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.

Evaluation of short-interfering RNAs treatment in experimental rabies due to wild-type virus

ABSTRACTWe have evaluated the efficacy of short-interfering RNAs targeting the nucleoprotein gene and also the brain immune response in treated and non-treated infected mice. Mice were inoculated with wild-type virus, classified as dog (hv2) or vampire bat (hv3) variants and both groups were treated or leaved as controls. No difference was observed in the lethality rate between treated and non-treated groups, although clinical evaluation of hv2 infected mice showed differences in the severity of clinical disease (p = 0.0006). Evaluation of brain immune response 5 days post-inoculation in treated hv2 group showed no difference among the analyzed genes, whereas after 10 days post-inoculation there was increased expression of 2',5'-oligoadenylate synthetase 1, tumor necrosis factor alpha, interleukin 12, interferon gamma, and C-X-C motif chemokine 10 associated with higher expression of Ngene in the same period (p < 0.0001). In hv2 non-treated group only higher interferon beta expression was found at day 5. The observed differences in results of the immune response genes between treated and non-treated groups is not promising as they had neither impact on mortality nor even a reduction in the expression of N gene in siRNA treated animals. This finding suggests that the use of pre-designed siRNA alone may not be useful in rabies treatment.

Notificacion evento: rabia en humanos y en perro / Event Notification: rabies in humans and dogs

Una vez realizado el seguimiento y monitoreo epidemiológico del Programa Nacional de Zoonosis hacia los Programas Departamentales de los SEDES, se pudo obtener la siguiente información con relación a la situación epidemiológica y epizoótica en el país hasta la semana epidemiológica 29 de la presente gestión.

Fatal rabies despite post-exposure prophylaxis.

Only sporadic reports of failure of post-exposure prophylaxis for rabies exist in the published literature. We are reporting such a case in a 3-year-old boy. The child had Category III dog bite on his right thigh. He presented with progressive ascending paralysis, finally developing quadriplegia and respiratory paralysis. Typical hydrophobia and aerophobia were absent. He received four doses of antirabies cell culture vaccine. He did not receive antirabies immunoglobulin. The boy succumbed on the 23 rd day of the dog bite. Diagnosis of rabies was confirmed in the laboratory by demonstration of Negri bodies, direct fluorescent antibody test and reverse transcriptase-polymerase chain reaction either on impression smear of brain or a piece of brain taken during autopsy.

Retrospective analysis of post-exposure to human anti-rabies treatment in Botucatu, São Paulo State, Brazil

This analysis aimed to identify characteristics of accidents that would, probably, provoke rabies infection. A total of 14,409 survey questionnaires for surveillance of human rabies from the Brazilian Information System for Disease Notification (SINAN), from 2000 to 2005, were analyzed. Regarding demographics, it was observed that 7,377 (51.5 percent) of the victims were white, 4,458 (30.93 percent) were children and 8,008 (55.58 percent) were males. Urban cases were prevalent (88.10 percent) while dogs were the animals most frequently involved in accidents, in 11,700 cases (81.19 percent). Bites (84.35 percent) and scratches (19.15 percent) were the most prevalent exposure types, and occurred predominantly on victims' extremities (38.79 percent). The prophylactic measure taken in 6,179 cases comprised anti-rabies vaccine; of these victims, 421 (2.92 percent) showed systemic reactions while 693 (4.80 percent) reported no response. The importance of developing awareness in professionals that should correctly report post-exposure immunoprophylaxis cases is emphasized given the high number of individuals who receive this type of treatment annually.

Antibody and cytokine seerum levels in patients subjected to anti-rabies prophylaxis with serum-vaccination

Rabies is considered a fatal disease once clinical symptoms have developed. The aim of this study was to evaluate epidemiological aspects and immune response in patients attacked by domestic and wild animals and subjected to post-exposure rabies treatment with equine serum and associated vaccine. Thirty-three patients were evaluated; they were between 13 and 65 years old, 75.8% were male and 24.2% female, and from the Botucatu neighborhood. Twenty healthy control individuals with the same age range were also studied. Specific antibodies to equine immunoglobulins and IFN-g, IL-2, IL-4, and IL-10 production were evaluated by ELISA. IgM, IgE, IgG and subclasses, and rabies virus antibodies serum levels were determined by nephelometry and seroneutralization methods, respectively. No anaphylactic or serum sickness allergic reactions were observed in patients after treatment. Anti-equine IgG levels were significantly higher than those of IgM after 14 and 28 days of treatment. Protective antibodies to rabies virus > 0.5 UI/ml were detected in 84.6% and 75% of patients at days 14 and 28, respectively. IFN-g, IL-2 and IL-10 levels in patients before and 48h after treatment were significantly higher than in controls suggesting that both Th1 and Th2 cells were activated in the patients. Serum IgM levels were higher at day 14, and IgG2 and IgE levels were higher at day 28 of treatment. These results suggest that post-exposure rabies treatment in humans induces significant alterations in patient immune response characterized by increased levels of cytokines, serum levels of specific rabies virus antibodies, and the equine serum components employed in the treatment

Rabies..Exacerbated problem in Ibn ElKhatib Hospital

Rabies rate increased last 6 months reaching 17 cases admitted to IBN. Al Kateeb hospital, Is caused by RNA virus genus lyssa virus of the rhabdoviridae family. It is primarily an infection of animals but is occasionaly transmitted to man by bites and produce encephalomyelits which is nearly always fatal. In most parts of the world domestic dog is the main vector of human rabies. The virus can pentrate broken skin and intact mucous membranes, also the human rabies resulting from inhalation of the virus is exceptionally rare, and theoritically, Rabies is communicable from person to person. The symptom of either furious or pralytic rabies will develop depending on wether the brain or spinal cord is predominately affected. The diagnosis of rabies can be confirmed in the animal responsible for the bite by immunofluorescene of brain impression smear or histological examination for nigri bodies while in patients rabies can be confirmed early in the illness by antigen detection using immuno fluorescence and by virus isolation from saliva and other secretions. Treatment of rabies is conservative and the prognosis virtually hopeless. At the time of the bite, However before the virus has invaded the nervous system, correct cleaning of the wound and the use of post- exposure immunization reduce the risk of rabies, pre- exposure prophylaxis and post- exposure prophylaxis is essential to prevent the disease

Effect of bacillus of Calmette-Guerin, avridine and Propionibacterium acnes as immunomodulators on rabies in mice

Avaliou-se a resposta imune celular e humoral de camundongos inoculados com virus rabico de rua e submetidos aos imunomoduladores Onco-BCG, avridina e Propionibacterium acnes. Os animais submetidos ao tratamento com P. acnes apresentaram um maior percentual de sobrevivencia quando comparados aos dos demais tratamentos. Foram observados menores niveis de IFN-gama nos animais infectados, sugerindo imunossupressao viral. O teste do Coxim Plantar nao foi eficaz para a deteccao da resposta de hipersensibilidade retardada na metodologia utilizada, contrariamente ao MIF. A sobrevivencia dos animais nao apresentou correlacao com os niveis de anticorpos soroneutralizantes, concentracao de IFN-gama e resposta ao MIF

Dimorfismo ultraestructural y opciones no utilizadas previamente para el tratamiento de la encefalitis rábica humana / Ultrastructural dimorphism and unused options in the management of human rabies encephatitis

Se hace una revisión de diferentes tratamientos experimentales en cultivo de células y en ratones con rabdovirus rábico fijo que no ha tenido aplicación práctica. Se plantean tratamientos opcionales no utilizados previamente para la encefalitis rábica humana, basados en hipótesis congruentes. Se señala el empleo del agente quimioterápico 5 fluorouracilo (5-FU). Se sugiere la anestesia por éter, dado que este compuesto a baja concentración inhibe el crecimiento viral. Otra opción sería la radioterapia como la empleada para tumores cerebrales. También se ha sugerido la craniectomía descomprensiva bilateral complementaria y el empleo de inhibidores no-nucleósidos de transcriptasas virales.

Funcionamiento y evaluación del centro de atención antirrábica: región sanitaria VIII: Municipalidad de General Pueyrredón: Buenos Aires, Argentina / Appraisement of the Antirrhabies Center, from 1991 to 1993: Municipality General Pueyrredón, province Buenos Aires, Argentine Republic

A partir del año 1991 se unificó la atención antirrábica en el centro de Salud Municipal Nª 1, el que depende administrativa y técnicamente del Dpto. de Promoción de la Salud. Esta unificación dio oportunidad de estudiar, controlar y adecuar los recursos disponibles para la atención del mordido. A partir del año 1991, se nota una tendencia al aumento en el número de consultas como también la cantidad de perros sin dueños que deambulan por la calle, como de las denuncias que se registran cada año. Se hace notar también que en los tres años que se analizan en este estudio, el perro se ubica en primer lugar, entre los animales causantes de estos accidentes. Se observa una mayor cantidad de tratamientos completos, como también de tratamientos suspendidos como consecuencia del control y alta veterinaria de los animales. Por último, se comprueba un aumento de las consultas en los meses de primavera y verano como consecuencia de la mayor actividad al aire libre y el incremento de población. Debe insistirse en las medidas de prevención a través de una persistente educación de la salud a nivel de la población general, tendiente a evitar los accidentes de esta naturaleza