Atendimentos antirrábicos humanos pós-exposição: tendência temporal de sua prevalência no Ceará, de 2007 a 2015

Profile of human anti-rabies care and post-exposure prophylaxis in the state of São Paulo

Background:

Rabies is an anthropozoonosis that greatly impacts public health and is transmitted by infected mammals. Aggression by animals is notifiable and may result in anti-rabies post-exposure prophylaxis (PEP). This study aimed to characterize anti-rabies PEP notifications in São Paulo state, Brazil.

Methods:

A descriptive study was conducted using data provided by the SINAN between 2013 and 2017.

Results:

A total of 572,889 aggressions were recorded during the study period, characterized mostly by dogs (83.5%), single wounds (56.9%), superficial wounds (58.6%), and hands/feet (34.6%).

Conclusions:

Animal observation was the most frequent recommendation, even in cases of attacks from non-domestic animals.

Description of human anti-rabies post-exposure prophylaxis care notifications in Brazil, 2014-2019

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.

Risk areas for Human Visceral Leishmaniosis 2007-2018: A temporal and spatial analysis in Ceará, Brazil

Visceral leishmaniasis (VL) is considered as an important tropical disease because it rapidly spreads across a wide geographical area. This study aimed to analyse the temporal and spatial patterns of incidence, mortality and case fatality rates due to human VL in Ceará, Brazil, from 2007 to 2018. This is an ecological study involving time series and spatial analyses, and data were obtained from human VL notifications. Temporal trend analysis was carried out using the Joinpoint Regression Program. SaTScan 9.6 was used for conducting spatial analyses, and ArcMap 9.2 was used for building maps. There were 6,066 incident cases and 516 deaths due to human VL. There was an increasing trend in the incidence rate from 2007 to 2014 (annual per cent change [APC] = 3.8; 95% confidence interval [CI]:0.5 to 7.3; p = .031). Mortality (APC = -0.3; 95%CI: -2.5 to 1.9; p = .765) and VL case fatality rates (APC = -3.0; 95%CI: -4.3 to -1,7; p = .188) showed non-significant decline. The incidence rates were higher in the northwest and south regions of the state, with 11 high incidence rate clusters from 2007 to 2010, seven clusters in 44 municipalities from 2011 to 2014, and six clusters in 49 municipalities from 2015 to 2018. During 2007-2010, only one significant mortality rate cluster was identified in the southern region (relative risk [RR] = 7.6); during 2011-2014, two clusters in the northwest region were identified (RR=3.9 and RR=4.6). In the last period, a cluster of 11 municipalities in the southern region was identified (RR = 4.2). Mortality rate clusters were identified in the centre-south (2007-2010), northwest and south (both from 2011 to 2018). VL has a heterogeneous distribution, with maintenance of clusters with high incidence and mortality rates, as well as case fatality rates in municipalities in the northwest and south regions. These clusters present areas with the greatest risk of transmission of human VL.

Epidemiology of human rabies in the state of Ceará, Brazil, 1970 to 2019

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.

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

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.