Historia de la rabia en Chile: tres tesis médicas

En la antigüedad ya se describía la rabia como una enfermedad zoonótica fatal cuyo pronóstico inexorable superaba todas las alter-nativas terapéuticas de los más célebres médicos. La realidad chilena sobre esta enfermedad a fines del siglo XIX fue descrita certeramente por el médico mártir Pedro Videla Órdenes en su tesis "La rabia" de 1879, destacando la descripción clínica de la rabia, su pronóstico fatal y la ausencia de tratamientos eficaces. Tan sólo seis años después, en 1885, el aclamado químico y microbiólogo Louis Pasteur desarrolló la vacuna antirrábica, logrando por primera vez en la historia de la humanidad prevenir esta terrible enfermedad. En Chile, se inició rápidamente la implementación de la vacuna Pasteur, vacunando al primer chileno el 7 de julio de 1896. Los doctores Milcíades Espinosa y Arturo Atria, en sus tesis "Generalidades sobre la rabia" (1898) y "Sobre la rabia y su profilaxia en Chile" (1905), respectivamente, abordaron esta primera etapa del desarrollo de la vacuna antirrábica en el país.

In antiquity, rabies was already described as a fatal zoonotic disease whose inexorable prognosis exceeded all the therapeutic alternatives of the most famous doctors. The Chilean reality about this disease at the end of the 19th century was accurately described by the martyred doctor Pedro Videla Ordenes in his thesis "La rabia" of 1879, highlighting in it his description about the unknown etiological agent, the fatal prognosis of the disease and the absence of effective treatments. Just six years later, in 1885, the acclaimed chemist and microbiologist Louis Pasteur developed the rabies vaccine, managing to prevent this terrible disease for the first time in human history. In Chile, the implementation of the Pasteur vaccine began rapidly, vaccinating the first Chilean on July 7, 1896. Doctors Milcíades Espinosa and Arturo Atria, in their theses "Generalidades sobre la rabia" (1898) and "Sobre la rabia y su profilaxia en Chile" (1905), respectively, addressed this first stage of the development of the rabies vaccine in the country.

El rol mediador de la eficacia grupal y la rabia hacia la desigualdad en la relación identificación social y acciones colectivas en el contexto de Octubre -19 en Chile / The mediating role of group efficacy and rage towards inequality in the relationship between social identification and collective actions in the context of October -19 in Chile

Resumen El objetivo de este estudio es analizar, en el contexto de Octubre-19 en Chile, el rol mediador de la eficacia grupal sobre las acciones del movimiento social y la rabia dirigida hacia la desigualdad en Chile en la relación entre identificación social con movimientos sociales y participación en acciones colectivas. La muestra se compone por 315 jóvenes chilenos, con edades comprendidas entre 18 y 29 años. Nuestros resultados indican que existe un efecto indirecto de la identidad social con el movimiento social en la participación en acciones colectivas mediado completamente por la rabia hacia la desigualdad en Chile y las percepciones de eficacia en las acciones del movimiento social.

Abstract This study aims to analyze, in the context of October-19 in Chile, the mediating role of group efficacy on social movement actions and anger directed towards inequality in Chile in the relationship between social identification with social movements and participation in collective actions. The sample consists of 315 young Chileans, aged between 18 and 29. Our results indicate that there is an indirect effect of social identity with the social movement on participation in collective action mediated entirely by anger towards inequality in Chile and perceptions of efficacy in social movement actions.

Intervención de foco de brote de rabia animal en el municipio de Anapoima, Cundinamarca, Colombia, 2019 / Animal rabies outbreak intervention in the municipality of Anapoima, Cundinamarca, Colombia, 2019 / Intervenção do foco de surto de raiva animal no município de Anapoima, Cundinamarca, Colômbia, 2019

Objetivo: realizar la investigación y contención de brote de rabia animal en el perímetro del foco del caso índice del municipio de Anapoima. Métodos: estudio de investigación de brote con intervención del foco de índole retrospectivo, a partir de la confirmación del caso por laboratorio el 26 de abril de 2019. El equipo de respuesta inmediata departamental (conformado por tres médicos veterinarios, dos epidemiólogos y una enfermera), fue activado y desarrolló acciones en la zona de foco definido en 5 km alrededor de la vivienda del caso índice (vereda Panamá, sector Gallinazos, finca La Esmeralda del municipio de Anapoima). Tanto la población humana como la de gatos y perros de la zona fueron caracterizadas, se determinan factores de riesgo, se controló la población animal con vacunación y gestión del riesgo. Resultados: fueron visitadas 26 veredas que correspondieron al total del foco con 3.185 viviendas y se censaron 3.489 personas, de las cuales el 47% eran de sexo femenino y el 53% de sexo masculino. La cobertura de vacunación canina para control en el foco fue de 88% y la felina del 83%. Conclusiones: se confirma rabia en su ciclo silvestre en el departamento de Cundinamarca, con transmisión de animal silvestre a animal doméstico, con alto riesgo de transmisión a los humanos.

Objective: conduct the research and containment of the animal rabies outbreak in the focus perimeter of the index case in the municipality of Anapoima. Methods: outbreak investigation study with retrospective focus intervention, starting with laboratory confirmation of the case on April 26, 2019. The departmental immediate response team (made up of three veterinarians, two epidemiologists, and a nurse) was activated and carried out actions in the focus area defined as 5 km surrounding the dwelling of the index case (Panama township, Gallinazos sector, La Esmeralda farm, municipality of Anapoima). Both the human population, cats and dogs in the area were characterized. Risk factors were determined, the animal population was controlled with vaccination and risk management. Results: 26 townships were visited which corresponded to the total of the focus point with 3,185 dwellings. 3,489 people underwent a census, of which 47% were female, and 53% were male. The canine vaccine coverage to exercise control in the focus area was 88% with 83% for feline vaccination. Conclusions: rabies was confirmed in the forest cycle in the department of Cundinamarca, with transmission from forest animals to domestic animals, with a high risk of transmission to humans.

Objetivo: realizar a pesquisa e contenção do surto de raiva animal no perímetro do foco do caso índice no município de Anapoima. Métodos: estudo retrospectivo de pesquisa de surto com intervenção focal, baseado na confirmação laboratorial do caso em 26 de abril de 2019. A equipe departamental de resposta imediata (composta por: três veterinários, dois epidemiologistas e uma enfermeira), foi acionada e realizou ações na zona foco definida em 5 km ao redor da casa do caso índice (aldeia Panamá, setor Gallinazos, fazenda La Esmeralda do município de Anapoima). População humana, gatos e cães da área foram caracterizados, determinaram-se os fatores de risco, a população animal foi controlada com vacinação e gestão de risco. Resultados: foram visitadas 26 aldeias que correspondiam ao total do foco com 3.185 domicílios e 3.489 pessoas cadastradas, sendo 47% do sexo feminino e 53% do sexo masculino. A cobertura da vacinação canina para controle no foco foi de 88% e felina 83%. Conclusão: a raiva no seu ciclo silvestre é confirmada no departamento de Cundinamarca, com transmissão de animais silvestres para animais domésticos, com alto risco de transmissão para humanos.

Vigilancia de las agresiones causadas por animales susceptibles a rabia, una lesión de causa externa evitable, Casanare-Colombia, 2012-2016 / Surveillance to Aggressions by Rabies-Susceptible Animals, a Preventable Injury Caused by External Causes in Casanare (Colombia) 2012-2016 / Vigilância de agressões causadas por animais susceptíveis à raiva, uma lesão de causa externa evitável, Casanare-Colômbia, 2012-2016

Resumen La vigilancia, prevención y control de la rabia es una prioridad para la salud pública, especialmente, la rabia transmitida por perros (variante 1) y la rabia silvestre. El objetivo de esta investigación fue describir el comportamiento epidemiológico del evento entre 2012-2016 en el departamento de Casanare-Colombia. El estudio fue descriptivo, retrospectivo a partir de la notificación de casos al Sistema Nacional de Vigilancia en Salud Pública-Sivigila-. Variables a estudio: a) características sociodemográficas, b) agresión/contacto, c) exposición, d) inmunización y e) tratamiento. Aplicación de estadística descriptiva y cálculo de indicadores de vigilancia. Datos analizados con el paquete estadístico Epi-Info 7.2.2.2™. El 98.5 % (6036/6131) de casos procedentes de Casanare, distribuidos en 2012 (1229; 20.4 %), 2013 (1180;19.5 %), 2014 (1227; 20.3 %); 2015 (1153;19.1 %), 2016 (1247; 20.7 %); del 72.5 % del área urbana; 55.4 % del sexo masculino; edad promedio 24.3(± 20.7) valor mínimo 0.01 y valor máximo 97 años; 40.7 % de 5-19 años; 37.5 % estudiantes, 13.3 % amas de casa, 5.4 % menores de edad, 19.4 % con registro de ocupación, de ellos, 29.8 % (349/1172) agricultores; 1.5 % hospitalizados; todos vivos. El 80.6 % (721/894) de exposición leve tuvieron tratamiento adecuado, 4.3 % (37/894) se aplicó suero antirrábico; 91.1 % (653/717) de exposición grave con tratamiento adecuado; 26.7 % (1611/6036) de los casos estuvieron expuestos al virus de la rabia. Incidencia por 100.000 habitantes de exposición rábica: 2012-2016 (344.8); tasa de hospitalización 11.5/100 000. Se evidencia el incumplimiento del indicador de tratamiento adecuado, es decir, en los casos clasificados como exposición leve, aplicar únicamente cinco dosis de vacuna antirrábica (esquema de vacunación completo); y, en exposición grave, aplicar el esquema de vacunación completo y suero antirrábico. Se recomienda continuar/mantener las actividades de vigilancia del evento y los esfuerzos para evitar la transmisión de la rabia humana.

Abstract Surveillance, prevention and control of the rabies are a priority in public health, especially when it is transmitted by dogs (variant 1) and by wild animals. This research intended to describe the epidemiological behavior of these events during 2012-2016 in the Casanare Province (Colombia). It is a retrospective descriptive study based on the cases reported to the National Surveillance System for Public Health -Sivigila-. The study variables are: a) socio-demographics; b) aggression/contact; c) exposure; d) immunization; and e) treatment. Application of descriptive statistics and calculation of surveillance indicators: Data were analyzed using the statistical software Epi-Info 7.2.2.2™. The 98.5% (6036/6131) of the cases in Casanare were distributed as follows: 2012 (1229; 20.4%), 2013 (1180;19.5%), 2014 (1227; 20.3%); 2015 (1153;19.1%), 2016 (1247; 20.7%). Out of them 72.5% were in the urban area; 55.4% were male subjects; average age was 24.3 (± 20.7) being the lowest age 0.01 and the highest 97 years and 40.7% were in the 5-19-year range; 37.5% were students, 13.3% housewives, 5.4% minors, and 19.4% had reported occupation (to wit, 29.8% (349/1172) farmers; 1.5% hospital patients; all of them alive). The 80.6% (721/894) with mild exposure were appropriately treated, 4.3% (37/894) were administered anti-rabies serum. The 91.1% (653/717) with serious exposure were appropriately treated. The 26.7% (1611/6036) of the cases were exposed to the rabies virus. Incidence per each 100,000 inhabitants exposed to the rabies was as follows: 2012-2016, 344.8 cases; hospitalization rate 11.5/100,000. It was found a non-compliance with the appropriate treatment indicator, i.e., the cases rated as mild exposure required administering only five doses of rabies vaccine (full vaccine scheme), and the cases rated as serious exposure required administering the full vaccine scheme plus the anti-rabies serum. It is recommended to keep/maintain the event surveillance activities as well as the efforts to prevent the human rabies transmission.

Resumo A vigilância, prevenção e controle da raiva são prioridade para a saúde pública, especialmente a raiva transmitida por cães (variante 1) e a raiva selvagem. O objetivo desta pesquisa foi descrever o comportamento epidemiológico do evento entre 2012-2016 no departamento de Casanare, Colômbia. O estudo foi descritivo, retrospectivo a partir da notificação de casos no Sistema Nacional de Vigilância em Saúde Pública-Sivigila-. Variáveis em estudo: a) características sociodemográficas, b) agressão/contato, c) exposição, d) imunização e e) tratamento. Aplicação de estatística descritiva e cálculo de indicadores de vigilância. Dados analisados com o pacote estatístico Epi-Info 7.2.2.2™. 98.5% (6036/6131) de casos procedentes de Casanare, distribuídos em 2012 (1229; 20.4%), 2013 (1180; 19.5%), 2014 (1227; 20.3%); 2015 (1153; 19.1%), 2016 (1247; 20.7%); de 72.5% da área urbana; 55.4% do sexo masculino; média de idade 24.3(±20.7) valor mínimo 0.01 e valor máximo 97 anos; 40.7% dos 5-19 anos; 37.5% estudantes, 13.3% donas de casa, 5.4% menores de idade, 19.4% com histórico de ocupação, sendo 29.8 % (349/1172) agricultores; 1.5% hospitalizados; todos vivos. 80.6% (721/894) de exposição leve tiveram tratamento adequado, 4.3% (37/894) foi aplicado soro antirrábico; 91.1% (653/717) de exposição grave com tratamento adequado; 26.7% (1611/6036) dos casos estiveram expostos ao vírus da raiva. Incidência por 100.000 habitantes em exposição à raiva: 2012-2016 (344.8); taxa de hospitalização 11.5/100 000. Evidencia-se desatenção do indicador de tratamento adequado, ou seja, nos casos classificados como exposição leve, aplicar unicamente cinco doses de vacina antirrábica (esquema de vacinação completo); e, em exposição grave, aplicar o esquema de vacinação completo e soro antirrábico. Recomenda-se continuar/manter as atividades de vigilância do evento e os esforços para evitar a transmissão da raiva humana.

Persistencia de la reemergencia de la rabia canina en el sur del Perú / Persistence of the reemergence of canine rabies in south Peru

En el siglo pasado la rabia canina fue endémica en nuestro país. En la década de los 1990's, el Perú implementó el plan de acción para la eliminación de la rabia urbana por recomendación de la Organización Panamericana de la Salud, logrando un control exitoso de la rabia. Pese a los esfuerzos desplegados, Puno mantuvo focos endémicos persistentes, y en el 2014, Arequipa reportó el primer evento de reintroducción de rabia urbana en Latinoamérica. El brote de rabia se intensificó en los últimos años en Arequipa, Puno y Cusco, con 19 casos de rabia canina el 2015, a 59 casos el 2016, continuando el 2017 con 47 casos, el 2018 con 46, y hasta julio del 2019, 17 casos. Así, hubo reintroducción de la rabia canina, estableciendo una situación de alta endemicidad no controlada. En el presente reporte, abordamos el contexto y persistencia de la reemergencia de la rabia canina en el sur del Perú.

In the last century, canine rabies was endemic in our country. In the 1990s, Peru implemented the action plan for the elimination of urban rabies on the recommendation of the Pan American Health Organization, achieving successful rabies control. Despite the efforts made, Puno maintained persistent endemic foci, and in 2014, Arequipa reported the first event of reintroduction of urban rabies in Latin America. The outbreak of rabies intensified in recent years in Arequipa, Puno and Cusco, with 19 cases of canine rabies in 2015, to 59 cases in 2016, continuing 2017 with 47 cases, 2018 with 46, and until July 2019, 17 cases Thus, there was reintroduction of canine rabies, establishing a situation of uncontrolled high endemicity. In this report, we address the context and persistence of the re-emergence of canine rabies in south Peru.

[Molecular characterization of the rabies virus' nucleoprotein in dogs from Arequipa, Peru]. / Caracterización molecular de la nucleoproteína del virus de la rabia en canes procedentes de Arequipa, Perú.

OBJECTIVE: . To characterize the nucleoprotein (N) and establish the origin of the rabies virus in dogs coming from Arequipa. MATERIALS AND METHODS.: Thirty samples of nervous tissue from the departments of Arequipa and Puno were analyzed. Total RNA was extracted from the samples and cDNA was synthesized to amplify the nucleoprotein gene, sequence it, and perform bioinformatics analysis. RESULTS: . A defined group was formed with respect to the external group (European bat lyssavirus). This group was classified into two subgroups, one constituted by samples coming from Puno and Arequipa (subgroup A), and another one by samples from Puno (subgroup B), exhibiting a nucleotide identity of 99.9% in subgroup A. This group was classified in two subgroups, one constituted by samples coming from Puno and Arequipa (subgroup A), and another one by samples from Puno (subgroup B), observing a nucleotide identity of 99.9% in subgroup A. CONCLUSIONS.: The groupings of viral sequences show that the cases of canine rabies reported in Arequipa are the result of the expansion of canine rabies from the endemic region of Puno.

OBJETIVOS.: Caracterizar la nucleoproteína (N) y establecer el origen del virus de la rabia en canes procedentes de Arequipa. MATERIALES Y MÉTODOS.: Se analizaron 30 muestras de tejido nervioso procedentes de los departamentos de Arequipa y Puno. Se extrajo el ARN total de las muestras y se sintetizó ADNc para amplificar el gen de la nucleoproteína, secuenciarlo y realizar el análisis bioinformático. RESULTADOS.: Se obtuvo la formación de un grupo definido con respecto al grupo externo (European bat lyssavirus). Este grupo fue clasificado en dos subgrupos, uno constituido por muestras procedentes de Puno y Arequipa (subgrupo A), y otro por muestras de Puno (subgrupo B), observándose una identidad nucleotídica de 99,9% en el subgrupo A. CONCLUSIONES.: Los agrupamientos de las secuencias virales muestran que los casos de rabia canina notificados en Arequipa son el resultado de la expansión de rabia canina procedente de la región endémica de Puno.

Caracterización molecular de la nucleoproteína del virus de la rabia en canes procedentes de Arequipa, Perú / Molecular characterization of the rabies virus' nucleoprotein in dogs from Arequipa, Peru

RESUMEN Objetivos. Caracterizar la nucleoproteína (N) y establecer el origen del virus de la rabia en canes procedentes de Arequipa. Materiales y métodos. Se analizaron 30 muestras de tejido nervioso procedentes de los departamentos de Arequipa y Puno. Se extrajo el ARN total de las muestras y se sintetizó ADNc para amplificar el gen de la nucleoproteína, secuenciarlo y realizar el análisis bioinformático. Resultados. Se obtuvo la formación de un grupo definido con respecto al grupo externo (European bat lyssavirus). Este grupo fue clasificado en dos subgrupos, uno constituido por muestras procedentes de Puno y Arequipa (subgrupo A), y otro por muestras de Puno (subgrupo B), observándose una identidad nucleotídica de 99,9% en el subgrupo A. Conclusiones. Los agrupamientos de las secuencias virales muestran que los casos de rabia canina notificados en Arequipa son el resultado de la expansión de rabia canina procedente de la región endémica de Puno.

ABSTRACT Objective . To characterize the nucleoprotein (N) and establish the origin of the rabies virus in dogs coming from Arequipa. Materials and Methods. Thirty samples of nervous tissue from the departments of Arequipa and Puno were analyzed. Total RNA was extracted from the samples and cDNA was synthesized to amplify the nucleoprotein gene, sequence it, and perform bioinformatics analysis. Results . A defined group was formed with respect to the external group (European bat lyssavirus). This group was classified into two subgroups, one constituted by samples coming from Puno and Arequipa (subgroup A), and another one by samples from Puno (subgroup B), exhibiting a nucleotide identity of 99.9% in subgroup A. This group was classified in two subgroups, one constituted by samples coming from Puno and Arequipa (subgroup A), and another one by samples from Puno (subgroup B), observing a nucleotide identity of 99.9% in subgroup A. Conclusions. The groupings of viral sequences show that the cases of canine rabies reported in Arequipa are the result of the expansion of canine rabies from the endemic region of Puno.

Caracterización molecular de la nucleoproteína del virus de la rabia en canes procedentes de Arequipa, Perú

Objective. To characterize the nucleoprotein (N) and establish the origin of the rabies virus in dogs coming from Arequipa. Materials and Methods. Thirty samples of nervous tissue from the departments of Arequipa and Puno were analyzed. Total RNA was extracted from the samples and cDNA was synthesized to amplify the nucleoprotein gene, sequence it, and perform bioinformatics analysis. Results. A defined group was formed with respect to the external group (European bat lyssavirus). This group was classified into two subgroups, one constituted by samples coming from Puno and Arequipa (subgroup A), and another one by samples from Puno (subgroup B), exhibiting a nucleotide identity of 99.9% in subgroup A. This group was classified in two subgroups, one constituted by samples coming from Puno and Arequipa (subgroup A), and another one by samples from Puno (subgroup B), observing a nucleotide identity of 99.9% in subgroup A. Conclusions. The groupings of viral sequences show that the cases of canine rabies reported in Arequipa are the result of the expansion of canine rabies from the endemic region of Puno.