Aim:To analyze the One Health approach regarding rabies surveillance, control, and prevention in Brazil's Ceará State, exemplified by a detailed description of rabies cases that occurred over 18 years.
Methods:We described in depth the history, case development, surveillance, and prevention measures of all cases of human rabies, 2004-2021. We analyzed patient charts and reviewed technical reports of the State Health Secretariat, in addition to analysis of personal notes from field missions.
Results:All six cases occurred in rural areas. The affected people came from resource-poor communities. The state rapid response team performed comprehensive actions and seminars in collaboration with the Municipal Health Secretariats and other stakeholder groups. Patients and their relatives were not aware about the risk of wildlifemediated rabies. A high number of wild animals (marmosets) kept as pets were collected in the communities. Only one patient presented at a primary health care center before the onset of symptoms but did not receive any postexposure prophylaxis due to logistic problems. Even after onset of symptoms, in all cases, the suspected diagnosis Conclusion: Rabies in Ceará is a wildlife-mediated disease of the most vulnerable rural populations. There is a need for ongoing integrated surveillance and control measures, information and education campaigns, and professional training, especially focusing on wildlife-mediated rabies. An integrated One Health approach -as exemplified by the presented rabies control program in Ceará -is critical for human rabies elimination.