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ARI SHAPIRO, HOST:

As climate change causes temperatures to rise and rainfall to worsen, cases of dengue fever are at an all-time high. In Brazil, it's known as breakbone fever, and year-round epidemics are becoming the norm in some tropical countries. This mosquito-borne disease is weighing heavily on health care systems, and it's pushing leaders to look for new solutions. Jill Langlois has this report from Sao Paulo, Brazil.

JILL LANGLOIS: It's 8:00 a.m. on a sunny autumn morning in Sao Paulo, and it's business as usual at Vila Santana Public Health Center in a neighborhood on the city's east side. Today is the first day Sao Paulo is vaccinating against dengue, a mosquito-borne disease that has left Brazil and other tropical and subtropical countries around the world in a state of emergency. Ten-year-old Alessandra Ravanhani Alves is sitting in one of the blue plastic chairs in the clinic, waiting to get her shot.

ALESSANDRA RAVANHANI ALVES: (Speaking Portuguese).

LANGLOIS: "I'm not afraid," she says. "I get a little bit anxious, but I'm fine. It's good because it protects us." Alessandra's dad, 47-year-old Alex Sandro da Silva Alves, sits next to her as name after name is called in the bustling waiting room.

ALEX SANDRO DA SILVA ALVES: (Speaking Portuguese).

LANGLOIS: "Vaccines are life," he says. "Vaccines are everything."

(SOUNDBITE OF CONSTRUCTION EQUIPMENT DRILLING)

LANGLOIS: Like so many other cities in Brazil, Sao Paulo has seen an overwhelming number of dengue cases in 2024. By mid-May, the city of 12 million surpassed 300,000 confirmed cases. The mosquito-borne disease is common in urban areas. It causes symptoms like fever, rash and muscle and joint pain in mild cases, and bleeding from the gums and nose, difficulty breathing and death when it becomes hemorrhagic.

(SOUNDBITE OF CONSTRUCTION EQUIPMENT DRILLING)

LANGLOIS: Construction sites, cemeteries, abandoned swimming pools, anywhere else where stagnant water collects can become breeding grounds for the mosquitoes to lay their eggs. Climate change, migration and urbanization have all played a hand in the worsening scenario, creating ideal conditions for the reproduction of mosquitoes.

(SOUNDBITE OF DRONES FLYING)

LANGLOIS: Brazil is looking for new solutions to prevent a dengue-ridden future. In the short term, it's amped up its fogging program, and the city is using drones to locate mosquito breeding grounds on private properties. And crucially, it's developing new vaccines. For long-term results, the city is releasing sterile male mosquitoes and mosquitoes carrying the Wolbachia bacteria, which reduces their ability to reproduce. And, of course, it's vaccinating as many people as possible.

UNIDENTIFIED NURSE: Alessandra, (speaking Portuguese).

LANGLOIS: Back at the clinic, a nurse greets Alessandra and her father. "So today, she's going to take the first dose of the vaccine against dengue. And then in three months, she'll come back and take the second," she says.

Alessandra looks at the vaccine vial in the nurse's hand and then closes her eyes. Seconds later, she opens them and smiles. Jill Langlois, NPR News, Sao Paulo, Brazil.

(SOUNDBITE OF NIKI SONG, "BEFORE") Transcript provided by NPR, Copyright NPR.

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