Clinical aspects of human rabies in the state of Ceará, Brazil: an overview of 63 cases

Abstract INTRODUCTION Rabies is considered one of the most relevant public health problems owing to its high fatality rate and the high number of deaths worldwide. METHODS We included patients with human rabies who attended a reference hospital in the state of Ceará during 1976-2019. RESULTS Data were available for 63 out of 171 (36.8%) patients. Of these patients, 48 (76.2%) were attacked by dogs. In recent years, wild animals have been the most common aggressor species (marmosets and bats). Only 39 (70%) patients were initially correctly suspected with rabies. Bites were the most frequent exposure (56; 96%), most commonly on the hands (21; 42%) and the head (9; 18.4%). Only 14 (22%) patients had sought medical assistance before the onset of symptoms, and only one completed post-exposure prophylaxis. The most prevalent signs and symptoms included aggressiveness/irritability (50; 79.4%), fever (42; 66.7%), sore throat/dysphagia (40; 63.5%), and myalgia (28; 44.4%). Hydrophobia was present in 17 patients (22.0%). CONCLUSIONS Most cases of human rabies in Ceará occurred due to the failure to seek medical assistance and/or the failure of the health system in initiating early post-exposure prophylaxis. There is a need for specific information and education campaigns focusing on the cycle of sylvatic rabies as well as prevention measures. Health professionals should undergo refresher training courses on the signs and symptoms of rabies and on the specific epidemiological features of the disease in Brazil.

Epidemiologia da raiva humana no estado do Ceará, 1970 a 2019 / Epidemiología de la rabia humana en el estado de Ceará, Brasil, 1970 a 2019 / Epidemiology of human rabies in the state of Ceará, Brazil, 1970 to 2019

Objetivo: Descrever os casos de raiva humana no estado do Ceará, Brasil, no período 1970-2019. Métodos: Estudo descritivo, sobre dados secundários da Secretaria da Saúde e do hospital de referência do Ceará. Resultados: Dos 171 casos, 75,7% ocorreram em homens, 60,0% nas idades até 19 anos e 56,0% em áreas urbanas. O cão foi agente transmissor em 74,0% dos casos; sagui em, 16,7%; e morcego, em 7,3%. Entre 1970 e 1978, houve crescimento do número de casos (pelo Joinpoint Regression Program, percentual da mudança anual [APC] = 13,7 - IC95% 4,6;41,5); e entre 1978 e 2019, redução (APC = -6,7 - IC95% -8,8;-5,9). Houve redução da transmissão por cães (71 casos; último caso em 2010) e aumento relativo por mamíferos silvestres (5 casos a partir de 2005). Conclusão: O estudo evidencia mudança na dinâmica da transmissão da raiva no período observado, com redução da transmissão por cão e incremento de casos por animais silvestres.

Objetivo: Describir los casos de la rabia humana en Ceará, Brasil, 1970-2019. Métodos: Estudio descriptivo con datos secundarios de la Secretaría de Salud y del hospital de referencia de Ceará. Resultados: De los 171 casos, 75,7% ocurrió en hombres, el 60,0% en los 19 años y el 56,0% en áreas urbanas. El perro fue transmisor en 74,0%, el mono tití en 16,7% y el murciélago el 7,3%. Entre 1970 y 1978, hubo un aumento de casos (por el Joinpoint Regression Program, cambio porcentual anual [APC] = 13,7 - IC95% 4,6; 41,5), entre 1978 y 2019 una disminución (APC= -6,7 - IC95% -8,8; -5,9). Hubo una reducción de la transmisión por perros (71 casos, el último en 2010) y un aumento por mamíferos salvajes (5 casos, desde 2005). Conclusión: El estudio muestra un cambio en la dinámica de la transmisión de la rabia en los últimos años, con reducción de la transmisión por perros y aumento de casos por animales salvajes.

Objective: To describe cases of human rabies in Ceará State, Brazil between 1970 and 2019. Methods: This was a descriptive study using secondary data from the Ceará State Department of Health and the state reference hospital. Results: Of 171 cases, 75.7% occurred in males, 60.0% in <19-year-olds, and 56.0% in urban areas. Rabies was transmitted by dogs in 74.0% of cases, marmosets in 16.7% and bats in 7.3%. Between 1970 and 1978, there was an increase of cases (using the Joinpoint Regression Program, annual percentage change [APC] = 13.7 - 95%CI 4.6;41.5), while between 1978 and 2019 there was a decrease (APC = -6.7 - 95%CI -8.8;-5.9). There was a reduction in transmission by dogs (71 cases, last case in 2010) and an increase by sylvatic animals (5 cases since 2005). Conclusion: This study demonstrates changes in rabies transmission dynamics during the period studied, with a reduction in transmission by dogs and an increase of transmission by sylvatic animals.

Health system collapse 45 days after the detection of COVID-19 in Ceará, Northeast Brazil: a preliminary analysis

Abstract INTRODUCTION: COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aim to describe the epidemiological course of cases and deaths due to COVID-19 and their impact on hospital bed occupancy rates in the first 45 days of the epidemic in the state of Ceará, Northeastern Brazil. METHODS: The study used an ecological design with data gathered from multiple government and health care sources. Data were analyzed using Epi Info software. RESULTS: The first cases were confirmed on March 15, 2020. After 45 days, 37,268 cases reported in 85.9% of Ceará's municipalities, with 1,019 deaths. Laboratory test positivity reached 84.8% at the end of April, a period in which more than 700 daily tests were processed. The average age of cases was 67 (<1 - 101) years, most occurred in a hospital environment (91.9%), and 58% required hospitalization in an ICU bed. The average time between the onset of symptoms and death was 18 (1 - 56) days. Patients who died in the hospital had spent an average of six (0 - 40) days hospitalized. Across Ceará, the bed occupancy rate reached 71.3% in the wards and 80.5% in the ICU. CONCLUSIONS: The first 45 days of the COVID-19 epidemic in Ceará revealed a large number of cases and deaths, spreading initially among the population with a high socioeconomic status. Despite the efforts by the health services and social isolation measures the health system still collapsed.

Ossos ID: uma proposta de banco de dados didático de peças anatômicas para área da saúde / Bones ID: a proposal of didactic database of anatomic parts to health area / Huesos ID: una propuesta de base de datos educativos de estructuras anatómicas para la área de salud

Objetivo: Desenvolvimento e padronização de uma base de dados didática para armazenamento de informações relacionadas às coleções de peças osteológicas humanas acondicionadas no ossário do Departamento de Morfologia da Universidade Federal do Ceará. Método: A presente pesquisa trata-se de um estudo descritivo-exploratório executado em três etapas distintas: na primeira, foi desenvolvida a base de dados OssosID; na segunda etapa foi realizado a aplicação da base de dados OssosID e a terceira etapa consistiu na disponibilização da base de dados OssosID em nuvem, a partir do uso de software gratuito disponível online. Resultados e Conclusão: Após o desenvolvimento, aplicação e disponibilização da base de dados OssosID,foi possível observar que esta plataforma tornou-se viável para o seu uso contínuo e de rotina nas atividades do Departamento de Morfologia da Universidade Federal do Ceará, podendo servir como modelo para outras instituições de ensino e pesquisa devido a sua facilidade de operação e uniformidade.

Objective: Development and standardization of a didactic database to storage information related to human osteological collections of stored pieces in the ossuary of the Department of Morphology (DM) of the Federal University of Ceará (UFC). Method: The present research it is about a study descriptive and exploratory executed in three distinct stages: at first, was developed the based data: OssosID; at the second stage was performed the implementation of the OssosID and the third step consisted in providing the database OssosID in cloud by using a free software available online. Results and Conclusion: After the development, application and availability of the basedata: OssosID, we could observe that this platform has become viable for its continued and routine use in the activities of the Department of Morphology, Federal University of Ceará, and it can be used as a model for other institutions of education and research, by its easy operation and uniformity.

Objetivo: Desarrollo y normalización de una base de datos de enseñanza para almacenar información relacionada con las colecciones osteológicas de datos piezas que se conservan en el osario del Departamento de Morfología (DM) de la Universidad Federal de Ceará (UFC). Método: La presente investigación es un estudio descriptivo y exploratorio, ejecutado en tres etapas distintas: en primer lugar, fue desarrollado el base de datos: OssosID; la segunda etapa se llevó a cabo la aplicación de la base de datos OssosID y el tercer paso consistió en el suministro de el base OssosID nube de la utilización de software libre disponible en línea. Resultados y Conclusión: Después del desarrollo, la aplicación y la disponibilidad de los datos OssosID base, se observó que esta plataforma sea posible para su uso continuado y rutinaria en las actividades del Departamento de Morfología de la Universidad Federal de Ceará, pueden servir como un modelo para otras instituciones educativas y de investigación, debido a su facilidad de operación y la uniformidad.