoH and PAHO/WHO confirmed the causal link of microcephaly and other congenital malformations with ZIKV.
Regarding the care of children born with microcephaly, in the first months there was a lot of mobilization of the media and medical area and the government of the time was sensitized and resources were decentralized to the most affected states for medical and physical therapy care and speech therapy, among others to alleviate the family dramas associated with this situation. Unfortunately, it seems that these children were forgotten by the current governments and this is very bad, as the costs to these families are tremendous and, it should be remembered, most cases of microcephaly occurred in the underprivileged population, which further complicates the situation and the future of these children.

BSTM: What do you think that could be done to give Tropical Medicine more priority and visibility with the government? Could the fact that you were director at IEC contribute in any way?

Dr. Pedro Fernando da Costa Vasconcelos: First I must say that we need to have an open and direct dialogue with the authorities of the Ministry of Health; without it, nothing will work. As I am a servant of the Ministry of Health at IEC, and I have good relationships at SVS [Health Surveillance Secretariat], I think we can be more involved in policy making for tropical and infectious diseases. But it is worth remembering that in addition to the education that must be prioritized in schools to teach children since preschool on how to prevent and control these diseases, a huge investment is necessary for sanitation, improved care at Basic Care Units, Emergency Care Units and tertiary attention. Recent epidemics of yellow fever have shown that even in reference hospitals, care needs improvements. I say this because the yellow fever lethality between 2016-2018 was very close to the lethality rates in previous years, when the cases occurred in remote areas and without the complex hospital structures of Minas Gerais, São Paulo, Rio de Janeiro and Espírito Santo States. Elaborating treatment consensus should be a priority for these diseases, which has already been done since the previous government. The BSTM will certainly play a key role in this construction.

BSTM: BSTM leads an initiative called BSTM Pro-Vaccines Brazil. What do you think are the current vaccination challenges for our country?

Dr. Pedro Fernando da Costa Vasconcelos: As I said earlier, it is necessary to increase vaccination coverage in the country, without this, there is no way to prevent or control epidemics of diseases such as measles, yellow fever and all others, including poliomyelitis. Therefore, the BSTMs initiative to lead the “BSTM Pro-Vaccines Brazil will have my full support. One of the greatest challenges of vaccination in Brazil is to encourage families, parents and guardians to bring their children to be immunized. Vaccines are in many cases the only way to prevent outbreaks from occurring. Back to measles, if vaccination coverage in Brazil was within the recommended range (over 95%), we would not have problems with measles, but the reality is different, and coverage in many states was close to 50%, that is to say one of two citizens were susceptible to the disease, and for this reason alone I would say that we are dealing with outbreaks in Amazonas, Para, Roraima and Sao Paulo, spending a lot of money that could have been used for other purposes in their own healthcare, trying to contain the measles epidemic in the country. The consequence was the loss of the measles elimination certification achieved by Brazil with many difficulties in a country of continental size and with a population of over 200 million.

BSTM: Newly elected, you take over management with a big challenge, to host the 56th MedTrop. Tell us a little about this.

Dr. Pedro Fernando da Costa Vasconcelos: Well, that was one of the arguments used by those who preceded me to persuade me to assume the presidency of the BSTM. Sinval, Mitermayer and Marcus told me about the difficulties in organizing the annual BSTM congress, and that it is much easier when the chair of the conference is also the president of BSTM. That is why I accepted, since next years congress will be in Belém, and also because I saw the success of the Recife congress during Sinvals term at office. We have other challenges ahead: increasing membership and also increasing regular membership dues. These numbers need to improve; We have agreed with the American Society of Tropical Medicine and Hygiene (ASTMH) and have agreed that a BSTM committee will discuss in Washington during the ASTMH annual congress an agreement for an integration between the BSTM and the ASTMH. If it works, we will extend it to other similar medical societies in other countries. This is a big challenge; to continue strengthening the BSTM Magazine; bringing the BSTM closer to the Ministry of Health, especially to the SVS [Health Surveillance Secretariat]. These are the main challenges, but of course, if others are to come, we will be ready to contribute with the BSTM to the Brazilian population, especially the neediest, the Ministry of Health, universities and the country!

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