Descrição das notificações de atendimento antirrábico humano para profilaxia pós-exposição no Brasil, 2014-2019

Abstract

Resumo 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.

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

“…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.…”

“…Regarding education, the highest percentage of occurrences was observed in individuals with elementary school education at the time of aggression ( Table 1 ), similar to data reported in Brazil (34.5%), where most of the occurrences were reported in individuals with complete elementary school education 2 . This predominance is possibly associated with the fact that lower-level education is more frequent among poorer individuals and, consequently, the dog is welcomed at home, not only as a pet but also to help protect the residence.…”

“…The correct characterization of aggression is necessary for proper adoption of rabies PEP recommendations following the guidelines of the Ministry of Health to prevent the victim from developing the disease, as well as to avoid the unnecessary application of either vaccine or rabies immunoglobulin when just observing the animal would be sufficient 2 - 5 .…”

“…However, despite the success achieved both in Brazil and São Paulo, a high number of human anti-rabies treatments have resulted mainly from aggression by dogs 2 , 3 . To reduce unnecessary treatments, it is necessary to improve knowledge of the epidemiological profile of notified aggression cases.…”

“…The search for anti-rabies PEP displayed an increasing trend that peaked in 2014, with an incidence of 2.62/1,000 inhabitants but was not statistically significant in the studied time interval (APC = 1.6%; 95% CI: -2.5 to 5.9; p = 0.307). During the period between 2014 and 2019, São Paulo had the highest number of human anti-rabies care notifications (708,307 [17.6%]), followed by Minas Gerais (438,500 [10.9%]), and Rio de Janeiro (RJ) (312,107 [7.7%]) 2 .…”