Avaliação do tratamento antirrábico humano pós-exposição, associado a acidentes com cães / Evaluation the human anti-rabies treatment associated with accidents with dogs

O estudo da profilaxia da raiva humana contribui para orientação quanto ao uso de vacinas e soros antirrábicos, servindo de base para a definição de estratégias de prevenção, controle e avaliação da doença. Objetivou-se avaliar o atendimento antirrábico humano pós-exposição e possíveis incompatibilidades com o protocolo do Ministério da Saúde, em agressões por cães, no município de Belo Horizonte. Analisaram-se as fichas de atendimento antirrábico do SINAN para comparação dos tratamentos prescritos com as Normas de Profilaxia antirrábica do Ministério da Saúde. As características dos atendimentos foram: quanto à exposição, 93,0% decorrentes de mordedura; quanto à localização da agressão, 35,5% ocorreram nos membros inferiores; quanto ao ferimento, 62,0% foram lesões únicas; quanto ao tipo de ferimento, 65,8% foram superficiais; quanto à condição do animal, 85,0% ocorreram por animais sadios; em 83,4% dos casos os animais eram observáveis; quanto ao tratamento, observação e vacina (57,3%). O tratamento foi inadequado em 32,7% das condutas. O número de tratamentos instituídos foi muito elevado, 75,7% dos casos. De todos os atendimentos 21,2% das indicações foram consideradas excessivas e 11,5% insuficientes. O sistema de vigilância apresenta falhas e existe a necessidade de corrigi-las para que as informações referentes à finalização dos casos sejam conclusivas.(AU)

The study of prophylaxis of human rabies contributes to guidance on the use of vaccines and anti-rabies serums, providing the basis for the definition of strategies for prevention, control and evaluation of the disease. This study aimed to evaluate the service to early post-exposure human anti-rabies and possible incompatibilities with the Ministry of Health protocol attacks by dogs in the city of Belo Horizonte. The anti-rabies care records of SINAN were analyzed for comparison of treatments prescribed in the Prophylaxis of Rabies Standards of the Ministry of Health. The characteristics of the calls were about the exposure, 93.0% resulting from biting; the location of the assault, 35.5% occurred in the lower limbs; the injury, only 62.0% were injuries; the type of injury, 65.8% were superficial; the condition of the animal, 85.0% occurred in healthy animals; 83.4% of the cases the animals were observed; as treatment, observation and vaccine (57.3%). The treatment was inadequate in 32.7%. The number of established treatments was very high, 75.7% of cases. In all 21.2% of indications consultations were considered excessive and 11.5% insufficient. The surveillance system is faulty and there is a need to correct them so that the information regarding the completion of cases are conclusive.(AU)

Quality of horse F(ab')2 antitoxins and antirabies immunoglobulins: protein content and anticomplementary activity

Among other applications, immunotherapy is used for the post-exposure treatment and/or prophylaxis of important infectious diseases, such as botulism, diphtheria, tetanus and rabies. The effectiveness of serum therapy is widely proven, but improvements on the immunoglobulin purification process and on the quality control are necessary to reduce the amount of protein aggregates. These may trigger adverse reactions in patients by activating the complement system and inducing the generation of anaphylatoxins. Herein, we used immunochemical methods to predict the quality of horse F(ab′)2 anti-botulinum AB, anti-diphtheric, antitetanic and anti-rabies immunoglobulins, in terms of amount of proteins and protein aggregates. Methods Samples were submitted to protein quantification, SDS-PAGE, Western blot analysis and molecular exclusion chromatography. The anticomplementary activity was determined in vitro by detecting the production of C5a/C5a desArg, the most potent anaphylatoxin. Data were analyzed by one-way ANOVA followed by Tukey's post-test, and differences were considered statistically significant when p < 0.05. Results Horse F(ab′)2 antitoxins and anti-rabies immunoglobulin preparations presented different amounts of protein. SDS-PAGE and Western blot analyses revealed the presence of protein aggregates, non-immunoglobulin contaminants and, unexpectedly, IgG whole molecules in the samples, indicating the non-complete digestion of immunoglobulins. The chromatographic profiles of antitoxins and anti-rabies immunoglobulins allowed to estimate the percentage of contaminants and aggregates in the samples. Although protein aggregates were present, the samples were not able to induce the generation of C5a/C5a desArg in vitro, indicating that they probably contain acceptable levels of aggregates. Conclusions Anti-botulinum AB (bivalent), anti-diphtheric, antitetanic and anti-rabies horse F(ab′)2 immunoglobulins probably contain acceptable levels of aggregates, although other improvements on the preparations must be carried out. Protein profile analysis and in vitro anticomplementary activity of F(ab′)2 immunoglobulin preparations should be included as quality control steps, to ensure acceptable levels of aggregates, contaminants and whole IgG molecules on final products, reducing the chances of adverse reactions in patients.(AU)

O cao, principal transmissor da raiva humana / The dog, main human rabies transmitter

O presente trabalho resume os principais dados sobre o virus da raiva, a cadeia epidemiologica, a sintomatologia e a importancia do cao na transmissao da raiva para o homem. Estudou-se 3 grupos de caes com objetivo de verificar a eficacia da vacina contra a raiva. Nos caes primovacinados (grupo A), nao foram detectados anticorpos antes da vacinaçao,21 dias apos a vacinaçao, o titutlo medio do grupo passou a 2,2 UI/ml e 31/34 caes ficaram protegidos contra a raiva. No grupo B, caes vacinados ha um ano, a media dos niveis de anticorpos foi de 0,3 UI/ml e apenas 12/34 caes continuavam protegidos. Vinte e um dias apos a revacinaçao a media atingiu 7,0 UI/ml,sendo que 29/34 caes ficaram protegidos. No grupo C, 18 meses apos a ultima revacinaçao a media dos niveis de anticorpos era 0,2 UI/ml e apenas 5/28 caes estavam protegidos. Trinta dias apos nova revacinaçao, a media dos titulos atingiu apenas 0,7 UI/ml.

Vacuna antirrabica de cerebro de raton lactante: Composicion antigenica y capacidad inmunogena / Suckling mouse brain rabies vaccine: Antigenic composition and immunogenic capacity

Suckling mouse brain (SMB) rabies vaccine is the preparation most widely used in the countries of Latin América and the Caribbean. This vaccine, prepared according to the Fuenzalida and Palacios method, consists of three fixed rabies virus strains (CVS, 51, and 91). However, the World Health Organization recommends that rabies vaccines for human use be prepared using only a single strain of this virus. In order to determine whether any one of the antigens of the SMB vaccine could be eliminated from the preparation, the immunogenic capacity of the standard trivalent SMB vaccine was compared with that of experimental bivalent (CVS-51, CVS-91, and 51-91) and monovalent (CVS, 51, and 91) SMB vaccines. The study was conducted using adult and suckling albino mice provided by the laboratory at the Pan Américan Zoonoses Center, Buenos Aires, Argentina, and different strains of fixed and street rabies virus. The experimental vaccines were prepared using the Fuenzalida-Palacios method. Potency and cross-immunity tests were conducted. The result showed that the trivalent vaccine was the most effective in protecting the mice againg both fixed and street rabies virus infections and also in inducing rapid development of neutralizing antibody at high titers

Vacuna antirrabica de cerebro de raton lactante. Tratamiento humano poseexposición en el Ecuador / Rabies suckling mouse brain vaccine. Postexposure human treatment in Ecuador

At the Leopoldo Izquieta Perez National Institute of Hygiene and Tropical Medicine in Guayaquil, Ecuador, between November 1983 and February 1985 an evaluation was done of the serological response of two groups, of 19 volunteers each, who received rabies suckling mouse brain (SMB) vaccine produced by that institution and quality- controlled by the PAHO/WHO Pan Américan Zoonoses Center. Two postexposure treatment schemes were used: one group received 14 doses of rabies SMB vaccine (one per day) plus three boosters at 10, 20, and 90 days after the last dose of the initial series; the other group recieved six doses (one per day) and two boosters at 20 and 90 days after completing the initial series. It was not possible to demonstrate statistically significant differences between the median titers of the rabies neutralizing antibody in the two groups at 32, 98, and 180 days after the beginning of the two treatments. The results of this study could serve as a basis for the health authorities of Ecuador in their adoption of a limited vaccination scheme that is more innocuous, effective, and economical than the scheme presently applied in that country

Origen y eliminación de elementos fibrosos observados en vacuna antirrábica CRL de uso humano / Origin and elimination of fibrous-like particles observed in rabies vaccine for human use

El presente trabajo describe la aparición de una alteración organoléptica observada en algunos lotes de vacuna antirrábica a cerebro de ratón lactante producidos en el Laboratorio Central de Salud Pública del Ministerio de Salud de la Provincia de Buenos Aires, consistente en la aparición de elementos de aspecto fibroso, blanquecinos, relativamente poco perceptibles, que se mantenían en suspensión en el líquido y no eran debidos a problemas de molienda. La técnica de producción seguida era la recomendada por los autores (Fuenzalida y Palacios), con las modificaciones propuestas por el Centro Panamericano de Zoonosis, que incluía una centrifugación bajo refrigeración a 17.000 g durante 10 minutos. La alteración descripta originaba una pérdida por descarte de dosis de vacuna del 20% o mayor y una relativa disminución de la potencia de las mismas. Los resultados obtenidos permiten concluir que durante el proceso de elaboración de vacuna antirrábica CRL se debe evitar la congelación del material nervioso en suspensión, recomendándose un rango de temperatura entre 3 y 5-C para todo el proceso