Fifty Years of the National Rabies Control Program in Brazil under the One Health Perspective.

In 1973, the National Rabies Program was created in Brazil through an agreement between the Ministry of Health and Agriculture. Since its beginning, it developed integrated action through access to free post-exposure prophylaxis (PEP) for people at risk, dog vaccination campaigns, a joint surveillance system, and awareness. This study aims to describe human rabies in Brazil under the One Health perspective in recent decades, including achievements in the control of dog-mediated cases and challenges in human cases transmitted by wild animals. This paper also explores possible drivers of human rabies in the Northeast Region with half of the cases. The first part of this study was descriptive, presenting data and examples by periods. Statistical analysis was performed in the last period (2010-2022) to explore possible drivers. Dog-mediated human cases decreased from 147 to 0, and dog cases decreased from 4500 to 7. A major challenge is now human cases transmitted by wild animals (bats, non-human primates, and wild canids). Most current human cases occur in municipalities with a tropical and subtropical moist broadleaf forest biome and a Gini index higher than 0.5. In the multivariable analysis, an association with temperature was estimated (OR = 1.739; CI95% = 1.181-2.744), and primary healthcare coverage (OR = 0.947; CI95% = 0.915-0.987) was identified as a protector. It is possible to significantly reduce the number of dog-mediated human rabies cases through the efforts presented. However, Brazil has wildlife variants of the rabies virus circulating. The association of human cases with higher temperatures in the Northeast is a concern with climate change. To reduce human cases transmitted by wild animals, it is important to continue distributing free PEP, especially in remote at-risk areas in the Amazon Region, and to increase awareness.

Progress towards eliminating canine rabies: policies and perspectives from Latin America and the Caribbean.

Human rabies transmitted by dogs is considered a neglected disease that can be eliminated in Latin America and the Caribbean (LAC) by 2015. The aim of this paper is to discuss canine rabies policies and projections for LAC regarding current strategies for achieving this target and to critically review the political, economic and geographical factors related to the successful elimination of this deadly disease in the context of the difficulties and challenges of the region. The strong political and technical commitment to control rabies in LAC in the 1980s, started with the regional programme coordinated by the Pan American Health Organization. National and subnational programmes involve a range of strategies including mass canine vaccination with more than 51 million doses of canine vaccine produced annually, pre- and post-exposure prophylaxis, improvements in disease diagnosis and intensive surveillance. Rabies incidence in LAC has dramatically declined over the last few decades, with laboratory confirmed dog rabies cases decreasing from approximately 25 000 in 1980 to less than 300 in 2010. Dog-transmitted human rabies cases also decreased from 350 to less than 10 during the same period. Several countries have been declared free of human cases of dog-transmitted rabies, and from the 35 countries in the Americas, there is now only notification of human rabies transmitted by dogs in seven countries (Bolivia, Peru, Honduras, Haiti, Dominican Republic, Guatemala and some states in north and northeast Brazil). Here, we emphasize the importance of the political commitment in the final progression towards disease elimination. The availability of strategies for rabies control, the experience of most countries in the region and the historical ties of solidarity between countries with the support of the scientific community are evidence to affirm that the elimination of dog-transmitted rabies can be achieved in the short term. The final efforts to confront the remaining obstacles, like achieving and sustaining high vaccination coverage in communities that are most impoverished or in remote locations, are faced by countries that struggle to allocate sufficient financial and human resources for rabies control. Continent-wide cooperation is therefore required in the final efforts to secure the free status of remaining countries in the Americas, which is key to the regional elimination of human rabies transmitted by dogs.

Rabies transmitted by vampire bats to humans: an emerging zoonotic disease in Latin America?

Human rabies transmitted by vampire bats reached new heights in Latin America in 2005. A total of 55 human cases were reported in several outbreaks, 41 of them in the Amazon region of Brazil. Peru and Brazil had the highest number of reported cases from 1975 to 2006. In Peru, outbreaks involving more than 20 cases of bat-transmitted human rabies were reported during the 1980s and 1990s. During this period, a smaller number of cases were reported from outbreaks in Brazil. A comparison of data from field studies conducted in Brazil in 2005 with those from the previous decade suggests similar bat-bite situations at the local level. The objective of this study was to review the epidemiological situation and, on the basis of this information, discuss possible factors associated with the outbreaks. Prevention and control measures already recommended for dealing with this problem are also reviewed, and some further suggestions are provided.

Rabies transmitted by vampire bats to humans: an emerging zoonotic disease in Latin America? / La rabia transmitida por murciélagos vampiros a humanos: ¿una zoonosis emergente en América Latina?

Human rabies transmitted by vampire bats reached new heights in Latin America in 2005. A total of 55 human cases were reported in several outbreaks, 41 of them in the Amazon region of Brazil. Peru and Brazil had the highest number of reported cases from 1975 to 2006. In Peru, outbreaks involving more than 20 cases of bat-transmitted human rabies were reported during the 1980s and 1990s. During this period, a smaller number of cases were reported from outbreaks in Brazil. A comparison of data from field studies conducted in Brazil in 2005 with those from the previous decade suggests similar bat-bite situations at the local level. The objective of this study was to review the epidemiological situation and, on the basis of this information, discuss possible factors associated with the outbreaks. Prevention and control measures already recommended for dealing with this problem are also reviewed, and some further suggestions are provided.

La rabia en humanos transmitida por murciélagos vampiros aumentó en América Latina en 2005. Se notificaron varios brotes con un total de 55 personas enfermas, 41 de ellas en la región amazónica de Brasil. Perú y Bolivia acumularon el mayor número de casos notificados entre 1975 y 2006. En Perú se informaron brotes de más de 20 personas con rabia transmitida por murciélagos en las décadas de 1980 y 1990. En ese período se informó un número menor de casos en los brotes de Brasil. Al comparar los datos de estudios de campo realizados en Brasil en 2005 con los obtenidos en décadas anteriores se observaron situaciones similares en cuanto a los casos de mordidas por murciélagos a nivel local. En este estudio se presenta una revisión de la situación epidemiológica y, a partir de esa información, se discuten los posibles factores asociados con los brotes. Se revisan también las medidas de prevención y control ya recomendadas para hacer frente a este problema y se ofrecen algunas recomendaciones adicionales.

Current status of human rabies transmitted by dogs in Latin America

Latin American countries made the political decision to eliminate human rabies transmitted by dogs by the year 2005. The purpose of the current study is to evaluate to what extent this goal has been reached. The epidemiological situation and control measures were analyzed and broken down within the countries by georeferencing. The 27 human cases reported in 2003 occurred in some 0.2 percent of the second-level geopolitical units (municipalities or counties) in the region, suggesting that the disease is a local problem. Several areas within the countries reported no more transmission of rabies in dogs. Nearly 1 million people potentially exposed to rabies received treatment. On average, 34,383 inhabitants per health post receive anti-rabies treatment (range: 4,300-148,043). Nearly 42 million dogs are vaccinated annually. Surveillance is considered fair according to the epidemiological criteria adopted by the study. Samples sent for rabies testing represent 0.05 percent of the estimated canine population (range: 0.001 to 0.2 percent). The countries are quite close to achieving the goal.

Os países da América Latina tomaram a decisão política de eliminar a raiva humana transmitida por cão até 2005, e o objetivo deste estudo é analisar o cumprimento desta meta. A situação epidemiológica e as ações de controle foram analisadas de forma desagregada dentro dos países, utilizando-se georreferenciamento da informação. Os 27 casos humanos relatados em 2003 ocorreram em cerca de 0,2 por cento das unidades de segundo nível geopolítico (municípios) da região. Esse dado sugere que a doença atualmente é muito localizada. Vários países não reportam mais transmissão de raiva em cães. Cerca de 1 milhão de pessoas são potencialmente expostas ao risco da raiva e recebem atendimento médico. Existem em média 34.383 (classe: 4.300-148.043) habitantes por posto de saúde com tratamento anti-rábico. São vacinados cerca de 42 milhões de cães anualmente, 70 por cento deles no Brasil e México. A vigilância epidemiológica para a raiva foi considerada média pelos critérios estabelecidos no estudo, sendo enviada 0,05 por cento da população canina estimada de amostras para diagnostico de raiva. Foi considerado que os países estão muito próximos de alcançar a meta.

Current status of human rabies transmitted by dogs in Latin America.

Latin American countries made the political decision to eliminate human rabies transmitted by dogs by the year 2005. The purpose of the current study is to evaluate to what extent this goal has been reached. The epidemiological situation and control measures were analyzed and broken down within the countries by georeferencing. The 27 human cases reported in 2003 occurred in some 0.2% of the second-level geopolitical units (municipalities or counties) in the region, suggesting that the disease is a local problem. Several areas within the countries reported no more transmission of rabies in dogs. Nearly 1 million people potentially exposed to rabies received treatment. On average, 34,383 inhabitants per health post receive anti-rabies treatment (range: 4,300-148,043). Nearly 42 million dogs are vaccinated annually. Surveillance is considered fair according to the epidemiological criteria adopted by the study. Samples sent for rabies testing represent 0.05% of the estimated canine population (range: 0.001 to 0.2%). The countries are quite close to achieving the goal.

Wildlife, exotic pets, and emerging zoonoses.

Most emerging infectious diseases are zoonotic; wildlife constitutes a large and often unknown reservoir. Wildlife can also be a source for reemergence of previously controlled zoonoses. Although the discovery of such zoonoses is often related to better diagnostic tools, the leading causes of their emergence are human behavior and modifications to natural habitats (expansion of human populations and their encroachment on wildlife habitat), changes in agricultural practices, and globalization of trade. However, other factors include wildlife trade and translocation, live animal and bushmeat markets, consumption of exotic foods, development of ecotourism, access to petting zoos, and ownership of exotic pets. To reduce risk for emerging zoonoses, the public should be educated about the risks associated with wildlife, bushmeat, and exotic pet trades; and proper surveillance systems should be implemented.

Veterinary public health activities in the Pan American Health Organization over the past 58 years: 1949-2007.

The veterinary public health activities of the Pan American Health Organization (PAHO) over the past 58 years have been devoted to the strategic orientation and development of priorities for the health sector with three main strategic areas, as follows: surveillance, prevention and control of zoonoses, prevention of foodborne diseases and promotion of animal health to boost production and productivity and, consequently, food security and socio-economic development. For PAHO, the link between health and agriculture is undeniable and their integration essential.

Emerging or re-emerging bacterial zoonoses: factors of emergence, surveillance and control.

Surveillance and control of emerging bacterial zoonoses is essential in order to prevent both human and animal deaths and to avoid potential economic disorders created by trade barriers or a ban on free circulation of human or animal populations. An increased risk of exposition to zoonotic agents, the breakdown of the host's defenses, the emergence of bacterial strains resistant to antibiotics and their widespread distribution as well as conjunctural causes associated with the action or inaction of man have been identified as the main factors leading to the emergence or re-emergence of bacterial zoonoses. After an in-depth review of these various factors, the present manuscript reviews the main components of detection and surveillance of emerging or re-emerging bacterial zoonoses. A description of the systems of control and the main obstacles to their success is also presented. Detection and surveillance of emerging zoonoses have greatly benefited from technical progress in diagnostics. The success of detection and control of emerging bacterial zoonoses is largely based on international solidarity and cooperation between countries.

The control of human (neuro)cysticercosis: which way forward?

Taenia solium cysticercosis, and its public health and economic consequences, appears to be a growing problem in poor areas of Africa, Asia and Latin America where people eat pork and traditional pig husbandry is practiced (and expanding). Its burden is counted in terms of human disease (mainly neurocysticercosis related epilepsy) and economic losses, in a context of both commercial and traditional subsistence pig farming. Although substantial fragmentary information seems to be available from local settings, national and global burdens due to T. solium cysticercosis are still to be comprehensively assessed. With regard to control, several strategies have been checked out at a small or medium scale and have proven to be successful. Yet, no intervention programmes have been implemented so far at the national level with proven success. Although T. solium cysticercosis is considered to be a potentially eradicable disease, there is no evidence yet that it is feasible and recommendable to envisage this within a reasonable time frame. However, it appears realistic to aim for the rapid definition of a simple package of interventions, which can routinely be carried out by existing services and structures, and will give an optimal, long-term return in terms of burden relief. Also, a number of international initiatives and opportunities currently exist in which a more pro-active attitude towards the control of T. solium cysticercosis can be integrated and promoted. Commitment of both national and local authorities to control the disease needs to be convincingly solicited and, as for most zoonotic diseases, an interdisciplinary approach is essential.

La venta de alimentos en la vía pública en América Latina / Street food vending in Latin America

A pesar de los ocasionales intentos de eliminarla, la venta de alimentos en la vía pública en América Latina parece estar aumentando, estimulada por las crecientes poblaciones urbanas marginales, el desempleo que crea innumerables vendedores callejeros potenciales, las grandes distancias recorridas cotidianamente entre el lugar de trabajo y el hogar, la demanda de alimentos baratos y culturalmente apropiados cerca de los lugares de trabajo y la escasez o ausencia de establecimientos permanentes que sirvan ese tipo de alimentos. Además de representar una carga oculta para los servicios públicos, la industria de los alimentos de venta callejera, por lo general no reglamentada y casi clandestina, tiende a no observar normas adecuadas de higiene y a plantear considerables problemas de salud pública. En este contexto, las epidemias de cólera en América Latina han atraído la atención hacia el potencial de transmisión de enfermedades que tienen los alimentos vendidos en la calle y han estimulado el apoyo a los intentos de resolver ese problema. En este momento, más que fútiles intentos de abolir esa venta, aparentemente se requiere un criterio nuevo y más positivo mediante el cual los países modifiquen sus reglamentaciones para permitir la adaptación constructiva y pacífica de la venta callejera de alimentos a un nuevo estilo de vida de las sociedades latinoamericanas. Esto implica una reorganización jurídica orientada a establecer estructuras para la venta de alimentos en la vía pública y permitir la aplicación de medidas -especialmente el suministro y la utilización de agua inocua- que fomenten las normas adecuadas de higiene y el consumo de alimentos no peligrosos. También implica crear programas para proporcionar adiestramiento apropiado a los inspectores y educación sanitaria tanto a los vendedores como a los consumidores de esos alimentos; esto significa que hay que promover y adoptar métodos mejores para preparar y vender alimentos. No hay motivos para suponer que estas medidas constituirán una panacea inmediata para el problema de la venta de callejera de alimentos; sin embargo, hay buenas razones para pensar que pueden mejorar notablemente la situación actual

La venta de alimentos en la vía pública en América Latina / Street food vending in Latin America

A pesar de los ocasionales intentos de eliminarla, la venta de alimentos en la vía pública en América Latina parece estar aumentando, estimulada por las crecientes poblaciones urbanas marginales, el desempleo que crea innumerables vendedores callejeros potenciales, las grandes distancias recorridas cotidianamente entre el lugar de trabajo y el hogar, la demanda de alimentos baratos y culturalmente apropiados cerca de los lugares de trabajo y la escasez o ausencia de establecimientos permanentes que sirvan ese tipo de alimentos. Además de representar una carga oculta para los servicios públicos, la industria de los alimentos de venta callejera, por lo general no reglamentada y casi clandestina, tiende a no observar normas adecuadas de higiene y a plantear considerables problemas de salud pública. En este contexto, las epidemias de cólera en América Latina han atraído la atención hacia el potencial de transmisión de enfermedades que tienen los alimentos vendidos en la calle y han estimulado el apoyo a los intentos de resolver ese problema. En este momento, más que fútiles intentos de abolir esa venta, aparentemente se requiere un criterio nuevo y más positivo mediante el cual los países modifiquen sus reglamentaciones para permitir la adaptación constructiva y pacífica de la venta callejera de alimentos a un nuevo estilo de vida de las sociedades latinoamericanas. Esto implica una reorganización jurídica orientada a establecer estructuras para la venta de alimentos en la vía pública y permitir la aplicación de medidas -especialmente el suministro y la utilización de agua inocua- que fomenten las normas adecuadas de higiene y el consumo de alimentos no peligrosos. También implica crear programas para proporcionar adiestramiento apropiado a los inspectores y educación sanitaria tanto a los vendedores como a los consumidores de esos alimentos; esto significa que hay que promover y adoptar métodos mejores para preparar y vender alimentos. No hay motivos para suponer que estas medidas constituirán una panacea inmediata para el problema de la venta de callejera de alimentos; sin embargo, hay buenas razones para pensar que pueden mejorar notablemente la situación actual

Version revisada de un documento presentado en la Conferencia "Street Foods: Epidemiology, Management and Practical Approaches" celebrada en Beijing, China, del 19 al 21 de octubre de 1993. Se publica en inglés en el Bull. PAHO. Vol. 28(4), 1994

Street food vending in Latin America

Despite occasional attempts to repress it, street food vending in Latin America appears to be on the rise- encouraged by growing marginal urban populations, the unemployed status of innumerable potential street vendors, lengthening commutes for workers, public demand for cheap and culturally appropriate food near workplaces, and a shortage or absence of regular establishments serving such food. Besides placing a hidden burden on public services, the generally unregulated and quasi clandestine street food industry tends to observe poor hygienic practices and to pose significant public health problems. Within this context, Latin America's cholera epidemics have drawn increasing attention to street food's potential for disease transmission and have created growing support for attempts to resolve these troubles. What appears needed at this point, rather than futile attempts at abolition, is a new and more positive approach wherein countries change their regulations so as to permit peaceful and constructive adaptation of street food vending to a new style of Latin American social life. This implies legal reorganization directed at structurally developing street food vending and permitting application of measures- especially provision and use of safe water- that will foster good hygiene and safe foods. It also implies creating programs to provide appropriate training for inspectors as well as health education for both vendors and consumers of street food; and it implies promoting and adopting improved methods for preparing and selling such food. There is no reason to suppose these measures will provide and immediate panacea for the street food vending problem; but there is good reason to think they can immensely improve the situation that exists today

Vacunas antirrabicas / Rabias vaccines

A pesar de los avances espectaculares en la tecnología médica y veterinaria en lo referente a la producción de vacunas antirrábicas y en los métodos de vigilancia y control de rabia, esta enfermedad sigue siendo un importante problema de salud pública en la mayoria de los países del mundo y unalimitante a la población animal, especialmente en America Latina

Rabia / Rabies

Inicia el documento con una aproximación de las pérdidas humanas, animales y económicas que se registran por causa de la rabia; también se hace un señalamiento de la distribución geográfica mundial en donde con excepción de algunos países y áreas se presenta. Asimismo marca tres ciclos de transmisión de la rabia: urbano, rural y selvático. El primero es característico de países desarrollados y es mantenido por los perros, los brotes epizoóticos en áreas urbanas son originados por animales selváticos. El ciclo rural se presenta en países en desarrollo y el perro es primordial en la cadena epidemiológica. El ciclo selvático es mantenido por varias especies animales. Situación en México: ocupa el 2§ lugar en la región de las Américas en casos de rabia humana, despues de Brasil, éste último ha disminuido significativamente su número y México no, al grado que en 1988 registró casi el doble de casos que Brasil. Además México ocupa el 1§ lugar en el continente de casos de rabia en perros. Para 1989 se registraron 14,525 casos de rabia animal; se vacunaron a 5,400,000 perros de los 7,400,000 programados; se eliminaron 100,672 perros de los 487,600 programados. Y en el mismo año se dieron 65 casos de rabia humana, disminuyendo 12.2//en relación al año anterior. Baja California y Campeche son los únicos Estados que en los últimos tres años permanecen libres de rabia animal