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Volume 32, Number 4—April 2026
Research
Dengue Incidence, Seroprevalence, and Expansion Factors from Active Surveillance, Brazil, 2016–2021
, Morgan A. Marks, Elizabeth M. Anderson, Alejandra Esteves-Jaramillo, Germán Áñez, José A. Sousa Moreira, and Fernanda Castro Boulos
Table 3
Incidence rates of virologically confirmed dengue and expansion factors, by municipality and state, Brazil, 2016–2021*
| Municipality | DEN-03-IB incidence rate (95% CI) | SINAN incidence rate (95% CI) | Expansion factor (95% CI)† |
|---|---|---|---|
| São Paulo, SP‡ | 0 (0–414.4) | 978.0 (972.5–983.5) | 0 (0.0–0.004) |
| São José do Rio Preto, SP | 2,069.1 (1,385.7–2,971.6) | 14,134.9 (14,027.5–14,242.9) | 0.15 (0.14–0.15) |
| Belo Horizonte, MG | 1,249.2 (763.1–1,929.3) | 3,951.4 (3,927.0–3,976.0) | 0.32 (0.30–0.33) |
| Rio de Janeiro, RJ | 0 (0–625.4) | 283.6 (279.6–287.6) | 0 (0–0.013) |
| Laranjeiras, SE§ | 1,576.2 (1,078.1–2,225.1) | 507.8 (430.8–594.6) | 3.1 (3.0–3.3) |
| Recife, PE | 673.4 (336.1–1,204.8) | 237.9 (230.6–245.5) | 2.8 (2.6–3.1) |
| Fortaleza, CE | 53.4 (1.4–297.5) | 834.5 (823.6–845.4) | 0.06 (0.05–0.08) |
| Salvador, BA | 2,170.0 (1,083.3–3,882.8) | 228.6 (223.1–234.1) | 9.5 (9.1–9.9) |
| Manaus, AM | 444.1 (213.0–816.8) | 527.0 (517.6–536. 6) | 0.84 (0.77–0.93) |
| Boa Vista, RR | 1,214.5 (800.4–1,767.0) | 846.8 (819.7–874.5) | 1.4 (1.4–1.5) |
| Porto Velho, RO | 786.5 (458.2–1,259.2) | 1,110.1 (1,082.4–1,138.3) | 0.71 (0.66–0.76) |
| Brasília, DF | 1,480.9 (948.8–2,203.4) | 4,661.7 (4,637.7–4,685.8) | 0.32 (0.30–0.33) |
| Cuiabá, MT | 1,494.4 (984.8–2,174.3) | 263.0 (250.4–276.0) | 5.7 (5.4–6.0) |
| Campo Grande, MS | 2,030.7 (1,183.0–3,251.4) | 1,219.4 (1,197.0–1,242.3) | 1.7 (1.6–1.7) |
| Porto Alegre, RS | 0 (0–705.7) | 504.1 (492.8–515.6) | 0 (0–0.007) |
*Incidence rates of virologically confirmed dengue in the placebo arm of the DEN-03-IB trial of a live attenuated tetravalent dengue vaccine, Butantan-DV (cases/100,000 person-years), or dengue confirmed cases in SINAN (cases/100,000 population). AM, Amazonas; BA, Bahia; CE, Ceará; DF, Distrito Federal; MG, Minas Gerais; MS, Mato Grosso do Sul; MT, Mato Grosso; PE, Pernambuco; RJ, Rio de Janeiro; RO, Rondônia; RR, Roraima; RS, Rio Grande do Sul; SE, Sergipe; SINAN, Sistema de Informação de Agravos de Notificação; SP, São Paulo. †Expansion factor is the ratio of virologically confirmed dengue cases from active surveillance of the placebo arm of DEN-03-IB per 100,000 person-years over dengue confirmed cases from the national passive surveillance system, SINAN, per 100,000 population. A value >1 would indicate potential underreporting by SINAN, whereas a value <1 is indicative of potential underreporting by active follow-up. ‡Two DEN-03-IB clinical sites were located in São Paulo. §Used for the municipality closest to the Aracaju, SE, clinical site.
1Preliminary results from this study were presented at the American Society for Tropical Medicine and Hygiene annual meeting; November 13–17, 2024, New Orleans, Louisiana, USA.