Profilaxia pré-exposição à raiva humana nos cursos de graduação em Medicina Veterinária: avaliação e modelo de programa
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Data
2019-07-12
Autores
Olivari, Marina Beanucci Delamonica
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A raiva ainda é considerada uma doença negligenciada e um grave problema de Saúde Pública, responsável por milhares de mortes anualmente, tanto de animais como de seres humanos. No Brasil, o Ministério da Saúde considera os estudantes de Cursos de Medicina Veterinária como grupo com risco de exposição permanente ao vírus da raiva devido às atividades ocupacionais exercidas durante a graduação, incluindo aulas práticas, estágios curriculares e extracurriculares. Atualmente, no Estado de São Paulo, há 43 cursos de Veterinária computados pelo CFMV, os quais estão distribuídos por 32 municípios. Por esse motivo, o presente estudo teve como propósito realizar diagnóstico de situação sobre a PArPrE para estudantes dos cursos de graduação em Medicina Veterinária do Estado de São Paulo, avaliando-se os riscos e elaborando um modelo de programa de imunização pré-exposição que poderá ser utilizado em todos os cursos de Veterinária do Brasil. Para tanto, foram desenvolvidos e aplicados questionários individuais aos responsáveis pela profilaxia dos alunos em 23 instituições de ensino que demonstraram interesse em participar da pesquisa; foram analisadas as matrizes curriculares dos cursos de graduação priorizando as disciplinas práticas relacionadas aos períodos de risco de exposição ao vírus da raiva; foi delineado o perfil epidemiológico da doença no Brasil e no Estado de São Paulo; e foi feita a associação geográfica dos casos positivos com a localização das instituições de ensino. Observou-se que 43,48% dos cursos pesquisados não oferecem a profilaxia aos alunos e nem solicitam o controle sorológico dos mesmos para participação das atividades práticas durante o curso. As disciplinas práticas obrigatórias com risco de exposição ao vírus da raiva representam, em média, 19,65% do total de horas das matrizes analisadas e iniciam-se, predominantemente, no segundo semestre do curso. Ademais, constatou-se que o Estado de São Paulo notificou 24,19% dos animais acometidos pela raiva, no período de 2015 a 2018, em todo o Brasil. Observou-se também o aparecimento de um novo ciclo da doença, chamado secundário, envolvendo morcego, cão ou gato e ser humano, revelando a importância dos quirópteros na cadeia epidemiológica da raiva. A enfermidade se distribuiu, de 2011 a 2018, por 270 municípios do Estado de São Paulo. Observaram-se casos positivos para a raiva animal em 27 cidades com instituições de ensino que ofertam o Curso de Veterinária. Destas, 12 cursos não ofertam a profilaxia a seus estudantes e 19 não informaram ou não participaram da pesquisa. Sugere-se o planejamento de um programa contínuo de PArPrE nas IES formadoras de médicos veterinários, em conjunto com a Secretaria de Saúde dos municípios, com previsão de ações de educação em saúde e conscientização desses estudantes. Por fim, propõe-se um modelo de programa que possa ser estendido a todos os Cursos de Medicina Veterinária do Brasil.
Rabies has still considered a neglected disease and a serious Public Health problem, which is responsible for thousands of animals and humans deaths’ every year. In Brazil, the Ministry of Health considers students of Veterinary course as a group at risk of permanent exposure to rabies virus, due to occupational activities during graduation, including practical classes, curricular and extracurricular internships. In 2018, the Federal Council of Veterinary Medicine considered, in the State of São Paulo, 43 Veterinary Medicine courses distributed in 32 municipalities. For this reason, the present study aimed to realize a situational diagnosis on pre-exposure prophylaxis of rabies to Veterinary students of São Paulo State, to evaluate the risks and to elaborate a model of pre-exposure immunization program that can be used in Veterinary courses in Brazil. For that, individual questionnaires were developed and applied to the responsible for the students prophylaxis in the 23 colleges that showed interest in participate of research; the curricular matrices of the undergraduate courses were analyzed emphasizing the practical disciplines related to the periods of exposition of rabies virus risk; the epidemiological profile of the disease was delineated in Brazil and in São Paulo State; and the positive cases were geographical associated with the location of educational institutions. It was observed that 43.48% of the institutions surveyed didn't offer the prophylaxis to the students and didn't request the students' serological control to participate of practical activities during the course. The compulsory practical disciplines with risk of exposure to the rabies virus represent, on average, 19.65% of the total hours of the analyzed matrices and it begin, predominantly, in the second period of the course. In addition, it was verified that the São Paulo State presented 24.19% of animals affected by the disease, from 2015 to 2018. It has also observed the appearance of a new cycle of the disease, called secondary, involving bat, dog or cat and human, which revealed the importance of bats in the epidemiological chain of rabies. The disease was distributed by 270 municipalities of São Paulo’s State from 2011 to 2018. There were positive cases of rabies in 27 cities which have educational institutions that offer the course of Veterinary. Of these, 12 courses don't offer prophylaxis to their students and 19 neither report and nor participate in the research. It is suggested the planning of a continuous program of pre-exposure prophylaxis in Veterinary colleges, together with the Municipal Health Secretariats. This program must include actions of health education and awareness of these students. Finally, it has proposed a model program that can be used to every Brazilian’s Veterinary Courses.
Rabies has still considered a neglected disease and a serious Public Health problem, which is responsible for thousands of animals and humans deaths’ every year. In Brazil, the Ministry of Health considers students of Veterinary course as a group at risk of permanent exposure to rabies virus, due to occupational activities during graduation, including practical classes, curricular and extracurricular internships. In 2018, the Federal Council of Veterinary Medicine considered, in the State of São Paulo, 43 Veterinary Medicine courses distributed in 32 municipalities. For this reason, the present study aimed to realize a situational diagnosis on pre-exposure prophylaxis of rabies to Veterinary students of São Paulo State, to evaluate the risks and to elaborate a model of pre-exposure immunization program that can be used in Veterinary courses in Brazil. For that, individual questionnaires were developed and applied to the responsible for the students prophylaxis in the 23 colleges that showed interest in participate of research; the curricular matrices of the undergraduate courses were analyzed emphasizing the practical disciplines related to the periods of exposition of rabies virus risk; the epidemiological profile of the disease was delineated in Brazil and in São Paulo State; and the positive cases were geographical associated with the location of educational institutions. It was observed that 43.48% of the institutions surveyed didn't offer the prophylaxis to the students and didn't request the students' serological control to participate of practical activities during the course. The compulsory practical disciplines with risk of exposure to the rabies virus represent, on average, 19.65% of the total hours of the analyzed matrices and it begin, predominantly, in the second period of the course. In addition, it was verified that the São Paulo State presented 24.19% of animals affected by the disease, from 2015 to 2018. It has also observed the appearance of a new cycle of the disease, called secondary, involving bat, dog or cat and human, which revealed the importance of bats in the epidemiological chain of rabies. The disease was distributed by 270 municipalities of São Paulo’s State from 2011 to 2018. There were positive cases of rabies in 27 cities which have educational institutions that offer the course of Veterinary. Of these, 12 courses don't offer prophylaxis to their students and 19 neither report and nor participate in the research. It is suggested the planning of a continuous program of pre-exposure prophylaxis in Veterinary colleges, together with the Municipal Health Secretariats. This program must include actions of health education and awareness of these students. Finally, it has proposed a model program that can be used to every Brazilian’s Veterinary Courses.
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Palavras-chave
Educação em saúde, Imunização, Vírus da raiva, Zoonoses, Health education, Immunization, Rabies virus, Zoonosis