Safety and immunogenicity of freeze-dried rabies vaccine (Vero-cells) for human use in healthy people aged 9-65 years / 中华预防医学杂志

Objective: To assess the safety and immunogenicity of freeze-dried rabies vaccine (Vero-cells) for human use on different immunization procedures in healthy people aged 9-65 years. Methods: A randomized, blind, positive-controlled clinical study was conducted in March 2015. The eligible residents aged 9-65 were recruited in Dengfeng city and Biyang County, Henan Province. A total of 1 956 subjects were enrolled. The subjects were randomly (1∶1∶1) assigned to 5-dose control group, 4-dose trial group and 5-dose trial group, with 652 subjects in each group. The subjects of 5-dose control group were immunized with control vaccine on days 0, 3, 7, 14 and 28. The subjects of 4-dose trial group were immunized with trial vaccine on days 0, 7 and 21 (2-1-1 phases) and the subjects of 5-dose trial group were immunized with trial vaccine on days 0, 3, 7, 14 and 28. A combination of regular follow-up and active reporting was used to observe local and systemic adverse reactions till 30 days after the first and full immunization, and the incidence rate of adverse reactions in three groups was analyzed and compared. The venous blood was collected before the first immunization, 7 days after the first immunization, 14 days after the first immunization and 14 days after the full immunization. The neutralizing antibody of rabies virus was detected by rapid fluorescent focus inhibition test (RFFIT), and the seropositive conversion rate and geometric mean concentration (GMC) of antibody were calculated. Results: The adverse reaction rates in 5-dose control group, 4-dose trial group and 5-dose trial group were 41.87% (273/652), 35.43% (231/652) and 34.97% (228/652), respectively. The adverse reaction rates of 4-dose trial group and 5-dose trial group were lower than those of the 5-dose control group (P<0.05). The local reactions were mainly pain, itching, swelling and redness in injection site, while the systemic reactions were mainly fever, fatigue, headache and muscle pain. The severity of adverse reactions was mainly mild (level 1), accounting for 85.33% (518/607), 89.02% (373/419) and 88.96% (427/480) of the total number of adverse reactions in each group. At 14 days after the first immunization and 14 days after the full immunization, the antibody positive conversion rates of three groups were all 100%. At 7 days, 14 days after the first immunization and 14 days after the full immunization, the GMCs of three groups were 0.60, 0.72, 0.59 IU/ml, 20.42, 23.99, 24.38 IU/ml and 22.95, 23.52, 24.72 IU/ml, respectively, with no significant difference (P>0.05). Conclusion: The freeze-dried rabies vaccine (Vero-cells) for human use has good safety and immunogenicity when inoculated according to 5-dose and 4-dose immunization procedures.

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.

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).

A study about the epidemiological characteristics of rabies of the cases of medical treatment from a certain hospital in Beijing from 2011 to 2020 / 中华预防医学杂志

From 2011 to 2020, there were 111 213 cases of rabies exposed people recruited from the rabies immunization clinic of a hospital in Beijing. The monthly distribution of patients in each year was not statistically significant (P>0.05). The distribution of patients showed remarkable seasonality, with the exposure peak from May to October. The ratio of male to female was 1∶1.3. The majority of patients were aged 20-29 years old (39.1%) and in-service personnel (56.5%). Level-Ⅱ wounds (84.2%) were more common than level-Ⅲ wounds (14.9%). The number of visits to level-Ⅲwounds increased rapidly since 2017. The most common injured body part was hand (60.7%). Dogs were the most common animal for injuries (60.6%), followed by cats (32.3%), of which most were host animals (75.5%). The vaccination rate from 2016 to 2020 [49.8% (24 276/48 703)] was significantly higher than that from 2011 to 2015[18.6% (6 559/35 272)](χ²=8597.18, P<0.001).

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.

Vacinas COVID-19 e outros imunobiológicos ­ intervalos preconizados / COVID-19 vaccines and other immunobiological drugs ­ recommended intervals

Com o início do programa de vacinação contra a COVID-19 no Brasil, surgiu uma série de questionamentos relacionados ao uso dos imunizantes. Neste documento, o grupo de estudo da COVID-19 da Associação Brasileira de Alergia e Imunologia (ASBAI) avalia as evidências científicas e se posiciona em relação aos intervalos preconizados entre a administração das vacinas contra o SARS-CoV-2 e dos imunobiológicos.

With the beginning of the COVID-19 vaccination program in Brazil, a series of questions related to the use of vaccines arose. In this document, the COVID-19 study group of the Brazilian Association of Allergy and Immunology (ASBAI) assesses the scientific evidence and takes a stand for the recommended intervals between the administration of SARS-CoV-2 vaccines and that of immunobiological drugs.

Spatial distribution of anti-rabies post-exposure treatments associated with the decentralization process in Belo Horizonte, 2007 to 2011

Cases of canine attacks on people are reported because of the proximity of the dog to the households in several Brazilian cities. In the present study, we aim to evaluate post-exposure anti-rabies treatments with canine accidents between the years 2007 to 2011 in Belo Horizonte - MG. Duly notified data were obtained from the National System of Notifiable Diseases (SINAN). The spatial characteristics of the cases during the period of the study referred to the neighborhoods and the nine sanitary districts of the municipality of Belo Horizonte - MG. For georeferencing and spatial analysis, we used the software Maporama to identify the coordinates and the Geographic Information System ArcGIS for mapping. Considering the 6.153 prophylactic services that were georeferenced, the Norte, Venda Nova, Leste, and Centro Sul regions were highlighted due to the higher frequency of registered cases. It is suggested that an integrative action focused on canine population control, health education and epidemiological surveillance studies could contribute to the reduction of canine aggression cases.

Producción de sueros y vacunas en Chile, la importancia del abastecimiento local / Production of vaccines in Chile, the importance of local supply

Resumen En Chile, se produjeron vacunas desde fines del siglo XIX hasta inicios del siglo XXI de manera ininterrumpida. La producción se realizó en institutos del Estado, desde donde se abastecía al Servicio de Salud para los programas de vacunación. Además de fabricar, envasar y distribuir vacunas, los institutos del Estado, en particular el Instituto Bacteriológico (IB), exportaron vacunas a Latinoamérica y realizaron investigación y desarrollo, destacándose en este ámbito con la vacuna Fuenzalida-Palacios para el control de la rabia humana y canina. El presente estudio provee un listado de vacunas producidas en Chile en los institutos del Estado entre fines del siglo XIX y el año 2005, y una discusión sobre las visiones del rol de Estado que justificaron las acciones respecto de la producción de vacunas en Chile. El Estado desarrollista de mediados del siglo XX, dio paso al Estado neoliberal que se institucionalizó con la constitución de 1980 definiendo el rol subsidiario que ha guiado la discusión en materia de producción de vacunas locales en las últimas décadas.

Abstract In Chile, vaccines were produced from the late 19th century to the early 21st century without interruption. The production was carried out in State institutes, from where the health service was supplied for the vaccination programs. In addition to manufacturing, packaging and distributing vaccines, the State institutes, in particular the Instituto Bacteriológico (IB), exported vaccines to Latin America and carried out research and development, standing out in this area with the Fuenzalida-Palacios vaccine for the control of human and canine rabies. The present study provides a list of vaccines produced in Chile at State institutes between the end of the 19th century and 2005, and a discussion on the visions of the State role that justified the actions regarding the production of vaccines in Chile. The developmental State of the mid-twentieth century gave way to the neoliberal State that was institutionalized with the 1980 constitution, which defines the subsidiary role of the State that has guided the discussion on local vaccine production in the last decades.

Vacunación canina y felina masiva en México: pobre rectoría y fallo de mercado / Massive canine and feline vaccination in Mexico: poor governance and market failure

Resume: Objetivo: Analizar la rectoría y los mecanismos de procuración de insumos en el contexto del Programa de Acción Específico de Prevención y Control de la Rabia Humana y la Semana Nacional de Vacunación Antirrábica canina y felina en México (SNVA-C). Material y métodos: La información se obtuvo mediante solicitudes al Instituto Nacional de Transparencia, Acceso a la Información y Protección de Datos Personales. Resultados: De 2009 a 2017 se aplicaron 158.9 millones de dosis de vacuna antirrábica canina y felina (VAR-CF) por un monto de compra aproximado de 1 915 MDP. Se documentó una débil rectoría que permite prácticas monopólicas y compras fragmentadas y directas. Las adquisiciones se han fincado con precios que varían entre entidades federativas y son significativamente más altos que los precios internacionales. Conclusión: Después de 30 años de operación de la SNVA-C en México, persisten pagos excesivos para la VAR-CF, los cuales son indicativos de una falla importante del mercado, caracterizada por nula competencia, información asimétrica y estructuras de incentivos desalineadas que impiden obtener un precio competitivo.

Abstract: Objective: To analyze decision-making concerning stewardship and procurement mechanisms in the context of the Program for Prevention and Control of Human Rabies and the National Canine and Feline Vaccination Week in Mexico. Materials and methods: The information was obtained through requests to the National Institute of Transparency, Access to Information and Protection of Personal Data. Results: From 2009 to 2017, 158.9 million doses of canine rabies vaccine (VAR-CF) were applied with an estimated budget of 1 915 million pesos. Our findings suggest weak stewardship and ineffective governance that allows monopolistic practices and fragmented and direct purchases. Prices for the same product vary discretionally between states and are significantly higher than those offered at international level. Conclusions: After 30 years of operation of the SNVA-C in Mexico, high prices of the VAR-CF persist, which are indicative of a significant market failure, characterized by zero competition, asymmetric information and misaligned incentive structures that precluded favorable price negotiation.

Nota técnica sobre esquema de profilaxia da raiva / Technical note on rabies prophylaxis scheme

Critérios para esquema de prevenção de raiva no Estado do Tocantins. Controle sorológico. Restrito a pessoas com risco de exposição permanente ao vírus da raiva, como: Médicos veterinários, técnicos da Agência de Defesa Agropecuária, biólogos, funcionários do Naturatins que atuam em captura de mamíferos silvestres, espeleólogos.

Criteria for a rabies prevention scheme in the State of Tocantins. Serological control. Restricted to people at risk of permanent exposure to the rabies virus, such as: Veterinarians, technicians from the Agricultural Defense Agency, biologists, Naturatins employees who work in capturing wild mammals, cavers.

Criterios para un plan de prevención de la rabia en el estado de Tocantins. Control serológico. Restringido a personas en riesgo de exposición permanente al virus de la rabia, tales como: Veterinarios, técnicos de la Agencia de Defensa Agrícola, biólogos, empleados de Naturatins que trabajan en la captura de mamíferos silvestres, espeleólogos.

Post-exposure human rabies prophylaxis: spatial patterns of inadequate procedures in Ceará - Brazil, 2007 to 2015

Abstract INTRODUCTION: This study investigated the spatial distribution of inappropriate post-exposure human rabies procedures in Ceará, Brazil, between 2007 and 2015. METHODS: The ecological study population was based on the records of post-exposure human rabies procedures from the Notification Disease Information System. We analyzed the data using the Moran Index (I) and the Moran Local Index. RESULTS: There were 222,036 (95.8%) records with inappropriate post-exposure human rabies procedures. There was heterogeneity in their spatial distribution, with two significant clusters in the northeast and northwest regions. CONCLUSIONS: These findings help elaborate differentiated strategies to reduce unnecessary post-exposure human rabies procedures.

Bovine rabies: economic loss and its mitigation through antirabies vaccination / Raiva em bovinos: perdas econômicas e sua mitigação através da vacinação antirrábica

Rabies is among the most common neurological disease in cattle in Brazil, causing significant economic losses. Data on the economic impact of rabies in livestock are available in several countries. However, in Brazil, these data focus mainly on the public health point o view, emphasizing the costs related to the prevention of rabies in humans, in dogs, or wildlife. Specific studies carried out in different regions of Brazil indicate critical economic losses caused by rabies in cattle in this country. However, the studies on the losses caused by the disease in cattle lack a detailed analysis of the affected rural properties based on data from official disease control agencies. The objective of this work was to evaluate the economic impact of bovine rabies, and its mitigation through antirabies vaccination in rural properties in Mato Grosso do Sul, Midwestern Brazil.(AU)

A raiva é uma das doenças neurológicas mais comuns em bovinos no Brasil, causando perdas econômicas significativas. Dados sobre o impacto econômico da raiva em bovinos de vários países estão disponíveis. No entanto, no Brasil, esses dados enfocam principalmente o ponto de vista de saúde pública, enfatizando os custos relacionados à prevenção da raiva em humanos, em cães ou animais silvestres. Estudos pontuais realizados em diferentes regiões do Brasil indicam perdas econômicas importantes causadas pela raiva em bovinos no país. No entanto, os estudos sobre as perdas causadas pela doença em bovinos carecem de uma análise detalhada das propriedades rurais afetadas com base em dados das agências oficiais de controle de doenças. O objetivo deste trabalho foi avaliar o impacto econômico da raiva bovina e sua mitigação através da vacinação antirrábica em propriedades rurais de Mato Grosso do Sul, no Centro-Oeste do Brasil.(AU)

Perfil epidemiológico do atendimento antirrábico humano em uma área de planejamento do município do Rio de Janeiro / Epidemiological profile of human antirabic care in a planning area of the city of Rio de Janeiro / Perfil epidemiológico de la atención antirrábica humana en un área de planificación del municipio de Río de Janeiro

A raiva é considerada um problema de saúde pública no Brasil e no mundo. O atendimento antirrábico está entre os três agravos de maior notificação no país. OBJETIVOS: descrever e caracterizar o perfil epidemiológico do atendimento antirrábico no município do Rio de Janeiro, na área programática 2.1, no período de 2010 a 2015. METODOLOGIA: estudo descritivo retrospectivo dos registros referentes aos atendimentos antirrábicos humanos inseridos no Sistema de Informação de Agravos de Notificação do município do Rio de Janeiro. Para a seleção dos dados utilizou-se o programa TabWin 32; a organização e análise foram desenvolvidas no Excel©. RESULTADOS: foram encontrados 8.681 registros. Destes, 8.235 (94,9%) foram atendimentos por provável pós-exposição ao vírus rábico. Das 8.235 notificações, 70% eram brancas, 56% do sexo feminino, com destaque para a faixa etária de 20 a 59 anos (54,7%). A principal forma de agressão foi a mordedura (83,1%) em mãos/ pés (41%), e o principal agressor os cães (74,4%), sendo indicadas em 72,3% dos casos observação e vacina. CONCLUSÃO: constatou-se que o perfil epidemiológico do atendimento antirrábico na área programática 2.1 ocorreu em pessoas brancas do sexo feminino com o tipo de exposição mordedura em mãos e pés, tendo como animal agressor o cão. Esses dados ajudam a pensar estratégias de prevenção. Torna-se importante a ampliação dos serviços que realizam o atendimento antirrábico, sobretudo vinculado à Estratégia de Saúde da Família. A capilarização desse atendimento é, no mínimo, um redutor de risco para a ocorrência da doença, por permitir os cuidados básicos imediatos.(AU)

Rabies is considered a public health problem in Brazil and worldwide. Anti-rabies care is among the three most reported health problems in the country. Objectives: to describe and characterize the epidemiological profile of anti-rabies care in the city of Rio de Janeiro, in the program area 2.1, from 2010 to 2015. Methodology: a retrospective descriptive study of the records of human anti-rabies care inserted in the Notification Disease Information System of the municipality of Rio de Janeiro. For data selection, we used the TabWin 32 program. The organization and analysis were developed in Excel©. Results: 8,681 records were found, and 8,235 of them (94.9%) were seen for probable post-exposure to the rabies virus. In these 8,235 notifications, 70% were white, 56% female, with emphasis on the age group from 20 to 59 years old (54.7%). The main aggression was the bite (83.1%) in the hands/feet (41%), and the main aggressor was the dog (74.4%), and 72.3% of the cases indicated observation and vaccine. Conclusion: the epidemiological profile of anti-rabies care in program area 2.1 occurred in female white people with exposure type of the bite on hands and feet, with the dog as an aggressor. These data help to think about...(AU) prevention strategies. The expansion of the services that perform anti-rabies care is important, especially linked to the Family Health Strategy. Broaden this service is

La rabia se considera un problema de salud pública en Brasil y en todo el mundo. La atención antirrábica se encuentra entre los tres problemas de salud más notificados en el país. Objetivos: describir y caracterizar el perfil epidemiológico de la atención antirrábica en el municipio de Río de Janeiro, en el área del programa 2.1, de 2010 a 2015. Metodología: estudio descriptivo retrospectivo de los registros relacionados con la atención antirrábica humana insertados en el Sistema de Enfermedades de Declaración Obligatoria del municipio de Río de Janeiro. Para la selección de datos utilizamos el programa TabWin 32; La organización y el análisis se desarrollaron en Excel©. Resultados: se encontraron 8.681 registros. De éstos, 8.235 (94,9%) fueron casos de probable exposición posterior al virus de la rabia. De las 8.235 notificaciones, el 70% eran de personas blancas, el 56% mujeres, con énfasis en el grupo de edad de 20 a 59 años (54,7%). La principal forma de agresión fue la mordedura (83,1%) en las manos / pies (41%), y el agresor principal fue el perro (74,4%), en el 72,3% de los casos se indicaron observación y vacunación. Conclusión: se encontró que el perfil epidemiológico de la atención antirrábica en el área del programa 2.1 se produjo en mujeres blancas con el tipo de exposición mordedura en manos y pies, provocadas por perros. Estos datos ayudan a pensar en estrategias de prevención. Es importante ampliar los servicios que brindan atención antirrábica, especialmente vinculados a la Estrategia de salud familiar. La capilarización de este servicio es al menos un reductor de riesgo de la enfermedad, ya que permite la atención básica inmediata.(AU)

Human rabies post-exposure prophylaxis relative to the disease epidemiological status / Tratamento antirrábico humano pós-exposição em relação à situação epidemiológica da doença

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.

Resumo O objetivo da presente pesquisa foi avaliar a conduta profilática adotada após agressões por cães e gatos no município de Araçatuba, SP, com base no Manual Técnico de Tratamento Antirrábico Humano e considerando-se as situações de raiva não controlada (1990-1996) e controlada (1997-2010). Foi realizada uma análise retrospectiva dos dados das fichas do SINAN (W64-CID10) preenchidas pelo serviço de atendimento antirrábico no período de 1990 a 2010. Na maioria dos casos os acidentes foram leves (76,9%) e os animais agressores estavam sadios (75,4%), resultando em 53,3% de dispensa do tratamento. Em 64,6% dos casos em que houve indicação de tratamento esta foi considerada inadequada. No período de raiva não controlada houve maior indicação do tratamento com vacina e soro (43,4%) e no de raiva controlada o tratamento com três doses de vacina Fuenzalida e Palácios ou duas doses de vacina de cultivo celular (76,5%). No período de raiva controlada as condutas foram mais adequadas, segundo as recomendações técnicas, do que no período de raiva não controlada (p < 0,0001), embora, em ambos os períodos, tenha se observado uma aplicação excessiva de soro e vacina.

Vigilancia, prevención y control de la rabia: Ciudad de Buenos Aires: Junio 2018 / Surveillance, prevention and control of rabies: City of Buenos Aires: June 2018

La rabia es una enfermedad viral, de distribución mundial que afecta al hombre y a todos los mamíferos tanto domésticos como silvestres, con una letalidad del 100% afectando el sistema nervioso central. Se transmite por medio de la inoculación del virus contenido en la saliva del animal infectado, principalmente por mordeduras o el lamido de heridas, o por predación cuando un animal caza un murciélago infectado y toma contacto con el virus desde el encéfalo del quiróptero. Otras formas de transmisión, menos frecuentes son por trasplante de tejidos infectados o por aerosoles. En este apartado, se describe la situación epidemiológica de esta zoonosis en la Ciudad de Buenos Aires: observación de animales mordedores, detección de virus rábico en muestras mediante diagnóstico de laboratorio, vacunación de animales y control poblacional mediante esterilizaciones quirúrgicas, acciones de control de focos de rabia, y seguimiento de animales con exposición a murciélagos positivos a rabia o no analizables

Circulação do vírus da raiva em animais no município de Natal-RN e profilaxia antirrábica humana de pós-exposição, no período de 2007 a 2016 / Circulation of rabies virus in animals in the municipality of Natal-RN and post-exposure human anti-rabies prophylaxis, from 2007 to 2016

Introdução: A raiva, antropozoonose viral de alta letalidade, é considerada um grave problema de saúde pública no Brasil e no mundo. Objetivo: caracterizar o perfil da profilaxia antirrábica humana pós-exposição e identificar as áreas com casos positivos de raiva em animais no município de Natal-RN. Métodos: Trata-se de um estudo epidemiológico. Os dados das fichas de investigação de atendimentos antirrábicos humanos registrados no Sistema de Informação de Agravos de Notificação (Sinan), no período de 2007 a 2016, foram tabulados e calculados os coeficientes anuais de incidência dos atendimentos quanto às variáveis sociodemográficas e específicas. Foi elaborado um mapa no software Q-GIS dos coeficientes de incidência dos atendimentos por 100 mil habitantes por bairro, indicando-se as áreas epizootias por raiva. Resultados: Houve 18.798 atendimentos, com maior incidência no ano de 2015. A faixa etária mais acometida foi de 0-13 anos, em indivíduos do sexo masculino. Na maioria dos casos, a exposição foi pela mordedura e os locais anatômicos mais afetados foram mãos/pés. A espécie canina esteve envolvida na maioria dos casos. Em 64,9% dos tratamentos foi indicado o tratamento com vacinas. Os bairros Lagoa Azul, Potengi, Nossa Senhora da Apresentação, Ponta Negra e Pitimbu registraram os maiores coeficientes de incidência, além da ocorrência da epizootia por raiva em quirópteros. Conclusão: O município de Natal apresenta áreas de elevados riscos para a ocorrência da raiva humana, sendo o cão a espécie mais envolvida em agressões e as crianças e adolescentes os grupos mais vulneráveis.(AU)

Introduction: Rabies, a highly lethal viral anthropozoonosis, is considered a serious public health problem in Brazil and in the world. Objective: to characterize the profile of post-exposure human anti-rabies prophylaxis and to identify areas with positive cases of rabies in animals in the city of Natal-RN. Methods: This is an epidemiological study. The data of the records of human rabies treatment research recorded in the Sinan Information System (Sinan), between 2007 and 2016, were tabulated and the annual incidence coefficients of the consultations were calculated for sociodemographic and specific variables. A map in the Q-GIS software of the incidence coefficients of care per 100,000 inhabitants per neighborhood was drawn up, indicating the epizootic areas due to rabies. Results: There were 18,798 visits, with higher incidence in the year 2015. The most affected age group was 0-13 years in males. In most cases, the exposure was by bite and the anatomic sites most affected were hands / feet. The canine species was involved in most cases. Treatment with vaccines was indicated in 64.9% of the treatments. The Lagoa Azul, Potengi, Nossa Senhora da Apresentação, Ponta Negra and Pitimbu districts registered the highest incidence coefficients, as well as occurrence of rabies epizootics in chiroptera. Conclusion: The municipality of Natal presents high risk areas for the occurrence of human rabies, with the dog being the most involved in the aggression, and the most vulnerable groups of children and adolescents.(AU)

Avaliação do tratamento antirrábico humano pós-exposição, associado a acidentes com cães / Evaluation the human anti-rabies treatment associated with accidents with dogs

O estudo da profilaxia da raiva humana contribui para orientação quanto ao uso de vacinas e soros antirrábicos, servindo de base para a definição de estratégias de prevenção, controle e avaliação da doença. Objetivou-se avaliar o atendimento antirrábico humano pós-exposição e possíveis incompatibilidades com o protocolo do Ministério da Saúde, em agressões por cães, no município de Belo Horizonte. Analisaram-se as fichas de atendimento antirrábico do SINAN para comparação dos tratamentos prescritos com as Normas de Profilaxia antirrábica do Ministério da Saúde. As características dos atendimentos foram: quanto à exposição, 93,0% decorrentes de mordedura; quanto à localização da agressão, 35,5% ocorreram nos membros inferiores; quanto ao ferimento, 62,0% foram lesões únicas; quanto ao tipo de ferimento, 65,8% foram superficiais; quanto à condição do animal, 85,0% ocorreram por animais sadios; em 83,4% dos casos os animais eram observáveis; quanto ao tratamento, observação e vacina (57,3%). O tratamento foi inadequado em 32,7% das condutas. O número de tratamentos instituídos foi muito elevado, 75,7% dos casos. De todos os atendimentos 21,2% das indicações foram consideradas excessivas e 11,5% insuficientes. O sistema de vigilância apresenta falhas e existe a necessidade de corrigi-las para que as informações referentes à finalização dos casos sejam conclusivas.(AU)

The study of prophylaxis of human rabies contributes to guidance on the use of vaccines and anti-rabies serums, providing the basis for the definition of strategies for prevention, control and evaluation of the disease. This study aimed to evaluate the service to early post-exposure human anti-rabies and possible incompatibilities with the Ministry of Health protocol attacks by dogs in the city of Belo Horizonte. The anti-rabies care records of SINAN were analyzed for comparison of treatments prescribed in the Prophylaxis of Rabies Standards of the Ministry of Health. The characteristics of the calls were about the exposure, 93.0% resulting from biting; the location of the assault, 35.5% occurred in the lower limbs; the injury, only 62.0% were injuries; the type of injury, 65.8% were superficial; the condition of the animal, 85.0% occurred in healthy animals; 83.4% of the cases the animals were observed; as treatment, observation and vaccine (57.3%). The treatment was inadequate in 32.7%. The number of established treatments was very high, 75.7% of cases. In all 21.2% of indications consultations were considered excessive and 11.5% insufficient. The surveillance system is faulty and there is a need to correct them so that the information regarding the completion of cases are conclusive.(AU)

Análise descritiva dos atendimentos antirrábicos humanos no Rio Grande do Sul entre 2012 a 2016 / Descriptive analysis of human rabies treatments in Rio Grande do Sul between 2012 and 2016

Há um grande número de atendimentos antirrábicos humanos (AARH) provocados por acidentes com herbívoros domésticos, quirópteros e felinos, registrados no banco de dados do Sistema de Informação de Agravos de Notificação (SINAN) nos últimos anos. As fichas de investigação do atendimento antirrábico humano são a fonte oficial de descrição de dados do paciente, espécie animal agressora, antecedentes epidemiológicos e tratamento. São essas informações que norteiam e decidem o desfecho do caso de agressão. Este trabalho tem como objetivo apresentar uma análise descritiva dos AARH no estado do Rio Grande do Sul (RS), no período de 2012 a 2016, com o propósito de contribuir para a melhoria das práticas de vigilância em saúde. Foi realizado um estudo descritivo com dados secundários oriundos do banco de dados do SINAN, onde foram analisados os dados de 163.978 fichas de investigação de AARH do RS. Além disso, foram realizadas uma análise espacial e uma análise de associação entre as varáveis da ficha AARH. As variáveis que apresentaram maior índice de incompletude foram a "escolaridade", "condição final do animal após observação", "tipo de ferimento" e "animal passível de observação". O perfil do AARH, no RS, mostrou que 63% dos casos estão na faixa etária de 15 a 65 anos. O tipo de exposição ao vírus rábico mais constante foi a mordedura, com 82,5% de frequência, na forma de ferimento único, com 61%, mais frequente em mãos e pés (32%) e membros inferiores (37%). A espécie agressora predominante foi a canina (87,7%), seguida pelos felinos (8%), herbívoros domésticos (2%), quirópteros (0,45%), primatas (0,16%) e raposas (0,05%). Em 73% dos casos os animais agressores são descritos como sadios, e os cães e gatos passíveis de observação representaram 74%. Os dados referentes às condutas de tratamento, demonstram que a "observação do animal" (34,4%) e a "observação + vacina" (38,7%) foram os tratamentos mais indicados para os pacientes. Houve associação estatística do sexo masculino e a ocorrência de casos de AARH envolvendo as espécies agressoras "quiróptero" (RP 1,38, IC95% 1,19-1,6) e "herbívoro doméstico" (RP 2,79, IC95% 2,58-3,02). As agressões por felinos foram cerca de duas vezes mais frequentes em indivíduos do sexo feminino quando comparadas com indivíduos do sexo masculino (RP de 2,09, IC95% 2,02-2,16). Houve aproximadamente duas vezes mais chance (RP 2,34, IC95% 2,25-2,43) das agressões por felinos ocorrerem em indivíduos com maior escolaridade. Em relação aos tipos de ferimentos, os quirópteros apresentaram uma chance 45% maior de provocar ferimentos superficiais do que as demais espécies agressoras. Em contrapartida, a chance de ocorrência de ferimentos profundos ou dilacerantes é 15% maior em agressões por primatas em comparação com todos os demais animais agressores. No RS, 82% dos pacientes procuraram atendimento médico em um dia após a agressão animal, o que pode mostrar uma maior percepção de risco de exposição ao vírus rábico. Foi realizado tratamento envolvendo soro e/ou vacinação em 50% das agressões por cães e gatos que eram em sua grande maioria observáveis e sadios. Em todos os municípios do RS houve a notificação de AARH, com maior concentração na região metropolitana de Porto Alegre, na região da serra e na região de Passo Fundo, seguidas das regiões de Pelotas, Santa Maria, Santa Rosa, Frederico Westphalen e Litoral Norte. A identificação do perfil dos pacientes de AARH também pode direcionar ações de educação em saúde. A análise dos dados permite concluir que a baixa completude das fichas consiste em um problema para melhor interpretação das 13 informações obtidas no atendimento de AARH. Considerando que a taxa de incidência de raiva em cães e gatos é muito baixa no RS, haveria uma grande economia de insumos se o critério observação de cães e gatos fosse melhor utilizado. A identificação das áreas de maior ocorrência de AARH, e áreas de sobreposição de AARH com casos de raiva animal podem direcionar as ações de vigilância em saúde. (AU)

There are cases of human rabies post-exposure prophylaxis (RPEP) generated by accidents with domestic herbivores, chiroptera and felines, registered in the database of the Brazilian Ministry of Health (SINAN) in recent years. The database from human rabies surveillance is the official source for describing patient data, animal species, epidemiological history and treatment. This information guides and establishes the approach of the case. The aim of this study is to provide a descriptive analysis of the human rabies post-exposure prophylaxis in the Rio Grande do Sul state, from 2012 to 2016. A descriptive study was carried out with secondary data from the SINAN database where the data were analyzed from 163,978 records of RPEP from RS. In addition, a spatial analysis and an analysis of association between the variables of the RPEP was performed. The variables that presented the highest proportion of incompleteness were "educational level", "final condition of the animal after observation", "type of injury" and "if the animal observation was possible". The profile of potential human exposure to rabies in RS showed that around 63% of the cases were registered between the ages of 15 to 65 years old. The most frequent type of potential exposure to rabies virus was animal bite, with 82.5% frequency, particularly as a single wound (61%). The aggression was more frequent in hands and feet (32%) and lower limbs (37%). The predominant aggressor species was canine (87.7%), followed by felines (8%), domestic herbivores (2%), chiroptera (0.45%), primates (0.16%) and foxes (0.05%). There was a statistical association between males patients and the occurrence of RPEP cases involving bats (PR 1.38) and domestic herbivores (PR 2.79). Feline aggressions were about twice as frequent in women (PR 2.39). There was approximately two times more odds (PR 2.34) that feline aggressions in individuals with higher educational level. In contrast, the odds of occurrence of deep or tearing injuries is 15% higher in aggressions by primates compared to all other animals. In RS, 82% of the patients sought medical care one day after the animal aggression, which may show a greater perception of the risk of rabies exposure. Treatment involving rabies immunoglobulin and/or vaccination was performed in 50% of the aggressions by dogs and cats that were mostly observable and healthy. In all the municipalities of the RS state, there was notification of RPEP, with greater concentration in the metropolitan region of Porto Alegre, in the regions of Serra and Passo Fundo, followed by Pelotas, Santa Rosa, Frederico Westphalen and North Coast. The identification of the profile of the RPEP patients can also direct actions of health education. The analysis of the data allows the conclusion that the low completeness of the records consists of a problem for a better understand of the information obtained from post-exposure prophylaxis database. Considering that the incidence rate of rabies in dogs and cats is very low in RS state, there would be a great saving of immunobiologicals if the observation criterion of dogs and cats was better used. The identification of areas of higher occurrence of RPEP, and areas of RPEP overlap with cases of animal rabies may direct health surveillance actions.

Clinical analysis of rabies post-exposure prophylaxis for animal bite in emergency department

OBJECTIVE: This study examined patients who visited the emergency department of a national medical center equipped with rabies vaccine and rabies immunoglobulin to confirm whether the treatment for rabies vaccination was appropriate in the emergency department. METHODS: This was a retrospective study that included 397 patients from January 1, 2014, to October 31, 2017. The patients finally diagnosed with animal bites according to the International Classification of Diseases, 10th revision code, at emergency department were collected. RESULTS: Most of the patients were 20–30 years old. Most of them were bitten by a dog, especially in the upper limb. Only 84% of patients who met the domestic rabies post-exposure prophylaxis (PEP) criteria were vaccinated. Patients who did not meet the criteria, approximately 22.3%, were also vaccinated. Complications after vaccination included clinical symptoms, such as headache, numbness, mild itching, and heating sensation. CONCLUSION: Rabies is a disease that can be prevented through PEP. Rabies PEP is relatively expensive and difficult to vaccinate easily, so it is desirable to subdivide the existing domestic rabies PEP guidelines into reality. Emergency physicians should know the proper rabies vaccination criteria and vaccinate patients only if necessary. This will help reduce medical resources and the complications of rabies vaccinations.

Quality of horse F(ab')2 antitoxins and antirabies immunoglobulins: protein content and anticomplementary activity

Among other applications, immunotherapy is used for the post-exposure treatment and/or prophylaxis of important infectious diseases, such as botulism, diphtheria, tetanus and rabies. The effectiveness of serum therapy is widely proven, but improvements on the immunoglobulin purification process and on the quality control are necessary to reduce the amount of protein aggregates. These may trigger adverse reactions in patients by activating the complement system and inducing the generation of anaphylatoxins. Herein, we used immunochemical methods to predict the quality of horse F(ab′)2 anti-botulinum AB, anti-diphtheric, antitetanic and anti-rabies immunoglobulins, in terms of amount of proteins and protein aggregates. Methods Samples were submitted to protein quantification, SDS-PAGE, Western blot analysis and molecular exclusion chromatography. The anticomplementary activity was determined in vitro by detecting the production of C5a/C5a desArg, the most potent anaphylatoxin. Data were analyzed by one-way ANOVA followed by Tukey's post-test, and differences were considered statistically significant when p < 0.05. Results Horse F(ab′)2 antitoxins and anti-rabies immunoglobulin preparations presented different amounts of protein. SDS-PAGE and Western blot analyses revealed the presence of protein aggregates, non-immunoglobulin contaminants and, unexpectedly, IgG whole molecules in the samples, indicating the non-complete digestion of immunoglobulins. The chromatographic profiles of antitoxins and anti-rabies immunoglobulins allowed to estimate the percentage of contaminants and aggregates in the samples. Although protein aggregates were present, the samples were not able to induce the generation of C5a/C5a desArg in vitro, indicating that they probably contain acceptable levels of aggregates. Conclusions Anti-botulinum AB (bivalent), anti-diphtheric, antitetanic and anti-rabies horse F(ab′)2 immunoglobulins probably contain acceptable levels of aggregates, although other improvements on the preparations must be carried out. Protein profile analysis and in vitro anticomplementary activity of F(ab′)2 immunoglobulin preparations should be included as quality control steps, to ensure acceptable levels of aggregates, contaminants and whole IgG molecules on final products, reducing the chances of adverse reactions in patients.(AU)