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.

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).

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)

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

Perfil da profilaxia antirrábica humana pré-exposição no estado do Rio Grande do Sul, 2007-2014 / Healthcare profile of rabies pre-exposure prophylaxis in the state of Rio Grande do Sul, Brazil, 2007-2014 / Perfil de la profilaxis antirrábica humana pré-exposición en el Estado de Rio Grande del Sur, Brasil, 2007-2014

OBJETIVO: descrever o perfil dos atendimentos para profilaxia antirrábica pré-exposição (PArPE) humana realizados no estado do Rio Grande do Sul, Brasil, de acordo com as Normas Técnicas de Profilaxia da Raiva Humana. MÉTODOS: estudo descritivo com dados do Sistema de Informação de Agravos de Notificação (Sinan), referentes a atendimentos antirrábicos notificados no período 2007-2014. RESULTADOS: somente 2,4% dos atendimentos antirrábicos realizados corresponderam a PArPE (5.721/239.245), sendo 42,5% deles referentes a estudantes e 10,3% a profissionais da área de medicina veterinária, biologia e zootecnia; indivíduos entre 20 e 64 anos de idade representaram 71,8% dos imunizados e a frequência dessa profilaxia foi de 53,5/100 mil habitantes no estado, com variação entre as regionais de saúde de 13,1 a 185,1/100 mil hab. CONCLUSÃO: observou-se baixa frequência de PArPE, sugerindo que essa ferramenta de prevenção contra a raiva se encontra negligenciada, colocando em risco ocupacional grande número de pessoas.

OBJECTIVE: to describe the profile of healthcare provision regarding rabies pre-exposure prophylaxis (RPrEP) in the state of Rio Grande do Sul, Brazil, as compared with the Technical Standards for Rabies Prophylaxis in Humans. METHODS: this was a descriptive study using Notifiable Disease Information System data on anti-rabies healthcare provided between 2007 and 2014. RESULTS: only 2.4% of anti-rabies healthcare related to RPrEP (5,721/239,245), 42.5% of these were veterinary, biology and zootechnics students and 10.3% were professionals from the same areas; individuals aged 20 to 64 accounted for 71.8% of the total number of people vaccinated and the frequency of this form of prophylaxis was 53.5/100,000 inhabitants for the state as a whole, varying between 13.1 to 185.1/100,000 inhabitants in the state's different health districts. CONCLUSION: RPrEP frequency was found to be low, suggesting that this rabies prevention tool has been neglected, leaving a large number of people at occupational risk.

OBJETIVO: describir el perfil de atendimientos para profilaxis antirrábica pré-exposición humana (ParPE) realizados en el estado de Rio Grande del Sur, Brasil, conforme a las normas técnicas de Profilaxis de Rabia Humana. MÉTODOS: estudio descriptivo transversal utilizando datos del Sistema de Información de Enfermedades de Declaración Obligatoria (Sinan) entre 2007 y 2014, referentes a atendimientos antirrábicos notificados. RESULTADOS: solamente 2,4% de los atendimientos antirrábicos realizados correspondieron a ParPE (5.721/239.245), siendo que 42,5% eran estudiantes, 10,3% profesionales del área de Veterinária, Biologia y Zootecnia y 4,3% tuvieran ocupación ignorada; 71,8% de los individuos inmunizados tenía entre 20 y 64 años, y la incidencia de profilaxis fue de 53,5/100 mil habitantes, con una variaciones regionales entre 13,1 y 185,1/100.000 hab. CONCLUSIÓN: observamos una baja frecuencia de ParPE, lo que sugiere que esta herramienta de prevención contra la rabia está descuidada, colocando en riesgo un gran número de personas.

Avaliação da profilaxia no primeiro atendimento pós-exposição ao vírus da raiva / Evaluation of primary care prophylaxis post-exposure to the rabies virus

OBJETIVO: Avaliar o tratamento profilático do primeiro atendimento anti-rábico pós-exposição. MÉTODOS: Estudo transversal, descritivo e analítico, com dados do Sistema de Informação de Agravos de Notificação. Analisados 39.087 atendimentos, excluídos 1.091 (2,79%) casos de re-exposição e préexposição, resultando em 37.996 atendimentos pós- exposição. Realizada análise de regressão logística para adequação de conduta. RESULTADOS: Observou-se predomínio da raça branca (83,93 %), sexo masculino (54,58 %), ensino fundamental (66,13%), idades entre 20-59 anos (45,0%), seguido por 0 a 12 anos (32,88%) e residentes na zona urbana (91,97%). Considerou-se 15.500 (41,56%) atendimentos inadequados 10.587 (28,11%) atendimentos deficitários, ou o paciente não recebeu o tratamento necessário, e 5.013 (13,44%) pacientes receberam atendimento mais do que o necessário para a profilaxia antirrábica. CONCLUSÃO: A profilaxia pós-exposição da raiva foi considerada inadequada necessitando de uma melhor abordagem na admissão e atenção no preenchimento dos registros de dados.

OBJECTIVE: To evaluate primary care prophylactic post-exposure anti-rabies treatment. METHODS: This was a cross-sectional, descriptive and analytical study, with data from the Information System for Notification of Diseases. It analyzed 39,087 visits, excluding 1,091 (2.79%) cases of re-exposure and pre-exposure, resulting in 37,996 post-exposure visits. A logistic regression analysis was performed for adjustment of the treatment. RESULTS: A predominance of Caucasians (83.93%), male (54.58%), primary school educational level (66.13%), ages between 20-59 years (45.0%) , followed by 0 to 12 years (32.88%), and residents in the urban area (91.97%) was observed. Among the visits, 15,500 (41.56%) were considered inadequate, 10,587 (28.11%) were deficient or the patient did not receive the necessary treatment, and 5,013 (13.44%) patients received more than what was necessary for rabies prophylaxis. CONCLUSION: The post-exposure prophylaxis for rabies was considered inadequate and requires a better approach on admission, and attention in completing the notification in the data record.

Post-exposure prophylaxis against rabies at two newly designated intradermal rabies vaccination clinics in Kerala, India.

Background. The two-site intradermal rabies vaccination (IDRV) regimen was recently introduced in Kerala. We aimed to determine factors associated with exposure of category III severity among patients seeking prophylaxis against rabies at IDRV clinics. Methods. This hospital-based, cross-sectional study was done at two clinics in Thiruvananthapuram district, Kerala. Data were collected using a semi-structured questionnaire by direct interview and 320 patients were included. Bivariate analysis of quantitative variables was done using t-test and that of qualitative variables using chi-square test. Results. The mean (standard deviation) age of patients was 32.4 (19.6) years. Among the 320 cases, 202 (63.1%) had category III exposure. Lower extremities were the most frequent site of exposure (146, 45.6%). The most frequent mode of exposure was being bitten by an animal (214, 66.9%), often a dog. Residence in rural areas, exposure to dogs and wounds on the extremities had a significant association with severity of exposure. Conclusion. Animal exposures were more among people from rural areas. About two-thirds of exposures which necessitated post-exposure prophylaxis were category III.

Avaliação da conduta de profilaxia antirrábica indicada para pessoas envolvidas em agravos com cães e gatos no município de Jaboticabal, SP, no período de 2000 a 2006 / Evaluation of rabies post-exposure prophylaxis in humans injured by dogs and cats in the municipality of Jaboticabal, SP, from 2000 through 2006

Objetivando analisar as indicações de profilaxia antirrábica humana no Município de Jaboticabal-SP, foi realizado um estudo retrospectivo descritivo no período de 2000 a 2006, com levantamento de dados registrados nas fichas de investigação de atendimento e cálculo do custo com as vacinas destinadas à profilaxia pós-exposição. Constatou-se que 2.493 pessoas agredidas por animais foram submetidas à profilaxia com uso de vacina, num total de 7.108 doses e um custo de R$ 179.105,14. Da totalidade de casos notificados, 2.184 (71,5 por cento) foram causados por cães e gatos clinicamente sadios no momento da agressão e que assim se mantiveram durante o período de observação, a qual foi feita pela própria vítima ou pelo dono do animal. Considerando este fato e também a situação epidemiológica da raiva no Município, pode-se inferir que essas vítimas poderiam ter sido dispensadas da profilaxia; entretanto, apenas 464 o foram, ou seja, 1.720 pessoas podem ter recebido vacina sem necessidade, ou seja 4.590 doses a um custo de R$ 114.420,81. Em comparação com os números de outros municípios do Estado de São Paulo e com a média nacional, constata-se que o número de profilaxias pós-exposição contra raiva é muito alto em Jaboticabal, evidenciando que na conduta não se considerou o estado do agressor e a condição do Município de área controlada para raiva. Recomenda-se conscientização e capacitação permanentes das equipes de saúde pública quanto à epidemiologia da doença e à necessidade de observação adequada do animal agressor. É essencial a integração dos serviços médicos e veterinários no atendimento às vitimas, visando uma melhor avaliação do caso para que a decisão de se instituir ou não a profilaxia pós-exposição seja feita com critério e segurança.

The present study aimed to evaluate rabies post-exposure prophylaxis (PEP) in humans in the municipality of Jaboticabal, São Paulo from 2000 through 2006. A descriptive and retrospective study was conducted by collecting data available in patient records. Vaccination costs were also calculated; 2,493 patients injured by animals received PEP, totaling R$ 179,105.14 and 7,108 doses; 2,184 (71.5 percent) out of the total reports were caused by dogs and cats clinically healthy at the moment of the attack. These animals remained sound throughout the 10-day observation period. The observation was conducted by the victim or by the owner. Considering animal observation and the epidemiological status of rabies in the municipality, all of these patients could have been dismissed from PEP treatment. Instead, only 464 were dismissed, meaning that 1,720 patients were unnecessarily vaccinated. An estimated 4,590 doses and R$114,420.81 could have been saved. In comparison with rates of other municipalities of the State of São Paulo and with the national mean, the number of PEP in Jaboticabal is very high and it became evident that management evaluated neither the health status of the animal nor the epidemiological status of the area for rabies. Permanent awareness and education of public health professionals with respect to rabies epidemiology and the need to perform correct observation of the aggressors are recommended. It is essential that medical and veterinary services be integrated to provide better assessment of cases and safer decisions on the institution of PEP.

Perfil epidemiológico do atendimento antirrábico humano em Porto Alegre, RS, Brasil / Epidemiologic profile of human anti-rabies treatment in Porto Alegre, RS, brazil

As mordeduras animais são injúrias que se destacam pela possibilidade de transmissão da raiva, sendo esta uma doença com letalidade de 100 por cento. O objetivo deste trabalho foi caracterizar o perfil epidemiológico do atendimento antirrábico humano pós-exposição e analisar a adequação de sua indicação. Foi realizado estudo transversal, tendo como fonte de dados a ficha de notificação do SINAN preenchida nos serviços de saúde pelos profissionais responsáveis pelo atendimento no segundo semestre de 2006. Entre os 2.223 casos investigados, 50,3 por cento dos indivíduos eram do sexo masculino; a faixa etária com mais agressões foi a de 20 a 59 anos (47,6 por cento); a forma de agressão responsável pela maior número de atendimentos foi a mordedura (87,4 por cento) e 35,3 por cento das agressões ocorreram nos membros inferiores. A espécie animal predominante foi a canina (91,7 por cento). Em relação ao tratamento prescrito, 78,1 por cento dos sujeitos receberam indicação de vacina e 6,4 por cento, soro. Foram considerados como adequadamente indicados 96,2 por cento dos tratamentos. Embora os tratamentos tenham sido corretamente prescritos, faz-se necessária a valorização da observação do animal agressor para diminuir o número de tratamentos dispensados.

Animal bites are injuries that carry the risk of rabies transmission, a disease with a 100 percent mortality rate. The purpose of this study was to determine the epidemiologic profiles of post exposure human anti-rabies treatments and to analyze whether prescriptions were appropriate. This cross-sectional study collected data from the forms of the Brazilian Notification System (Sistema Nacional Agravos de Notificação - SINAN), which were filled out by the professionals responsible for treatment in healthcare services in the second semester of 2006. Of the 2,223 cases identified, 50.3 percent of the individuals were male, the age group with the greatest number of cases was 20 to 59 years (47.6 percent); the type of injury responsible for the largest number of medical consultations was animal bite (87.4 percent), and 35.3 percent of the injuries were in the lower extremities. Dogs were the animals that caused the most injuries (91.7 percent). The analysis of type of treatment showed that vaccination was prescribed for 78.1 percent of the individuals, and anti-rabies serum, for 6.4 percent. Of the all treatments, 96.2 percent were classified as correctly prescribed. Although treatments were classified as necessary, the option of keeping animals that cause aggressions under observation should be considered so that the number of treatments administered can be reduced.

Epidemiology of animal bites and rabies cases in India. A multicentric study.

Rabies, a disease of antiquity continues to be a major public health problem in India. Multiple factors contribute to high mortality and morbidity due to animal bites. An effective strategy for control of rabies takes into account the epidemiology of animal bites, rabies and factors influencing post exposure treatment. The study was carried out as a part of Agreement for Performance of Work (APW) from World Health Organization (WHO) during the period April 2001 to September 2002. Two sets of proformae were developed and used after field testing to interview cases of animal bites and get retrospective information about rabies cases. The study was carried out at six selected centres across the country viz. Delhi, Hyderabad, Raipur, Jamnagar, Coonoor and Rajahmundry and was co-ordinated by National Institute of Communicable Diseases (NICD), Delhi. The officials engaged in the study work were thoroughly trained in the study methodology before the start of the study itself. To maintain quality and uniformity supervisory checks were done during the survey. A total of 1357 fresh animal bite victims were interviewed (exit interview) from the anti-rabies centres (ARCs). Dog bites caused maximum morbidity (92%). Second most common biting animal was monkey (3.2%), followed by cat (1.8%), fox (0.4%) etc. Most bites (64.3%) were unprovoked bites by stray (64.7%) animals. In this study 72.4% animal bite victims were males and 47.5% were children in age group of 2-18 years. 63% had Category III exposure as per the WHO classification. Before coming to ARCs 58.5% people had washed the wound with water/soap or water alone. Some of the bite victims (10.8%) had also applied chillies, salt, turmeric powder, lime, snuff powder, paste of leaves, acid, ash given by Peer Baba (magician) etc. These practices varied from one region to another. The practice of wound washing at the ARC which is an important component of animal bite management was being practiced at only one of the six centres. Of the six centres, Rabies Immunoglobulin (RIG) was available and was being used at only two centres. The study was conducted in public sector ARCs where Nervous Tissue Vaccine (NTV) was available free of cost. All the centres were using NTV except Coonoor, which is using indigenously produced Tissue Culture Vaccine along with NTV. Analysis of 192 case records of rabies cases, from two centres, revealed that dog bites caused maximum mortality (96.9%). Nearly 40% were children below 15 years of age and 78.6% were males indicating that it is an exposure related disease. In all cases, failure to seek timely and appropriate treatment led to development of disease. This paper provides an overview of epidemiology of animal bites and retrospective information about rabies patients. There is a need to strengthen Information, Education and Communication (IEC) programme regarding merits of local wound management including "do's and don'ts". ARCs should be strengthened in terms of facilities and availability of safe and effective anti rabies immunobiologicals. There is a need to create awareness regarding epidemiology and at-home and hospital management of animal bites among the service providers and general community.

Protocolo de manejo en mordeduras por animales: revisión de la literatura e informe de casos / A protocol for the management of animal bites: a review of the literature and report of cases

Las mordeduras por animales son heridas complicadas. Estas lesiones pueden ser macerantes, punzantes, lacerantes o avulsivas. Es imprescindible la profilaxis antibiótica, antitetánica y antirrábica. El aspecto más importante es la limpieza de la herida y el ulterior cierre primario de la misma. El manejo postquirúrgico incluye un control estrecho para prevenir o controlar la infección y la revisión secundaria de la cicatriz para reconstrucción, en caso necesario.

Animal bites are complicated wounds. They may consist of crush, punctures, lacerations or avulsions lesions. Antibiotic, tetanus and rabies prophylaxis is indispensable. The most important principle is wound cleansing and subsequent lacerations primary closure. Postoperative management includes close observation to avoid or control infection and secondary scar revision for reconstruction, if necessary.

Socio-clinical profile of rabis cases in anti-rabies clinic, M. K. C. G. Medical College, Orissa.

A hospital based study was conducted in the anti-rabies clinic of a medical college of Orissa during April 1988 to May 2002. Of 24 clinically diagnosed and reported rabies cases during the four years study period, 62.5% were children below 15 years of age, 67% were males, 87.5% were victims of stray dogs, 79% had not taken any anti-rabies treatment though all had undergone treatment by traditional systems of medicine.

Acidentes humanos com macacos em relação a tratamentos profiláticos para a raiva, no Município de São Paulo, Brasil / Human accidents with monkeys in relation to prophylactic treatment for rabies, in the Municipal district of Säo Paulo, Brazil

Apesar do Município de São Paulo apresentar a raiva sob controle epidemiológico ( último caso de raiva em humanos foi registrado em 1981) e de 95,4 por cento de sua populaçäo residir na área urbana, se registram casos de acidentes humanos envolvendo animais silvestres e dentre estes, os macacos estäo envolvidos no maior número de casos. No período de 1996 a 1999 foram atendidas 69.967 pessoas vítimas de acidentes com animais, das quais 267 acidentes com macacos. Neste trabalho se estuda a incidência mensal e anual da ocorrência destes acidentes, bem como os tratamentos antirábicos realizados

Epidemiological characteristics of rabies in Delhi and surrounding areas, 1998.

OBJECTIVE: To describe the epidemiological characteristics of rabies in Delhi in 1998. METHODS: Analysis of the records of hydrophobia cases admitted to the Infectious Diseases Hospital, Delhi (IDH) in 1998. RESULTS: About 46 percent (99/215) of the hydrophobia cases admitted to the IDH in 1998 belonged to Delhi. The remaining came from the adjoining states, both urban and rural areas. In Delhi residents, overall hospitalization rate was 0.81 per 100,000 population. It was significantly higher in 5-14 year old than in other age groups and in males than in females (p <0.0009). Cases occurred round the year. Almost 96 percent cases (206/215) gave history of animal exposure, 13 days to 10 years (median 60 days) before hospitalization. Majority (195/206) had class III exposure. Animals involved were stray dog (193/206 = 90 percent), pet dog, cat, jackal, mongoose, monkey and fox. Most of cases were never vaccinated (78 percent) or inadequately vaccinated (22 percent); only 1 percent each received appropriate wound treatment, or rabies immunoglobulin. CONCLUSIONS: Rabies is a major public health problem in Delhi. Its incidence is significantly higher in 5-14 year old children than in other age groups. The results indicate the need to educate the community and health care workers about the importance of immediate and adequate post-exposure treatment and to start an effective control program for dogs, the principal vector of rabies.

Rabia Humana en Guatemala: estudio retrospectivo de 23 casos atendidos en el Hospital Infantil de Infectología y Rehabilitación de 1983 a 1998 / Human rabies in Guatemala: retrospective study of 23 cases followed in Children Infectious Diseases Hospital from 1983 to 1998

Se hace una revisión del problema de rabia con énfasis en los aspectos virológicos del agente infeccioso, datos epidemiológicos generales, manifestaciones, clínicas, diagnóstico, patología, tratamiento y prevención. El análisis de los 23 casos encontrados en los archivos del Hospital Infantil de Infectología y Rehabilitación de Guatemala, durante el período comprendido de 1983 a 1,998, reveló que 16 fueron de sexo masculino y 7 de sexo femenino. Según los grupos etáreos los casos se presentaron así: menores de 2 años: 1 niño (04.34/100); de 2 a 4 años: 4 (17.39/100); de 4 a 6 años: 0 (00.00/100); de 6 a 8 años: 10 (43.48/100) y de 8 a 13 años: 8 (34.78/100). En orden de frecuencia los enfermos procedían de los siguientes departamentos: Escuintla, Guatemala, Chimaltenango, Mazatenango, Jalapa, El Quiché, Sololá, Sacatepéquez y San Marcos. El antecedente de mordedura canina se presentó en 20 casos (86.95/100) y desconocido en 3 (14.04/100). El período de incubación fué tan corto como un día, el más prolongado 60 días y desconocido en 2 casos. Todos los pacientes fallecieron; 20, la mayoría al séptimo día y 2 al noveno día de hospitalización. Ningún paciente recibió vacuna post-exposición. El diagnóstico fue confirmado por estudios post morten demostrando los Cuerpos de Negri en cortes de cerebro.

Comparative evaluation of a simple indirect immunofluorescence test and mouse neutralization test for assaying rabies antibodies.

In this study, we have developed and evaluated a simple indirect immunofluorescence test (IIFT) to detect rabies antibodies in a two-step immunofluorescence assay. One hundred and eighty five serum samples from people who had taken different rabies vaccines and 8 pairs of serum and CSF samples from confirmed paralytic rabies cases were tested by IIFT and results evaluated in comparison to standard mouse neutralization test (MNT). Though the titres of rabies antibodies obtained with IIFT were 2-4 times lesser in comparison to MNT, a significant correlation was seen between the two tests (R = 0.883). The specificity of this IIFT was found to be 97.9% and the sensitivity was 97.2%. These results indicate that this simple and rapid IIFT can be used to screen large number of serum samples to monitor sero-conversion after pre or post exposure vaccination and may also assist in rapid ante-mortem diagnosis of atypical human rabies.

Antibody response in cattle after vaccination with inactivated and attenuated rabies vaccines

Despite the absence of current official reports showing the number of cattle infected by rabies, it is estimated that nearly 30,000 bovines are lost each year in Brazil. In order to minimize the important economic losses, control of the disease is achieved by eliminating bat colonies and by herd vaccination. In this study, we compare the antibody response in cattle elicited by vaccination with an attenuated ERA vaccine (AEvac) and an inactivated-adjuvanted PV (IPVvac) vaccine. The antibody titers were appraised by cell-culture neutralization test and ELISA, and the percentage of seropositivity was ascertained for a period of 180 days. IPVvac elicited complete seropositivity rates from day 30 to day 150, and even on day 180, 87 per cent of the sera showed virus-neutralizing antibody titers (VNA) higher than 0.5IU/ml. There were no significant differences between the VNA titers and seropositivity rates obtained with IPVvac in the two methods tested. AEvac, however, elicited significantly lower titers than those observed in the group receiving inactivated vaccine. In addition, the profiles of antirabies IgG antibodies, evaluated by ELISA, and VNA, appraised by cell-culture neutralization test, were slightly different, when both vaccines were compared.