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

Authors’ contribution

Estima NM and De Assis DM contributed to the concept of the study and data analysis and interpretation. All the authors contributed to the discussion of the results, literature review, drafting the manuscript, critically reviewing its intellectual content, approved the final version and declare themselves to be responsible for all aspects thereof, including the guarantee of its accuracy and integrity.

Conflicts of interest

The authors declare they have no conflicts of interest.

Sociodemographic characteristics	n	%
Sex (n = 4,031,640)
Male	2,111,369	52.4
Female	1,920,271	47.6
Age group (in years) (n = 4,033,084)
<1	54,947	1.4
1-19	1,368,486	33.9
20-39	1,054,952	26.2
40-59	947,557	23.5
≥60	607,142	15.0
Race/skin color (n = 3,451,110)
Brown	1,604,912	46.5
White	1,575,682	45.7
Black	224,721	6.5
Yellow	28,436	0.8
Indigenous	17,359	0.5
Schooling (n = 2,063,631)^a
Illiterate	66,629	3.2
Elementary education I	562,932	27.3
Elementary education II	711,513	34.5
High school education	555,174	26.9
Higher education	167,383	8.1
Zone of residence (n = 3,842,981)
Urban	3,386,589	88.1
Rural	436,408	11.4
Peri-urban	19,984	0.5

Variables	n	%
Epidemiological background
Type of exposure^a (n = 4,368,254)
Bite	3,575,717	81.9
Scratch	601,256	13.7
Lick	105,643	2.4
Indirect contact	52,294	1.2
Other	33,344	0.8
Location of the wound^a (n = 4,360,995)
Hands/feet	1,541,201	35.3
Lower limbs	1,488,110	34.1
Upper limbs	704,660	16.2
Head/neck	337,007	7.7
Torso	200,210	4.6
Mucous membrane	89,807	2.1
Wound (n = 3,908,181)
Single	2,336,416	59.8
Multiple	1,541,099	39.4
Not wounded	30,666	0.8
Type of wound^a (n = 3,948,063)
Surface	2,015,477	51.0
Deep	1,719,434	43.6
Laceration	213,152	5.4
Attacking animal species (n = 4,028,237)
Dog	3,281,190	81.5
Cat	612,690	15.2
Bat	31,786	0.8
Primate	19,769	0.5
Fox	5,661	0.1
Domestic herbivore	11,288	0.3
Other	65,853	1.6
Status of the animal (n = 3,872,508)
Healthy	2,762,232	71.3
Suspect	638,614	16.5
Dead/missing	455,362	11.8
Rabid	16,300	0.4
Current prophylaxis
Final status of the animal (n = 2,420,706)
Rabies negative (clinical)	2,083,834	86.1
Dead/put down/no diagnosis	283,273	11.7
Rabies negative (laboratory)	42,593	1.8
Rabies positive (clinical)	5,057	0.2
Rabies positive (laboratory)	5,949	0.2
Prophylaxis indicated (n = 3,929,787)
Observation + vaccination	1,736,036	44.2
Observation of animal	1,044,030	26.6
Vaccination	754,452	19.2
Anti-rabies serum + vaccination	329,124	8.4
Prophylaxis waived	56,850	1.4
Reexposure regimen	9,295	0.2
Prophylaxis interrupted (n = 2,226,105)
No	1,684,981	75.7
Yes	541,124	24.3
Reason for interruption (n = 541,124)
Dropout	339,356	62.7
Indicated by health center	167,363	30.9
Transfer	34,405	6.4
Active tracing, carried out by health center (n = 307,048)
Yes	236,862	77.1
No	70,186	22.9
Anti-rabies serum indicated (n = 2,133,632)
No	1,867,673	87.5
Yes	265,959	12.5

Prophylactic procedure	Appropriate		Inappropriate
	Appropriate		Insufficient		Excessive
	n	%	n	%	n	%
Indirect contact (n = 49,252)
Prophylaxis waived	1,648	3.3	-^a	-^a	-^a	-^a
Observation of animal	-^a	-^a	-^a	-^a	8,929	18.1
Observation + vaccination	-^a	-^a	-^a	-^a	17,468	35.5
Vaccination	-^a	-^a	-^a	-^a	13,656	27.7
Anti-rabies serum + vaccination	-^a	-^a	-^a	-^a	7,551	15.3
Minor accidents with domestic animals not suspected of having rabies (n = 541,874)
Prophylaxis waived	-^a	-^a	12,878	2.4	-^a	-^a
Observation of animal	294,670	54.4	-^a	-^a	-^a	-^a
Observation + vaccination	171,221	31.5	-^a	-^a	-^a	-^a
Vaccination	-^a	-^a	-^a	-^a	58,979	10.9
Anti-rabies serum + vaccination	-^a	-^a	-^a	-^a	4,126	0.8
Minor accidents with domestic animals suspected of having rabies (n = 144,681)
Prophylaxis waived	-^a	-^a	2,361	1.6	-^a	-^a
Observation of animal	-^a	-^a	20,162	13.9	-^a	-^a
Observation + vaccination	45,193	31.3	-^a	-^a	-^a	-^a
Vaccination	67,312	46.5	-^a	-^a	-^a	-^a
Anti-rabies serum + vaccination	-^a	-^a	-^a	-^a	9,653	6.7
Minor accidents with rabid, missing or dead domestic animals (n = 96,670)
Prophylaxis waived	-^a	-^a	2,051	2.1	-^a	-^a
Observation of animal	-^a	-^a	4,648	4.8	-^a	-^a
Observation + vaccination	-^a	-^a	1,091	1.1	-^a	-^a
Vaccination	78,663	81.4	-^a	-^a	-^a	-^a
Anti-rabies serum + vaccination	-^a	-^a	-^a	-^a	10,217	10.6
Severe accidents with domestic animals not suspected of having rabies (n = 2,123,730)
Prophylaxis waived	-^a	-^a	20,137	0.9	-^a	-^a
Observation of animal	-^a	-^a	654,262	30.8	-^a	-^a
Observation + vaccination	1,247,007	58.7	-^a	-^a	-^a	-^a
Vaccination	-^a	-^a	167,116	7.9	-^a	-^a
Anti-rabies serum + vaccination	35,208	1.7	-^a	-^a	-^a	-^a
Severe accidents with domestic animals suspected of having rabies (n = 437,035)
Prophylaxis waived	-^a	-^a	3,548	0.8	-^a	-^a
Observation of animal	-^a	-^a	43,361	9.9	-^a	-^a
Observation + vaccination	-^a	-^a	178,398	40.8	-^a	-^a
Vaccination	-^a	-^a	153,763	35.2	-^a	-^a
Anti-rabies serum + vaccination	57,965	13.3	-^a	-^a	-^a	-^a
Severe accidents with rabid, missing or dead domestic animals (n = 307,889)
Prophylaxis waived	-^a	-^a	4,530	1.5	-^a	-^a
Observation of animal	-^a	-^a	2,523	0.8	-^a	-^a
Observation + vaccination	-^a	-^a	16,331	5.3	-^a	-^a
Vaccination	-^a	-^a	148,904	48.4	-^a	-^a
Anti-rabies serum + vaccination	135,601	44.0	-^a	-^a	-^a	-^a
Accidents involving wild animals (n = 50,969)
Prophylaxis waived	-^a	-^a	803	1.6	-^a	-^a
Observation of animal	-^a	-^a	580	1.1	-^a	-^a
Observation + vaccination	-^a	-^a	3,607	7.1	-^a	-^a
Vaccination	-^a	-^a	10,778	21.1	-^a	-^a
Anti-rabies serum + vaccination	35,201	69.1	-^a	-^a	-^a	-^a
Indirect contact (n = 49,252)	1,648	3.3	-^a	-^a	47,604	96.7
Minor accidents (n = 783,225)	657,059	83.9	43,191	5.5	82,975	10.6
Severe accidents (n = 2,868,654)	1,475,781	51.4	1,392,873	48.6	-^a	-^a
Accidents involving wild animals (n = 50,969)	35,201	69.1	15,768	30.9	-^a	-^a
Total	2,169,689	57.8	1,582,411		42,2

[1] Correspondence
Nathalie Mendes Estima. thalie_estima@hotmail.com

Brasil

Brasil

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

Abstract

Objective:

Methods:

Results:

Conclusion: