{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:13:15Z","timestamp":1788315195873,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100021066","name":"Gates Ventures","doi-asserted-by":"publisher","award":["008975"],"award-info":[{"award-number":["008975"]}],"id":[{"id":"10.13039\/100021066","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Early warning systems (EWSs) are essential for alert, detection, and response to potential public health emergencies. Brazil's 2024 dengue epidemic, the largest ever recorded, offers a critical case for assessing correspondence between timely epidemic risk detection and health governance responsiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We collected data on dengue cases, deaths, and public health emergency declarations (PHEDs) at federal, state, and municipal levels. We evaluated the timeliness of 2024 emergency declarations by retrospectively mapping observed risk levels across all states and capitals, utilizing the 2023 federal endemic channel guidelines and the updated 2025 risk\u2010level criteria. Using logistic regressions, we investigated whether epidemic severity was associated with the enactment of a PHED, accounting for primary health coverage and political dynamics that influence local government declarations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The 2024 epidemic escalated rapidly. Brazil remained at an alert level for 19 consecutive weeks and at an epidemic level for 11, with epidemic risk thresholds reached unusually early. Eleven states and seven capitals issued PHEDs after epidemic thresholds were reached, and an additional five capitals were covered by overlapping state declarations. Despite prolonged epidemic conditions across 18 states and 20 capitals, only 11 states and 7 capitals issued emergency declarations. High\u2010burden jurisdictions such as Bahia and Bel\u00e9m did not declare emergencies. Logistic regression models show that only the duration at elevated risk levels significantly predicted emergency declarations, while political factors and primary health care coverage did not. That declarations followed prolonged epidemic exposure rather than early detection underscores the need for institutional mechanisms that translate surveillance signals into timely governance responses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The EWS framework was insufficiently responsive to the rapid dynamics of the 2024 dengue epidemic. Strengthening responsive governance requires adaptive surveillance tools and institutional mechanisms that link early detection to timely, coordinated responses, while accounting for decentralized decision\u2010making and uneven subnational capacities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tmi.70153","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T01:14:46Z","timestamp":1778548486000},"page":"1183-1193","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Warning Systems and Emergency Declarations During Brazil's Largest Dengue Outbreak"],"prefix":"10.1111","volume":"31","author":[{"given":"Lorena Guadalupe","family":"Barberia","sequence":"first","affiliation":[{"name":"Department of Political Science University of S\u00e3o Paulo, Avenida Professor Luciano Gualberto, Cidade Universit\u00e1ria  S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra Crispim","family":"Boing","sequence":"additional","affiliation":[{"name":"Department of Public Health Federal University of Santa Catarina, Campus Universit\u00e1rio Reitor Jo\u00e3o David Ferreira Lima, Centro de Ci\u00eancias da Sa\u00fade  Floranopolis SC Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nat\u00e1lia","family":"de Paula Moreira","sequence":"additional","affiliation":[{"name":"Department of Political Science University of S\u00e3o Paulo, Avenida Professor Luciano Gualberto, Cidade Universit\u00e1ria  S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murilo","family":"Motta","sequence":"additional","affiliation":[{"name":"Institute of International Relations University of S\u00e3o Paulo, Cidade Universit\u00e1ria  S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme Pereira","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Department of Political Science University of S\u00e3o Paulo, Avenida Professor Luciano Gualberto, Cidade Universit\u00e1ria  S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dara Aparecida Vilela","family":"Pinto","sequence":"additional","affiliation":[{"name":"Department of Political Science University of S\u00e3o Paulo, Avenida Professor Luciano Gualberto, Cidade Universit\u00e1ria  S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz Antonio Couto","family":"Soares","sequence":"additional","affiliation":[{"name":"Department of Political Science University of S\u00e3o Paulo, Avenida Professor Luciano Gualberto, Cidade Universit\u00e1ria  S\u00e3o Paulo SP Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o","family":"de Oliveira Gusm\u00e3o","sequence":"additional","affiliation":[{"name":"Department of Public Health Emergencies Ministry of Health of Brazil  Bras\u00edlia DF Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Paula Magalh\u00e3es","family":"Brito","sequence":"additional","affiliation":[{"name":"Department of Social Psychology University of S\u00e3o Paulo, Av. 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