Historia de la rabia en Chile: tres tesis médicas / History of rabies in Chile: three medical theses

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.

Dog Population Rabies Immunity before a Mass Vaccination Campaign in Lima, Peru: Vulnerabilities for Virus Reestablishment.

Lima, Peru, has not had a case of canine rabies since 1999. However, Lima remains at risk of rabies reintroduction due to the free movement of dogs from nearby rabies-endemic areas. In Latin America, rabies vaccination campaigns must reach 80% of dogs to halt transmission, but estimates of vaccine coverage are often unavailable, unreliable, or inaccurate. Quantifying virus neutralizing antibodies (VNA) allows monitoring of the immunological status of the canine population, evaluation of the degree of humoral protection to the virus, and assessing, partially, the population response to vaccination. We evaluated the dog population's immunity level against the rabies virus before a mass vaccination campaign in Lima. We collected 141 canine blood samples in the district of Surquillo and quantified rabies virus neutralizing antibody titers using the fluorescent antibody virus neutralization test). We surveyed dogs owners to reconstruct canine vaccination histories. Among dogs previously vaccinated, 73.9% exceeded the seroconversion threshold of > 0.5 IU/mL. Among all dogs, only 58.2% reached the titer limit for seroconversion. Dogs ≤ 1 year old constituted 26.2% of the total canine population and had lower levels of VNA than dogs > 1 year old (χ2 = 9.071; P = 0.028). Importantly, dogs vaccinated with single-pathogen vaccines had higher levels of VNA than those who received combined-pathogen vaccines (χ2 = 7.721; P = 0.005). We provide an important and timely glimpse to the immunity status of the dog population in urban areas of Lima, a metropolis near a dog rabies-endemic region.

RABIES VIRUS SEROSURVEY OF THE SMALL INDIAN MONGOOSE (URVA AUROPUNCTATA) ACROSS MULTIPLE HABITATS IN PUERTO RICO, 2014-21.

The small Indian mongoose (Urva auropuncata) is a rabies reservoir in Puerto Rico and accounts for over 70% of reported animal rabies cases annually. The presence of rabies virus-neutralizing antibodies (RVNA) is often used as a tool to measure exposure to rabies virus in wildlife populations. We conducted a serosurvey of mongooses at 11 sites representing six habitat types across Puerto Rico. We collected a serum sample from 464 individual mongooses during 2014-21. Overall, 80/464 (17.0%; 95% confidence interval, 14.1-20.9%; 55 male, 23 female, and two sexes not recorded) of individual mongooses sampled across all habitats were RVNA positive. The geometric mean (SD) RVNA titer for 80 unique seropositive animals was 0.58 (2.92) IU/mL. Our models indicated that the probability of mongooses being RVNA seropositive mostly varied by habitat, with some influence of sex in the individual-level analyses. Population-level RVNA seroprevalence is dynamic in mongoose populations, but these data may shed light on rabies virus transmission across regions to help inform rabies management activities in Puerto Rico.

Rabies, the cause of fatal encephalitis.

To describe the clinical progression and medical protocols applied in a 41 year old man who was bited by a bat three months before. The patient did not ask for medical care until acute tremor and pain in the right thoracic limb and hydro-phobia started. For a history of a wild animal bite associated with a unique clinical condition, we suspected of rabies encephalitis, confirming the diagnostic by pathology after his death. This case ocurred in Guadalajara, Jalisco, México, in April, 2022. The last case of human rabies reported in Jalisco secondary to bat bite was almost 30 years ago. As an uncomon disease, medical personnel and facilities should be prepared to attend this sort of cases after clinical suspicion. For the present case, the medical history was the key for diagnosis. Rabies is a disease caused by the neurotropic virus belonging to the Rhabdoviridae family whose prognosis is bleak, with mortality close to 100% and therapeutic options limited. This case emphasizes the high mortality of rabies virus infection and the importance of increasing awareness and education to the public in general, with regard to applying the vaccine as post-exposure prophylaxis.

Sf9 Cells Metabolism and Viability When Coinfected with Two Monocistronic Baculoviruses to Produce Rabies Virus-like Particles.

This work aimed to describe the dynamics of the Sf9 insect cells death and primary metabolism when this host is infected simultaneously by two recombinant baculoviruses (BV) expressing rabies glycoprotein (BVG) and matrix protein (BVM) genes to produce rabies virus-like particles (VLP) at different multiplicities of infection (MOI). Schott flasks essays covering a wide range of MOI for both BV were performed. Viable cell density, cell viability, glucose, glutamine, glutamate, lactate, ammonium, and rabies proteins concentrations were monitored over the infection phase. The expression of both recombinant proteins was not limited by glucose, glutamine, and glutamate in a broad MOI (pfu/cell) range of BVG (0.15-12.5) and BVM (0.1-5.0) using SF900 III serum free culture medium. Death phase initiation and the specific death rate depend on BV MOI. The wave pattern of nutrient/metabolite profiles throughout the viral infection phase is related to the baculovirus lytic cycle. The optimal MOIs ratio between BVG (2.5-4.5) and BVM (1.0-3.0) for maximum protein expression was defined. The produced rabies VLP sizes are close to 78 nm. In general, these work outputs bring a better understanding of the metabolic performance of Sf9 cells when infected by BV for producing VLP, and specifically, for progressing in a rabies VLP vaccine development.

Producción de vacunas en el antiguo Instituto Bacteriológico de Chile / Vaccine production at the ancient Bacteriological Institute of Chile

Se relata el nacimiento, auge y decadencia, de la producción de vacunas en el antiguo Instituto Bacteriológico de Chile, desde su fundación en 1929 hasta su fin en 1980, por boca de quien fuera por diecisiete años primero encargado de la fabricación de vacunas bacterianas y luego director de la institución. Las vicisitudes de la vacuna BCG, la introducción del toxoide tetánico, el fin de la vacuna antivariólica y el triunfo de vacuna antirrábica de Fuenzalida y Palacios, se narran a menudo con comentarios de quienes participaron en estos hechos.

The birth, rise and decline, of vaccine production at the Bacteriological Institute of Chile is recounted by mouth of who was for seventeen years first in charge of manufacturing and then director of the institution. The vicissitudes of the BCG vaccine, the introduction of tetanus toxoid, the end of smallpox vaccine, and the triumph of the rabies vaccine are often related with comments from those who participated in the events.

Heterogeneity in dog population characteristics contributes to chronic under-vaccination against rabies in Guatemala.

Guatemala has held dog rabies mass vaccination campaigns countrywide since 1984, yet the virus remains endemic. To eliminate dog-mediated human rabies, dog vaccination coverage must reach at least 70%. The Guatemala rabies program uses a 5:1 human:dog ratio (HDR) to estimate the vaccination coverage; however, this method may not accurately reflect the heterogeneity of dog ownership practices in Guatemalan communities. We conducted 16 field-based dog population estimates in urban, semi-urban and rural areas of Guatemala to determine HDR and evaluate the standard 5:1. Our study-derived HDR estimates varied from 1.7-11.4:1 (average 4.0:1), being higher in densely populated sites and lowest in rural communities. The community-to-community heterogeneity observed in dog populations could explain the persistence of rabies in certain communities. To date, this is the most extensive dog-population evaluation conducted in Guatemala, and can be used to inform future rabies vaccination campaigns needed to meet the global 2030 rabies elimination targets.

Vigilancia, prevención y control de enfermedades zoonóticas de notificación obligatoria en animales de la Ciudad de Buenos Aires: abril 2022 / Surveillance, prevention and control of zoonotic diseases of compulsory notification in animals of the City of Buenos Aires. April 2022

Informe sobre vigilancia clínica y observación de animales mordedores, vigilancia de laboratorio y detección de virus ràbico en muestras. Se describen también acciones de vigilancia, y de prevención y control de otras enfermedades zoonòticas de notificación obligatoria, realizadas por el Instituto de Zoonosis Luis Pasteur y la Comisión de Zoonosis del Consejo Profesional de Médicos Veterinarios, de la Ciudad de Buenos Aires.

Rabies in a previously vaccinated horse: case report / Raiva em equino previamente vacinado: relato de caso

Rabies is an acute, progressive, and fatal encephalomyelitis caused by a Lyssavirus. Horses affected by the disease may be a source of infection for humans. A rapid diagnosis is crucial to initiate a prompt and adequate infection control and public health measures. This manuscript reports the case of a 4-year-old gelding, 370 kg, healthy and routinely used for veterinary teaching purposes that developed rabies although vaccinated against it. Clinical signs included lameness, ataxia, muscle tremors, decubitus and pedalling, progressive paralysis, profuse salivation, teeth grinding, and whinnying. After 4 days, the animal was euthanised and definitive diagnosis was achieved through an animal inoculation test which was positive. Complementary findings included encephalomyelitis with perivascular cuffs and identification of Negri bodies in various areas of the brain.(AU)

A raiva é uma encefalomielite aguda, progressiva e fatal causada por um Lyssavirus. Cavalos acometidos pela doença podem ser uma fonte de infecção para homens. O rápido diagnóstico é crucial para que iniciem medidas de controle de infecção e de saúde pública adequadas. Esse manuscrito descreve o caso clínico de um equino de 4 anos, macho castrado, 370 kg, hígido, usado nas práticas didáticas da escola de veterinária que desenvolveu quadro clínico de raiva, apesar de ser vacinado contra a referida doença. Os sinais clínicos incluíram claudicação, ataxia, tremores musculares, decúbito e movimentos de pedalagem, paralisia progressiva, salivação profusa, bruxismo e relinchos. Após 4 dias, o animal foi eutanasiado e o diagnóstico definitivo foi feito através de prova biológica positivada. Os achados complementares incluíram os achados histopatológicos nos quais destacam-se encefamolielite com manguitos perivasculares e identificação de Corpúsculos de Negri em várias áreas do cérebro.(AU)

Vacunacion antirrábica en caninos y felinos de la Ciudad de Buenos Aires: Año 2021 / Rabies vaccination in Buenos Aires City: Year 2021

El objetivo del presente informe es exponer la situación actual de la vacunación antirrábica de la Ciudad de Buenos Aires, con el fin de realizar una planificación estratégica de prevención y control de la enfermedad. Se utilizaron datos sobre vacunación realizada por veterinarias privadas estimados a partir de la venta de talonarios por parte del Consejo Profesional de Médicos Veterinarios (CPMV); así como la vacunación realizada por los efectores públicos de salud: Instituto de Zoonosis Luis Pasteur (IZLP) y Mascotas de la Ciudad (MC).

Critical analysis of the cat's role in the epidemiology of rabies / Análise crítica do papel do gato na epidemiologia da raiva

Rabies is a fatal zoonosis of world importance that in many aspects is still neglected. Due to national vaccination campaigns for dogs and cats, there has been a drastic reduction in the number of cases of human rabies transmitted by dogs. However, due to species peculiarities, the cat can act as an important link in the epidemiological chain of rabies. Thus, this study aimed to evaluate Brazilian data on canine and feline rabies surveillance to determine the importance of the cat in the current context of rabies epidemiology. In Brazil, recent cases of ORCID ID 1. https://orcid.org/0000-0003-0764-5234 2. https://orcid.org/0000-0002-6569-749X 3. https://orcid.org/0000-0003-2999-323X human rabies transmitted by cats have been reported, showing the importance of this species in the epidemiological chain of the disease.(AU)

A raiva é uma zoonose fatal de importância mundial que em muitos aspectos ainda é negligenciada. Devido às campanhas nacionais de vacinação de cães e gatos, houve uma redução drástica no número de casos de raiva humana transmitida por cães. Contudo, por peculiaridades da espécie, o gato doméstico pode atuar como um elo importante na cadeia epidemiológica da raiva. Posto isto, objetivou-se avaliar os dados brasileiros da vigilância da raiva canina e felina para se determinar a importância do gato no contexto atual da epidemiologia da raiva. No Brasil, casos recentes de raiva humana transmitida por gatos foram relatados, evidenciando a importância dessa espécie na cadeia epidemiológica da doença.(AU)

The New Face of Human Rabies in Mexico, What's Next After Eradicating Rabies in Dogs.

In pre-Hispanic Mexico, dogs were not identified as an important source of rabies. We know from codexes and chronicles of the conquerors that at that time, rabies cases in humans and domestic animals were caused by local wildlife species such as bats. Canine-rabies virus variant seems to have arrived with Europeans. The first documented case of canine rabies in the Americas is found in Mexico in the Annals of the Holy Inquisition (16th century). During Mexico's independence, cases were frequently reported. In the 19th century the first attempts to control human rabies were made through sanitary measures such as elimination of rabid dogs and applying postexposure vaccination. During the first half of the 20th century, the efficacy of canine vaccination to prevent human rabies was established. However, in Mexico, despite reports of numerous human cases (>70/year), canine vaccination did not have enough coverage. It was only during the 1990s that Mexico made a serious commitment to eliminate dog-transmitted human rabies. Since the beginning, vaccination campaigns have been free and massive. Coverage increased from 7,100,000 doses in 1990 to more than 18,000,000 since 2017. This culminated in the elimination of dog-mediated human rabies cases since 2006. Subsequently, the epidemiology of rabies had changed. Nowadays, it is wildlife species (mainly bats and skunks) that are the source of human rabies. As a mega-biodiverse country Mexico has numerous wildlife species with potential to transmit rabies virus. Thus it is paramount to remain vigilant with respect to canine vaccination campaigns and to promote rabies research in wildlife.

Evaluation of maternal antibodies against rabies in puppies and kittens in Mazandaran Province, Iran / [Avaliação de anticorpos maternos contra a raiva em filhotes de cachorro e gatos na província de Mazandaran, Irã]

Rabies is a critical zoonotic high-risk disease, which has emerged as an important public-health problem. There are limited investigations that explore maternally derived antibody (MDA) in puppies and kittens from around the world. Furthermore, there is no such research in any province of Iran. This study measured the serum level of MDA in 10 puppies and their vaccinated bitches (n=20), 10 puppies and their unvaccinated bitches (n=20), 10 kittens with vaccinated queens and 10 kittens with unvaccinated queens. Antibodies against rabies were measured using quantitative, enzyme-linked immunosorbent assay (ELISA). Our results showed that 90% (9 out of 10) of puppies from vaccinated bitches were positive for anti-rabies antibodies, while test results for all puppies from non-vaccinated bitches were negative (P=0.001). Moreover, puppies' titers were significantly higher in the vaccinated group than the non-vaccinated group (P=0.003). There was a similar condition between vaccinated and non-vaccinated bitches (P=0.008). Although kittens' titers were significantly higher in the vaccinated group than the non-vaccinated group (P=0.03), only 20 percent of the kittens with vaccinated queens showed positive results, while all kittens from non-vaccinated queens were negative for anti-rabies antibodies (P=0.137).

A raiva é uma doença zoonótica crítica de alto risco, que surgiu como um importante problema de saúde pública. Há investigações limitadas que exploram anticorpos derivados da maternidade (MDA) em filhotes e gatos de todo o mundo. Além disso, não existe tal pesquisa em nenhuma província do Irã. Este estudo mediu o nível sérico do MDA em 10 filhotes e suas cadelas vacinadas (n=20), 10 filhotes e suas cadelas não vacinadas (n=20), 10 filhotes com rainhas vacinadas e 10 filhotes com rainhas não vacinadas. Os anticorpos contra a raiva foram medidos usando o ensaio quantitativo de imunoabsorção enzimática (ELISA). Nossos resultados mostraram que 90% (9 em cada 10) dos filhotes de cadelas vacinadas foram positivos para anticorpos anti-rábicos, enquanto os resultados dos testes para todos os filhotes de cadelas não vacinadas foram negativos (P=0,001). Além disso, os títulos dos filhotes foram significativamente mais altos no grupo vacinado do que no grupo não vacinado (P=0,003). Havia uma condição similar entre cadelas vacinadas e não vacinadas (P=0,008). Embora os títulos dos filhotes fossem significativamente mais altos no grupo vacinado do que no grupo não vacinado (P=0,03), apenas 20% dos filhotes com rainhas vacinadas apresentaram resultados positivos, enquanto todos os filhotes de rainhas não vacinadas foram negativos para anticorpos anti-rábicos (P=0,137).

Profilaxia pós-exposição antirrábica: evidências sobre pré-medicação, administração de soro e esquema vacinal / Anti-rabies post-exposure prophylaxis: evidence on premedication, serum administration and vaccination scheme

A raiva é uma zoonose transmitida ao homem pela inoculação do vírus rábico contido na saliva do animal infectado. A infecção por este vírus causa encefalite aguda com índice de letalidade próximo a 100%.Embora não haja cura para a raiva clínica, a doença é facilmente evitável pelo fornecimento oportuno de profilaxia adequada. A profiaxia antirrábica humana pode ser realizada pré (PrEP) ou pós (PEP) exposição potencial ao virus da raiva. As tecnologias utilizadas para esta profilaxia são as vacinas e os soros. Há diversos esquemas de profilaxia PrEP e PEP utilizados no mundo. No Brasil, há ainda indicação de administração de medicações prévias à infiltração de soro heterólogo, a fim de mitigar potenciais reações anafiláticas. A administração concomitante de vacinas, imunoglobulinas e pré-medicação para hipersensibilidade (anti-histamínicos e corticoides) através da via intramuscular é uma prática instituída no contexto municipal de Campo Grande - MS, ocasionando problemas recorrentes de falta de sítios para administração completa da profilaxia, especialmente em crianças. Quais os cuidados necessários durante a realização de Profilaxia Pós Exposição Antirrábica em situações de limitação de vias de administração e risco de hipersensibilidade? Após análise do conteúdo, a fim de concluir a revisão em tempo oportuno para a tomada de decisão da gestão, a equipe de pesquisa deliberou pela extração de dados somente dos estudos secundários. Os principais achados estão sumarizados em infográfico no APÊNDICE A. É indicada a modernização do Procedimento Operacional Padrão vigente na prefeitura de Campo Grande. A substituição das práticas relacionadas à pré-medicação IM, vacinação IM e administração de soro IM é cientificamente embasada e elimina o problema que originou a questão de pesquisa desta revisão, apresentando benefícios para gestão, profissionais e usuários do SUS.

A comparative review of serological assays for the detection of rabies virus-specific antibodies.

Rabies is a major public health problem with a fatality rate close to 100%, caused by a virus of the Lyssavirus genus, of which rabies virus (RABV) is the prototype. Nonetheless, the complete prevention can be achieved by the induction of neutralizing antibodies by pre- or post-exposure prophylaxis. According to the world health organization (WHO) and World Organization for animal health (OIE), serum titers of rabies virus neutralizing antibodies (RVNA) that are higher or equal to 0.5 international units (IU)/ml indicate adequate immune response after vaccination against rabies. Currently, RFFIT and FAVN are the gold standard tests recommended by both WHO and OIE for detecting and quantitating RVNA in biological samples from individuals or animals previously vaccinated and/or subjects suspected of having been infected by RABV. Although the tests RFFIT and FAVN are efficient, they are time-consuming, labor-intensive manual tests and not cost-effective for routine use. Following the previously mentioned, approaches with alternative methods have been developed to detect RVNA or rabies-specific antibodies in human or animal serum, but with variable success. This work summarizes the advances in the serological assays for the detection of neutralizing antibodies or rabies antibodies and assesses the individual immune status after vaccination against rabies, as well as the mechanisms of RABV neutralization mediated by antibodies. Therefore, the main alternative methods for the determination of RABV or rabies-specific antibodies are exposed, with promising results, besides being easy to execute, of low cost, and representing a possibility of being applied, according to the proposal of each test to the network of Rabies Surveillance Laboratories.

Human rabies post-exposure prophylaxis: a review of the treatment of accidents involving domestic cats / Profilaxia pós-exposição da raiva humana: uma revisão dos tratamentos envolvendo gatos domésticos

Rabies is an anthropozoonosis that presents approximately 100% lethality and expensive preventive assistance. Many human post-exposure anti-rabies treatments indicated for people at risk of exposure to rabies virus, usually due to some aggression by a mammalian animal, are instituted annually. This study aimed to evaluate the initial care of post-exposure prophylaxis of human rabies in Belo Horizonte between 2007 and 2016, involving accidents with domestic cats. It was found 71.1% agreement between the treatments instituted by health services and the protocol of the Ministry of Health. Treatments classified as insufficient totaled 18.3% and excessive, 10.6%. The animals were healthy in 68% and observable in 68.4% of the cases. Treatments involving the use of anti-rabies vaccine totaled 87.7%. The most frequent treatment adopted by the health services was observing the animals associated with the human anti-rabies vaccination in 56.7% of the cases. Imperfections in the filling of the notifications must be revised to enable improvements for future analyses. As for human prophylactic anti-rabies care, forming a multidisciplinary health team including veterinarians would be well on the way to improving the service offered.(AU)

A raiva é uma antropozoonose que apresenta aproximadamente 100% de letalidade e alto custo na assistência pre-ventiva. É instituído anualmente, um elevado número de tratamento antirrábico humano pós-exposição, o qual é indicado para pessoas que se encontram sob risco de exposição ao vírus rábico, geralmente devido a alguma agressão por animal mamí-fero. Este trabalho teve como objetivo avaliar o atendimento inicial da profilaxia pós-exposição da raiva humana, em Belo Horizonte, entre os anos de 2007 a 2016, envolvendo acidentes com gatos domésticos. Encontrou-se 71,1% de concordân-cia entre os tratamentos instituídos pelos serviços de saúde e o protocolo do Ministério da Saúde. Tratamentos classificados como insuficientes totalizaram 18,3% e excessivos 10,6%. Os animais eram sadios em 68% e observáveis em 68,4% dos casos. Tratamentos que envolviam o uso de vacina antirrábica totalizaram 87,7%. O tratamento adotado pelos serviços de saúde com maior frequência foi a observação do animal associada à vacinação antirrábica humana em 56,7% dos casos. É necessário que imperfeições no preenchimento das notificações sejam revistas de forma a possibilitar melhorias para análises futuras. Quanto ao atendimento antirrábico profilático humano, a formação de uma equipe multidisciplinar de saúde com inclusão de médi-cos veterinários seria uma forma de aprimorar o serviço oferecido.(AU)

Descrição das notificações de atendimento antirrábico humano para profilaxia pós-exposição no Brasil, 2014-2019 / Descripción de notificaciones de atención antirrábica humana para la profilaxis post-exposición en Brasil, 2014-2019 / Description of human anti-rabies post-exposure prophylaxis care notifications in Brazil, 2014-2019

Objetivo: Analisar os atendimentos antirrábicos humanos de profilaxia pós-exposição no Brasil. Métodos: Estudo descritivo utilizando dados do Sistema de Informação de Agravos de Notificação no Brasil, de 2014 a 2019. Resultados: Foram notificados 4.033.098 atendimentos antirrábicos, com média de 672.183 ao ano. Houve maior percentual de atendimentos em pessoas do sexo masculino (n = 2.111.369; 52,4%), menores de 19 anos de idade (n = 1.423.433; 35,3%), residentes em área urbana (n = 3.386.589; 88,1%), agredidas por cães (n = 3.281.190; 81,5%) e com mordeduras (n = 3.575.717; 81,9%), principalmente em mãos e pés (n = 1.541.201; 35,3%). A conduta profilática mais frequente foi observação e vacina (n = 1.736.036; 44,2%). A conduta profilática foi adequada em 57,8% (n = 2.169.689) e inadequada em 42,2% (n = 1.582.411) dos casos. Conclusão: Apesar das condutas profiláticas adequadas, foram observadas indicações inadequadas que, quando insuficientes, podem acarretar casos de raiva humana e, quando desnecessárias, desperdícios, inclusive desabastecimento de imunobiológicos.

Objetivo: Analizar la atención antirrábica humana de profilaxis post exposición en Brasil, de 2014 a 2019. Métodos: Estudio descriptivo utilizando datos del Sistema de Información de Agravamientos de Notificación en Brasil, de 2014 a 2019. Resultados: Se notificaron 4.033.098 atendimientos antirrábicos, con un promedio de 672.183 al año. Hubo mayor porcentual de atención a personas del sexo masculino (n = 2.111.369; 52,4%), menores de 19 años (n = 1.423.433; 35,3%), residentes en área urbana (n = 3.386.589; 88,1%), agredidas por perros (n = 3.281.190; 81,5%) y con mordidas (n = 3.575.717; 81,9%), principalmente en las manos y pies (n = 1.541.201; 35,3%). La conducta profiláctica más frecuente fue la observación y vacuna (n = 1.736.036; 44,2%). La conducta profiláctica fue adecuada en 57,8% (n = 2.169.689) e inadecuada en 42,2% (n = 1.582.411) de los casos. Conclusión: A pesar de las conductas profilácticas adecuadas, se observaron indicaciones inadecuadas que, cuando insuficientes, pueden resultar en casos de rabia humana y, cuando desnecesarias, desperdicios, incluso desabastecimiento de inmunobiológicos.

Objective: To analyze human anti-rabies post-exposure prophylaxis notifications in Brazil. Methods: This was a descriptive study using data from the Notifiable Diseases Information System in Brazil, from 2014 to 2019. Results: A total of 4,033,098 anti-rabies medical consultations were notified, averaging 672,183 a year. Percentage care was higher among males (n = 2,111,369; 52.4%), those under 19 years old (n = 1,423,433; 35.3%), living in urban areas (n = 3,386,589; 88.1%), attacked by dogs (n = 3,281,190; 81.5%) and bitten (n = 3,575,717; 81.9%), mainly on the hands and feet (n = 1,541,201; 35.3%). The most frequent prophylactic procedure was observation plus vaccination (n = 1,736,036; 44.2%). Prophylactic procedure was appropriate in 57.8% (n = 2,169,689) of cases and inappropriate in 42.2% (n = 1,582,411) of cases. Conclusion: Although there were appropriate prophylactic procedures, we also found procedures that were inappropriate and which, when insufficient, can result in cases of human rabies and, when unnecessary, can result in waste, including shortage of immunobiological products.

Profilaxia antirrábica humana: um diagnóstico de riscos e desperdícios em Fortaleza, Ceará, 2009 a 2019 / Human anti-rabies prophylaxis: a diagnosis of risks and wastes in Fortaleza, Ceará, 2009 to 2019 / Profilaxia humana antirrábica: um diagnóstico de riesgos y desperdicios en Fortaleza, Ceará, 2009 a 2019

Introdução: A raiva é uma antropozoonose que acomete apenas mamíferos. Todo atendimento por acidente por animal potencialmente transmissor da raiva deve ser notificado. A correta indicação de uso dos insumos para o tratamento profilático deve obedecer às normas do Ministério da Saúde, para que não sejam prescritos tratamentos incorretos ou desnecessários. Objetivo: Avaliar o desperdício de imunobiológicos e os riscos aos quais pacientes foram expostos devido a prescrições inadequadas da profilaxia antirrábica humana no município de Fortaleza, Ceará, de 2009 a 2019. Método: Estudo descritivo com dados secundários consolidados das Fichas de Investigação de Atendimento Antirrábico Humano do Sistema de Informação de Agravos de Notificação (SINAN). Resultados: Foram incluídas 53.251 notificações de atendimento antirrábico humano nesse trabalho. Deste total, 43,8% prescrições foram incorretas, sendo que 55,7% ofereceram risco à vida do paciente e 42,9% envolveram excesso de vacinas. Além disso, 43,3% continham lacunas em seu preenchimento. Conclusão: Foi possível constatar o alto percentual de fichas de atendimento antirrábico humano com prescrições inadequadas e preenchimento incompleto, evidenciando a necessidade de capacitação dos profissionais de saúde. Sugere-se a inclusão de médicos veterinários nos serviços de Atenção Primária e Vigilância Epidemiológica para reduzir erros e otimizar a utilização dos recursos públicos.

Introduction: Rabies is an anthropozoonosis that affects only mammals. All care for an accident by a potential rabies-transmitting animal must be notified. The correct designation of supplies for prophylactic treatment in Brazil must comply with the norms of the Brazilian Ministry of Health, so that incorrect or unnecessary treatments are not prescribed. Objective: To evaluate the immunobiological waste and the risks to which patients were exposed due to inadequate prescriptions for human anti-rabies prophylaxis in the city of Fortaleza, Ceará, from 2009 to 2019. Methods: Descriptive study using with consolidated secondary data from the Investigation Forms of Human Anti-rabies Care of the Brazilian Notifiable Diseases Information System. Results: 53,251 notifications of human anti-rabies care were included in this study. Of this total, 43.8% prescriptions were incorrect, with 55.7% offering risk to the patient's life and 42.9% involving excess vaccines. In addition, 43.3% contained gaps on notification form filling. Conclusion: It was possible to verify high percentage of records of human anti-rabies care with inadequate prescriptions and incomplete form filling, showing the need of training of health professionals. It is suggested that veterinarians be included in Primary Care and Epidemiological Monitoring services to reduce errors and optimize the use of public resources.

Introducción: La rabia es una antropozoonosis que afecta únicamente a los mamíferos. Toda atención a un accidente por un animal potencialmente transmisor de la rabia debe ser notificada. La indicación correcta para el uso de insumos para el tratamiento profiláctico debe cumplir con las normas del Ministerio de Salud brasileño, para que no se prescriban tratamientos incorrectos O innecesarios. Objetivo: Evaluar el desperdicio de inmunobiológicos y los riesgos que estuvieron expuestos los pacientes por prescripción inadecuada de profilaxis antirrábica humana en la ciudad de Fortaleza, Ceará, de 2009 a 2019. Métodos: Estudio descriptivo con datos secundarios consolidados de los Formularios de Investigación de Atención Antirrábica Humana del Sistema de Información de Enfermedades de Declaración Obligatoria brasileño. Resultados: En este estudio se incluyeron 53.251 notificaciones de atención antirrábica en humanos. De este total, el 43,8% de las prescripciones fueron incorrectas, el 55,7% de las cuales ofrecieron riesgo para la vida del paciente y el 42,9% involucró un exceso de vacunas. Además, el 43,3% contenía lagunas em su llenado. Conclusión: Se pudo constatar el alto porcentaje de registros de atención antirrábica humana con prescripción inadecuada y llenado incompleto, evidenciando la necesidad de capacitación de los profesionales de la salud. Se sugiere incluir a los veterinarios en los servicios de Atención Primaria y Vigilancia Epidemiológica para reducir errores y optimizar el uso de los recursos públicos.

Investigação de evento adverso associado à vacinação antirrábica / Investigation of adverse event following immunization associated with antirabies vaccine / Investigación del evento adverso asociado a la vacunación antirrábica

A raiva é uma antropozoonose endêmica no Brasil. O animal infectado transmite o vírus rábico principalmente através de mordeduras. Por muitos anos cães e gatos representaram a principal fonte de infecção para seres humanos em áreas urbanas. Desde o ano de 1973, o Programa Nacional de Profilaxia da Raiva estabelece que cães e gatos devem ser imunizados contra raiva. A vacinação animal é um meio seguro, confiável e eficaz para proteger animais contra doenças infecciosas e prevenir a transmissão de zoonoses, contudo a administração de vacinas não é isenta de riscos. Portanto as ocorrências de evento adverso associados à vacinação devem ser investigadas, pois a demonstração da segurança das vacinas contribuiu para o sucesso dos programas de imunização. Este estudo descreve o relato de caso de um animal suspeito de apresentar reação adversa à vacinação antirrábica.

Rabies is an endemic anthropozoonosis in Brazil. The infected animal transmits the rabies virus mainly by bites. For many years dogs and cats represented the main source of infection to humans in urban areas. Since 1973, the National Rabies Prophylaxis Program has established that dogs and cats must be immunized against rabies. The animal vaccination is safe, reliable and effective to protect animals against infectious diseases and prevent the transmission of zoonoses, however the administration of vaccines is not without risks. The occurrences of adverse events associated with vaccination should be investigated, because the demonstration of vaccine safety contributed to the success of immunization programs. This study describes a case report of one animal suspected of having an adverse reaction to rabies vaccination.

La rabia es una antropozoonosis endémica en Brasil. El animal infectado transmite el virus de la rabia principalmente a través de mordeduras. Durante muchos años, los perros y gatos representaron la principal fuente de infección para los humanos en las zonas urbanas. Desde 1973, el Programa Nacional de Profilaxis de la Rabia ha establecido que los perros y gatos deben ser inmunizados contra la rabia. La vacunación animal es una forma segura, fiable y eficaz de proteger a los animales contra enfermedades infecciosas y prevenir la transmisión de zoonosis, sin embargo, la administración de vacunas no está exenta de riesgos. Por lo tanto, se debe investigar la ocurrencia de eventos adversos asociados con la vacunación, ya que la demostración de la seguridad de la vacuna contribuyó al éxito de los programas de inmunización. Este estudio describe el reporte de un caso de un animal sospechoso de tener una reacción adversa a la vacunación antirrábica.