Human rabies post-exposure prophylaxis relative to the disease epidemiological status

Abstract

This study evaluated the prophylactic measures adopted after attacks by dogs and cats in the main city of Northwester São Paulo State, based on the technical manual for post-exposure treatment, considering the not controlled (1990-1996) and controlled (1997-2010) rabies status. A retrospective analysis was done using the data from the SINAN records (W64-CID10) between 1990 and 2010. In most cases, the accidents were mild (76.9%), and biting animals were healthy (75.4%); therefore, no treatment was needed in 53.3% of the cases. In 64.6% of cases, the prescribed PEP treatment was inappropriate. The most indicated PEP treatments consisted of vaccine and RIG (43.4%), and either three doses of mouse brain vaccine or two doses of cell culture vaccine (76.5%), during the not controlled and controlled rabies periods, respectively. The treatment was more appropriate and followed the technical recommendations during controlled rabies periods compared to not controlled (p < 0.0001) periods. However, excessive application of RIG and rabies vaccine was observed in both periods.

Profile of human anti-rabies care and post-exposure prophylaxis in the state of São Paulo

“…The injuries were predominantly single wounds and superficial, most frequently on the hands and feet, followed by the lower and upper limbs ( Table 1 ). These results are similar to those previously reported in other studies conducted in municipalities in the region of Araçatuba 5 , 7 , 8 and across the entire country 2 .…”

“…The incidence of aggression was similar between the sexes, with a predominance in males; the highest frequency was in the age group between 20 and 39 years, and was more prevalent in white people ( Table 1 ). The characteristics of the victims were similar to those reported in other studies 2 , 4 , 5 , 9 , 11 ; however, a higher frequency of female victims 12 was observed in RJ.…”

“…When comparing sex and age groups, a predominance of notifications was observed among male children (27.8%; 83,107/298,435), while female victims between 20 and 39 years old were the most frequent (28.1%; 77,076/274.253). Occurrences predominantly in male children, female adults, and the elderly have been reported by other authors in different parts of Brazil 5 , 7 , 9 , 12 .…”

“…To reduce unnecessary treatments, it is necessary to improve knowledge of the epidemiological profile of notified aggression cases. Studies involving aggression by dogs and cats have been conducted in the region of Araçatuba/SP to characterize the victim’s profile, type of injury, involved animals, and municipalities of notified occurrence 5 , 7 , 8 . This study aimed to describe the profile of human anti-rabies PEP after aggression by different animal species throughout the state of São Paulo between 2013 and 2017.…”

“As long as the patient tells you it was a dog that bit him, why do you need to know more?” A qualitative study of how healthcare workers apply clinical guidelines to treat dog bite injuries in selected hospitals in Uganda

“…This poses very few risks of rabies since all exposures are assured of getting the vaccine. However, this leads to unnecessary costs associated with PEP as observed in some studies [22,33]. Further, just like some clinicians explained in this study, there is a tendency for patients to demand administration of the ARV.…”