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: Ciudad de Buenos Aires, marzo 2022 / Surveillance, prevention and control of notifiable zoonotic diseases in animals: Buenos Aires City: march 2022

Informe con datos de vigilancia de rabia animal, y de otras enfermedades zoonóticas de notificación obligatoria, en la Ciudad de Buenos Aires: observación de animales mordedores, detección de virus rábico en muestras de laboratorio, vigilancia de reservorios de enfermedades zoonóticas, y vacunación antirrábica de animales.

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).

Vigilancia, prevención y control de enfermedades zoonóticas de notificación obligatoria en animales: Ciudad de Buenos Aires, febrero 2022 / Surveillance, prevention and control of notifiable zoonotic diseases in animals: Buenos Aires City, february 2022

La vigilancia epidemiológica permite alertar en forma temprana acerca de la ocurrencia de casos y del riesgo de transmisión en un lugar y tiempo determinados, registrar la tendencia a través del tiempo en diferentes áreas geográficas y monitorear las variantes de los virus circulantes. Su propósito es servir a las acciones de prevención y control, y a la orientación de las políticas públicas. La confirmación del diagnóstico por el laboratorio especializado y la efectiva notificación de los casos humanos y animales resultan elementos fundamentales para la vigilancia. En este informe se ofrecen datos de vigilancia de rabia animal, y de otras enfermedades zoonóticas de notificación obligatoria.

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).

Informe especial: Análisis comparativo de las denuncias de accidentes por mordeduras de animales de compañía en el contexto del ASPO por Covid-19 / Special report: Comparative analysis of reports of accidents caused by bites of pet animals in the context of ASPO by Covid-19

El aislamiento social, preventivo y obligatorio (ASPO) es una medida excepcional que el Gobierno Nacional adopta en un contexto crítico. Con el fin de proteger la salud pública frente a la propagación de la Covid-19, se dispuso que todas las personas que habitan, o se encuentren temporalmente, en las jurisdicciones donde rige esta normativa deberán permanecer en sus domicilios habituales, sólo pudiendo realizar desplazamientos mínimos e indispensables para aprovisionarse de artículos de limpieza, medicamentos y alimentos (Decreto Nacional 297/2020). En la Ciudad de Autónoma de Buenos Aires (CABA) rige desde el 20 de marzo el ASPO, y se ha ido flexibilizando a lo largo del tiempo. En este contexto se modificaron conductas, actividades e incluso asistencia a los centros de salud para consultas no relacionadas con Covid-19. En este informe pretendemos dar cuenta de la situación en relación a la denuncia de accidentes por mordeduras de animales de compañía. (AU)

Análise epidemiológica dos atendimentos da profilaxia antirrábica humana associados a acidentes com gatos / Epidemiological analysis of human anti-rabies prophylaxis associated with accidents with cats

Objetivou-se conhecer o perfil epidemiológico do paciente que buscou atendimento antirrábico pós-exposição associado a acidentes com gatos domésticos, em Belo Horizonte/MG, no período de 2007 a 2016. Realizou-se uma análise exploratória das fichas de notificação do atendimento antirrábico humano do Sistema de Informação de Agravos de Notificações (Sinan). Nos resultados, observou-se que 37,4% das pessoas eram adultas do gênero feminino, com idade entre 20 e 59 anos, 88,7% residentes em área urbana, 26,1% de etnia branca e apenas 31,7% dos pacientes buscaram atendimento antirrábico com até 24 horas da exposição ao vírus rábico. Lesões por mordedura ocorreram em 75,6% dos casos notificados. Quanto às características dos ferimentos, 59,6% foram superficiais, 62,2% ocorreram em mãos/pés e 50,1% foram lesões únicas. Na faixa etária de zero a 10 anos, as regiões anatômicas mãos/pés e cabeça/pescoço/face totalizaram 58,35%. Ressalta-se a necessidade de adoção de ações socioeducativas junto à população, devido ao risco de transmissão de raiva pelo gato, principalmente em áreas em que o vírus rábico circula em populações de morcegos. Sugerem-se melhorias no preenchimento das fichas de notificação do Sinan para melhor compreender o perfil epidemiológico dos pacientes que buscam o atendimento antirrábico e, assim, tornar mais eficaz a gestão desse serviço público.(AU)

The objective of this study was to know the epidemiological profile of the patient who sought post-exposure anti-rabies treatment associated with accidents with domestic cats in Belo Horizonte, Minas Gerais Brazil, from 2007 to 2016. An exploratory analysis of the reports on human rabies of the Notification of Injury Information System was performed. In the results, it was observed that 37.4% of the individuals were female adults aged 20-59 years, 88.7% were urban residents, 26.1% were white, and only 31.7% sought anti-rabies care within 24 hours of exposure to the rabies virus. Bite lesions occurred in 75.6%. Regarding the type of wound, 59.6% were superficial; as for the anatomical location, 62.2% occurred in hands / feet and 50.1% were single lesions. It is necessary to adopt socio-educational actions among the population, due to the risk of transmission of the rabies by the cat, especially in areas where the rabies virus circulates in bat populations. Improvements in the completion of the SINAN notification sheets are suggested to better understand the epidemiological profile of patients seeking anti-rabies treatment and thus improve the management of this public service.(AU)

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.

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

Análisis de las lesiones ocasionadas por mordeduras de animales de compañía en la Ciudad de Buenos Aires: Año 2017 / Analysis of the injuries caused by pets´s bites in the City of Buenos Aires: Year 2017

Las lesiones ocasionadas por mordeduras de animales de compañía constituyen un problema de importancia para la salud, por un lado se relaciona con los traumas directos y los derivados posteriormente tanto físicos como psicológicos, así como con aspectos relacionados con la transmisión potencial de una enfermedad mortal como es la rabia. Actualmente la rabia no se encuentra erradicada; aún se registran casos en animales de compañía de países limítrofes e incluso en provincias del norte de nuestro país. Asimismo en la Ciudad de Buenos Aires (CABA) se mantiene el ciclo aéreo de la rabia a través de los murciélagos. Éstos, al padecer la enfermedad, y por la afectación del sistema nervioso central, presentan: incoordinación, problemas de su sistema de radar, parálisis y muerte. Los perros y gatos domésticos, así como las personas, pueden tomar contacto con estos animales enfermos o muertos y contagiarse de rabia. Se analizan las denuncias efectuadas en la Ciudad de Buenos Aires durante 2017, así como los datos de los animales agresores

Rabia 99,9 % mortal, 100 % prevenible / Rabies 99,9 % deadly, 100 % preventable / Raiva 99,9 % mortal, 100 % evitável

La rabia es una zoonosis de causa viral que provoca una encefalitis aguda y progresiva invariablemente fatal, causante de unas 60.000 muertes anuales. La mayoría de los casos humanos se reportan en África y Asia, pero su distribución es mundial. Se bien se trata de una enfermedad en vías de eliminación en las Américas, ha habido un resurgimiento con nuevas áreas y países afectados en los últimos años. En áreas endémicas los casos humanos están relacionados con mordeduras por perros infectados, mientras que en el resto de los países se asocia a mordeduras de animales silvestres. Luego de las mordeduras, el uso apropiado de la profilaxis posexposición es universalmente efectiva. Por lo tanto, para disminuir la carga global de rabia humana, es fundamental el control de la rabia canina y la expansión de la disponibilidad de profilaxis. En Uruguay, si bien se eliminó la rabia humana en la década de 1960, desde el año 2007 asistimos a una situación epidemiológica compleja con la reintroducción de la rabia animal vinculada a murciélagos. Esto debe poner en alerta a la comunidad médica y veterinaria para evitar el resurgimiento de la rabia humana. Se necesita del esfuerzo conjunto de la medicina humana, veterinaria, de la población y del gobierno a través de políticas públicas con el fin de mantener la vigilancia epidemiológica, actuar sobre el control de la población de perros y aplicar medidas de profilaxis en humanos luego de la mordedura de animales. En la presente revisión se describe la situación en Uruguay, la presentación clínica de esta enfermedad y las indicaciones de profilaxis. (AU)

Rabies is a viral zoonosis that provokes severe and progressively fatal encephalitis, causing approximately 60,000 deaths per year. Most cases are reported in Africa and Asia, although it is globally distributed. Despite it being a disease that is about to be eradicated in the Americas, there has been an outbreak in new areas, affecting other countries in recent years. In endemic areas, human cases are caused by bites of an infected dog, whereas in the rest of the countries it is associated to bites by wild animals. After the bite, the appropriate use of the post-exposure prophylaxis is universally effective. Thus, in order to reduce the global burden of human rabies, it is essential to control dog rabies and to make prophylaxis even more available. In Uruguay, although human rabies was eradicated in the 60s, we have witnessed an epidemiologically complex situation since 2007, upon the new introduction of animal rabies associated to bats. The medical and veterinarian community needs to be alert to avoid this new outbreak of human rabies. We need the joint efforts of human medicine, veterinarians, the population and government by means of public policies with the purpose of conducting epidemiological surveillance, and work towards controlling the dog population and applying prophylactic measures in humans after dog bites. This review describes the situation in Uruguay, accounts for the clinical presentation of the disease and provides prophylactic guidelines. (AU)

La rabia es una zoonosis de causa viral que provoca una encefalitis aguda y progresiva invariablemente fatal, causante de unas 60.000 muertes anuales. La mayoría de los casos humanos se reportan en África y Asia, pero su distribución es mundial. Se bien se trata de una enfermedad en vías de eliminación en las Américas, ha habido un resurgimiento con nuevas áreas y países afectados en los últimos años. En áreas endémicas los casos humanos están relacionados con mordeduras por perros infectados, mientras que en el resto de los países se asocia a mordeduras de animales silvestres. Luego de las mordeduras, el uso apropiado de la profilaxis posexposición es universalmente efectiva. Por lo tanto, para disminuir la carga global de rabia humana, es fundamental el control de la rabia canina y la expansión de la disponibilidad de profilaxis. En Uruguay, si bien se eliminó la rabia humana en la década de 1960, desde el año 2007 asistimos a una situación epidemiológica compleja con la reintroducción de la rabia animal vinculada a murciélagos. Esto debe poner en alerta a la comunidad médica y veterinaria para evitar el resurgimiento de la rabia humana. Se necesita del esfuerzo conjunto de la medicina humana, veterinaria, de la población y del gobierno a través de políticas públicas con el fin de mantener la vigilancia epidemiológica, actuar sobre el control de la población de perros y aplicar medidas de profilaxis en humanos luego de la mordedura de animales. En la presente revisión se describe la situación en Uruguay, la presentación clínica de esta enfermedad y las indicaciones de profilaxis. (AU)

Protocolo del Sistema Nacional de Vigilancia Epidemiológica: enfermedades zoonóticas. No. 08 / Protocol of the National Epidemiological Surveillance System: zoonotic diseases. No. 08

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país.

Perfil dos atendimentos antirrábicos humanos no agreste pernambucano, 2010-2012 / Perfil de atenciones anti-rabia humana en la zona "agreste" de Pernambuco, Brasil, 2010-2012 / Profile of human anti-rabies treatment in the 'agreste' region of Pernambuco State, Brazil, 2010-2012*

Resumo Objetivo: descrever as características das notificações de atendimento antirrábico humano nos municípios da Mesorregião do Agreste Pernambucano, Brasil, de 2010 a 2012. Métodos: estudo descritivo com dados das fichas de atendimento antirrábico humano do Sistema de Informação de Agravos de Notificação (Sinan). Resultados: foram incluídas 10.138 notificações de atendimento antirrábico humano; a espécie mais frequentemente envolvida foi a canina (68,1%), sob condição sadia (79,9%); a mordedura foi o tipo de contato mais comum (83,8%); predominaram ferimentos múltiplos (58,3%), em mãos/pés (39,4%), e ferimentos profundos (56,8%); observou-se baixa frequência de administração da combinação de soro+vacina (10.5%), mesmo com 47,9% das lesões consideradas graves e, consequentemente, necessitando dessa conduta profilática. Conclusão: foi identificada possível realização de condutas profiláticas inadequadas, evidenciando necessidade de capacitação dos profissionais de saúde para uma correta instituição da profilaxia antirrábica humana e preenchimento adequado das fichas de notificação.

Resumen Objetivo: describir las características de las notificaciones de tratamiento anti-rabia humana en los municipios de la mesorregión del "agreste" de Pernambuco, Brasil, 2010-2012. Métodos: se realizó un estudio con datos de tratamiento anti-rabia humana del Sistema de Información de la Notificación de las Enfermedades (Sinan) Resultados: fueron incluidas 10.138 notificaciones de tratamiento anti-rabia humana; la especie involucrada en el mayor número de notificaciones fue canina (68,1%), bajo condiciones saludables (79,9%), y la mordedura fue el contacto más común (83,8%), causando lesiones múltiples (58, 3%) en manos/pies (39,4%), heridas profundas en el 56,8% de los casos; se observó un pequeño número da combinación suero+vacuna (10.5%), incluso a cuando 47,9% de las lesiones se consideró grave necesitando esa conducta profiláctica. Conclusión: se identificó la realización posible de medidas profilácticas inapropiadas, poniendo en evidencia la necesidad de una educación en salud a profesionales de salud para la correcta institución de la profilaxis para rabia humana y un mejor cumplimiento de los formularios de notificación.

Abstract Objective: to describe the characteristics of reported human anti-rabies treatment in municipalities of the 'agreste' region of Pernambuco State, Brazil, 2010-2012. Methods: this was a descriptive study using data from human anti-rabies medical records filed on the Information System for Notifiable Diseases (Sinan). Results: 10,138 reported records of anti-rabies treatment were included; canines were the most involved species (68.1%), in good health condition (79.9%). Biting was the most common contact (83.8%), causing multiple injuries (58.3%), to hands/feet (39.4%), and deep wounds in 56.8% of cases; combined vaccine + serum administration frequency was found to be low (10.5%), even though 47.9% of injuries were considered severe and therefore required this prophylactic procedure. Conclusion: possible inadequate prophylaxis procedures were found, showing the need for health worker training aimed at ensuring correct human anti-rabies prophylaxis and the proper filling in of medical record files.

Efecto del sacrificio de perros vagabundos en el control de la rabia canina / Effect of free-roaming dogs culling on the control of canine rabies

RESUMEN En la ciudad de Arequipa, Perú, se han detectado perros con rabia desde marzo de 2015, señal de la reintroducción del virus de la rabia (VR) en esta zona previamente declarada libre de esta enfermedad. La alta densidad de perros vagabundos ha sido considerada una de las causas de la continua transmisión del VR en el brote de la ciudad de Arequipa, alentando el sacrificio de perros como medida de salud pública. Sin embargo, la efectividad de esta medida de control no ha sido evaluada. El objetivo de esta revisión fue determinar la efectividad del sacrificio de perros vagabundos como medida de control de la rabia urbana. Se realizó la búsqueda de artículos sobre control de rabia canina o urbana en las bases de datos de Medline, Scopus y LILACS. Se incluyeron estudios originales y revisiones que hayan evaluado algún efecto del sacrificio de perros en la transmisión del VR. Veinte de 21 artículos concluyen que el sacrificio de perros vagabundos es inefectivo en reducir la trasmisión del VR e, incluso, puede tener consecuencias imprevistas que empeoren el problema. En conclusión, la evidencia disponible indica que sacrificar perros vagabundos no es efectivo para controlar la rabia urbana. Además, las diversas consecuencias negativas del sacrificio de los perros vagabundos reportadas en otras partes del mundo sugieren que el sistema de rabia urbana es altamente complejo y todos sus componentes deben ser tomados en cuenta durante la implementación de actividades de control.

ABSTRACT In the Peruvian city of Arequipa, rabid dogs have been detected since March 2015, signaling the reintroduction of the rabies virus (RV) in this previously officially-declared rabies free zone. High dog density is considered one of the causes for the continuous transmission of the RV in the outbreak in the city of Arequipa, which seemingly lends support to the culling of dogs as a public health measure. However, the effectiveness of culling free-roaming dogs to control urban rabies has not been evaluated. Objective to determine the effectiveness of free-roaming dog culling as a control measure of urban rabies. Source of data: We searched for articles on dog rabies control or urban rabies control in the databases of PubMed, Scopus and LILACS. The characteristics and results of the documents obtained were recorded. Eligibility criteria: We included original studies and reviews that have evaluated an effect of culling dogs in the transmission of RV. Data collection and evaluation: One of the authors (RCN) screened the articles found in the search based on their titles and abstracts. The data and results of the articles selected for full reading were evaluated by at least two authors. Results: 21 articles were eligible for full reading. 20 of 21 articles conclude that free-roaming dog culling is ineffective in reducing the transmission of RV and may even have unintended consequences that worsen the problem. We believe that the available evidence indicates that the sacrifice of free-roaming dogs is not effective to control urban rabies. In addition, the various negative consequences of free-roaming dog culling reported in other parts of the world suggest that the system of urban rabies is highly complex and all its components must be taken into account during the implementation of control activities.

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.

Proposta de nova metodologia de apoio para indicação racional de profilaxia antirrábica humana pós-exposição / Proposal of new support methodology for rational indication of post-exposure human anti-rabies prophylaxis

A avaliação dos casos de agressão por animais, sem critérios bem definidos, pode levar à indicação equivocada de tratamento antirrábico humano pós-exposição. O número desses tratamentos, em muitos municípios em todo o Brasil, tem preocupado as autoridades sanitárias. Assim, o presente trabalho objetivou avaliar os registros e a conduta da profilaxia antirrábica humana no Município de Jaboticabal, no período de 2007 a 2010, e propor uma nova metodologia de ação. Foi elaborada uma nova ficha de atendimento antirrábico humano, a ficha referência de atendimento a agressão animal e a ficha de visita zoossanitária, todas com seus respectivos manuais de instrução para preenchimento. Além disso, realizou-se a capacitação dos responsáveis pela sua aplicação e as visitas zoossanitárias. Foram avaliadas as informações das fichas de atendimento e dos resultados de visitas domiciliares e observação dos animais agressores; os dados foram tabulados em Excel e analisados com softwares EpiInfo e Action. Também calculou-se o custo direto das vacinas antirrábicas humanas aplicadas. Em 1.366 fichas analisadas, computou-se um agravo para cada 212 habitantes; das pessoas agredidas, 74,3% receberam tratamento pós-exposição, num total de 1.251 doses de vacina. A análise detalhada dos dados, aliada ao fato de Jaboticabal ser considerada região controlada para a raiva, permite questionar que 894 pessoas podem ter recebido vacina sem necessidade, totalizando 1.094 doses a um custo aproximado de 20 mil reais. Nas visitas zoossanitárias constatou-se que, dentre os animais agressores, 78,1% eram domiciliados; 84,4% estavam sadios nos dias 0 e 10; 55% dos ataques foram provocados, e 73% das agressões ocorreram nas próprias residências. Assim, maior atenção deve ser dispensada ao atendimento a agravos por animais, com adequações na ficha de registro, aplicação das fichas referência de atendimento a agressão animal e de visita zoossanitária. É essencial a interação dos serviços médicos e médicos veterinários, além da intensificação de programas educativos sobre comportamento animal, cuidados e posse responsável. Isso dará subsídios e segurança ao médico responsável no momento de indicar ou não o tratamento antirrábico humano pós-exposição.

A poor assessment of cases of animal attacks on humans may lead to inadequate human anti-rabies prophylaxis. The high number of post-exposure prophylaxis (PEP) treatments in many Brazilian cities has become a concern for Public Health authorities. The present study aimed to assess the records and the conduct of human PEP in the municipality of Jaboticabal, in the period 2007-2010, and to propose a new methodology. Versions for the following forms, together with instructions for filling them out, are proposed: human rabies medical attention form, animal attack notification form, and an animal-sanitary visit form. The personnel in charge of the health sector were trained for filling out these forms and conducting visits. The analysis of patient's records and the results of home visitation and animal observation data were evaluated. Data were organized in Excel spreadsheet and analyzed using EpiInfo and Action software. The direct cost of human vaccination was also calculated. From the 1,366 analyzed records, there was one animal attack per 212 inhabitants. Among the affected people, 74.3% received PEP, resulting in a total of 1,251 vaccine shots. The fact that Jaboticabal is located in a region that has a controlled status for rabies, together with the data analysis, allowed hypothesizing that 894 persons may have received unnecessary rabies shots, which resulted in a total of 1,094 shots at a cost of approximately 20 thousand Brazilian reais. During the animal-sanitary visits, it could be observed that among the aggressors, 78.1% were domiciled animals; 84.4% remained healthy between observation days 0 to 10; 55% of the attacks were provoked and 73% of the events happened inside the domicile. It can be concluded that greater importance should be given to animal attack cases. The patient's records, animal attack notification form and animal-sanitary visit forms should be reviewed and duly amended. The integration of medical and veterinary services is essential, as well as the intensification of educational programs on animal behavior, care and responsible ownership. These actions will provide greater support and safety to the physician in charge upon deciding whether to provide PEP treatment or not.

Comportamiento epidemiológico de la rabia paralítica bovina en la región central de México, 2001-2013 / Epidemiological trends in bovine paralytic rabies in central Mexico, 2001-2013

OBJETIVO:Determinar la distribución geoespacial de los casos de rabia paralítica bovina transmitida por Desmodus rotundus en los estados de Guanajuato, Querétaro y San Luis Potosí, México. MÉTODOS: Estudio epidemiológico transversal a partir de los casos notificados por las campañas estatales de control de la rabia paralítica bovina en Guanajuato (2008-2013), Querétaro (2005-2013) y San Luis Potosí (2001-2013). Se confirmaron los casos por inmunofluorescencia directa. Se elaboraron mapas de distribución de los casos por año y por especie, mediante el software ArcMap versión 10.1. Para identificar áreas con condiciones apropiadas para la presencia de casos se combinaron las variables bioclimáticas con los casos georreferenciados, mediante el programa MaxEnt versión 3.3.3. RESULTADOS: Se registraron 1 037 casos, de los cuales, 911 (87,9%) ocurrieron en San Luis Potosí, 82 (7,9%) en Querétaro y 44 (4,2%) en Guanajuato. Del total, 87,4% ocurrió en alturas menores de 1 500 msnm. En Guanajuato y Querétaro, 77,3% y 42,3% de los casos, respectivamente, ocurrieron en alturas mayores de 1 500 msnm. Los meses de mayor incidencia fueron de diciembre a marzo. La variante antigénica viral V11 fue la más frecuente (173 casos), presente en los tres estados estudiados. En el canal endémico, el promedio de casos se mantiene en la zona de seguridad de enero a marzo, pero de abril a junio excede la mediana. La distribución espacial de los casos muestra la diseminación reciente de la enfermedad, lo que coincide con la presencia del murciélago vampiro. CONCLUSIONES: La rabia paralítica bovina se ha extendido a regiones anteriormente libres de esta enfermedad. Las características ambientales y la altura sobre el nivel del mar no limitan la presentación de casos. Se debe mantener un monitoreo constante para la detección oportuna de casos. La vacunación se debe realizar antes del comienzo de las lluvias, sin esperar la aparición de brotes.

OBJECTIVE: To determine the geospatial distribution of bovine paralytic rabies cases transmitted by Desmodus rotundus in the Mexican states of Guanajuato, Querétaro, and San Luis Potosí. METHODS: This was a cross-sectional epidemiological study based on cases reported during statewide campaigns for the control of bovine paralytic rabies in Guanajuato (2008-2013), Querétaro (2005-2013) and San Luis Potosí (2001-2013). All cases were confirmed by direct immunofluorescence. Maps showing the distribution of cases by year and species were constructed using ArcMap version 10.1. To identify areas where conditions favor the appearance of cases, bioclimatic variables were combined with georeferenced cases using MaxEnt version 3.3.3. RESULTS: Of the 1037 cases recorded, 911 (87.9%) occurred in San Luis Potosí, 82 (7.9%) in Querétaro, and 44 (4.2%) in Guanajuato. Of the total number of cases, 87.4% occurred at altitudes of less than 1500 meters above sea level. In Guanajuato and Querétaro, 77.3% and 42.3% of the cases, respectively, occurred at altitudes greater than 1 500 meters above sea level. Peak incidence was recorded from December to March. The V11 antigenic variant of the virus was the most common (173 cases); it was found in all three states. In the endemic channel, the average number of cases remains within the security zone from January to March but exceeds the median value from April to June. The spatial distribution of cases shows that the disease has spread recently, which correlates with the presence of the vampire bat. CONCLUSIONS: Bovine paralytic rabies has spread to areas that were formerly free of the disease. Environmental characteristics and the altitude above sea level do not limit the appearance of cases. Constant monitoring should be conducted for early case detection. Vaccination should take place before the rainy season starts, without waiting for outbreaks to occur.