Human rabies post-exposure prophylaxis relative to the disease epidemiological status

Andrade, Bruno Fonseca Martins da Costa; Andrade, Taísa Santos de Melo; Queiroz, Luzia Helena

doi:10.1590/1413-81232018241.32832016

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Sumário

Temas Livres • Ciênc. saúde colet. 24 (1) • Jan 2019 • https://doi.org/10.1590/1413-81232018241.32832016 copy

Human rabies post-exposure prophylaxis relative to the disease epidemiological status

Tratamento antirrábico humano pós-exposição em relação à situação epidemiológica da doença

Authorship SCIMAGO INSTITUTIONS RANKINGS

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.

Key words
Rabies; Animal aggression; Post-exposure prophylaxis; Immunization schedule; Dogs

Variable	Classification	Characteristics
Wound	Mild	Single and superficial wound on the trunk and limbs
Wound	Severe	Multiple and deep wound, lacerating on the head, mucosa, hands and feet
Conducts	No Treatment	Anti-rabies vaccine or RIG was not prescribed and the animal was observed for 10 days
	PEP Treatment 1	Maximum three doses of mouse-brain vaccine on alternate days or even two doses of cell culture vaccine on day 0 and 3 during animal observation
	PEP Treatment 2	Seven consecutive doses and two boosters of mouse-brain vaccine or five doses of cell culture vaccine on days 0, 3, 7, 14 and 28
	PEP Treatment 3	RIG + ten doses with three boosters of mouse brain vaccine or RIG + five doses of cell culture vaccine
	Revaccination	The victim had been previously vaccinated against rabies and a booster was recommended
	Not rated	The number of doses prescribed was not compatible with the official treatment
	No Information	There was no information on the treatment given
Treatment Adequacy^* * According to Rigo and Honer9.	Appropriate	Medical conduct followed adequately the technical standards recommended for the type of exposure in order to avoid the risk of contracting rabies
	Inappropriate	Treatment did not follow the technical recommendations based on the type of the exposure
	Inconclusive	There was two or more missing information regarding the animal and nature of injury, making it impossible to evaluate the treatment
	No Information	There was no information on the treatment given.

Wound type		N	%
	Single	5577	66.5
	Multiples	2699	32.2
	Not filled	110	1.3
Characteristic of the wound		N	%
	Deep	3260	38.9
	Superficial	4542	54.2
	Tearing	126	1.5
	Not filled	702	8.1
Type of exposure		N	%
	Contact	383	4.2
	Scratch	1078	11.9
	Licking	154	1.7
	Bite	7399	81.4
	Not filled	74	0.8
Location of aggression		N	%
	Mucosa	41	0.4
	Head / neck	1149	12.5
	Hands / feet	1939	21.1
	Upper body	481	5.2
	Upper limbs	2490	27.1
	Lower members	3036	33.0
	Not filled	68	0.7
Aggressor species		N	%
	Canine	7476	89.1
	Feline	910	10.9

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[1] Collaborations

BFMC Andrade conception and experimental design, analysis and interpretation of the data, preparation of the manuscript; TSM Andrade tabulation of the data, exportation and statistical analysis; LH Queiroz conception and experimental design, analysis and interpretation of the data; revision of the manuscript in Portuguese and English.