Atendimento antirrábico humano pós-exposição no estado de São Paulo: perfil epidemiológico e avaliação de conduta
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Data
2021-02-22
Autores
Andrade, Bruno Fonseca Martins da Costa
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Universidade Estadual Paulista (Unesp)
Resumo
A Raiva é uma antropozoonose de grande impacto na saúde pública, conhecida desde a antiguidade, cujo agente etiológico pertence ao gênero Lyssavirus. É transmitida aos mamíferos por contato com a saliva de animais infectados com soluções de continuidade da pele ou mucosa, levando a uma encefalomielite severa, progressiva e geralmente letal. As agressões aos humanos por animais, principalmente cães e gatos, são de notificação obrigatória e podem resultar na necessidade de profilaxia antirrábica. Na última década foram notificados 38 casos de raiva humana no Brasil e apenas um indivíduo foi curado. O objetivo do presente estudo foi descrever o perfil dos atendimentos antirrábico humano, após agressão por diferentes espécies de animais e avaliar a conduta adotada no tratamento antirrábico, pós-exposição, especificamente por agressões de cães e gatos, em todas as regiões do estado de São Paulo, no período de 2013 a 2017. Foi realizado um estudo descritivo utilizando-se as informações disponíveis no SINAN (CID10-W64) e avaliando-se o perfil epidemiológico das notificações e a profilaxia realizada às vítimas de agressões por cães e gatos. Foram registradas 572.889 notificações no período, com média de 114.578 casos ao ano e coeficiente de incidência de 2,62 casos a cada 1.000 habitantes. Não houve diferença estatística significante (p=0,213) quanto à distribuição das agressões no estado. A maior porcentagem de agressões fora pela espécie canina, seguida dos felinos e os morcegos em terceiro lugar com 0,87%. Houve predominância entre as vítimas do sexo masculino e a faixa etária mais acometida foi a de 20 a 39 anos. A agressão mais frequente foi a mordedura causada por cães. As características das lesões foram únicas e superficiais em mãos/pés, seguidas de membros inferiores. Dentre as condutas indicadas, a maior prevalência foi a observação do animal por 10 dias, conduta esta também considerada inadequada com menor frequência. Em indivíduos envolvidos em acidentes com morcegos, primatas e herbívoros, foi mais frequente a aplicação de soro e vacinação. A conduta profilática indicada foi adequada em 68,8% das notificações, porém o tratamento realizado foi adequado em apenas 55,5% dos indivíduos, com uma diferença significante (p<0,0001) entre eles, e resultando em 246.787 doses de vacina e 8.888 doses de soro antirrábico administrados em discordância do esquema profilático recomendado pelo Ministério da Saúde. Sugere-se a adoção de ações que visem minimizar o número de acidentes com cães e gatos, a melhoria das condições de observação dos animais agressores e a otimização de recursos, bem como a adoção de medidas profiláticas corretas que visem mormente garantir a completa proteção ao indivíduo e à sociedade, evitando gastos desnecessários.
Rabies is an anthropozoonosis of great impact on public health, known since antiquity, whose etiological agent belongs to the genus Lyssavirus. It is transmitted to mammals by the contact of the saliva of infected animals, leading to severe, progressive and generally lethal encephalomyelitis. Humans attacks by animals, especially dogs and cats, are compulsorily notifiable and may result in rabies post-exposure treatment. In Brazil 38 cases of human rabies have been reported in the past decade and only one individual has been cured. The objective of the present study is to describe the profile of post-exposure human anti-rabies care, after aggression by different animal species and to evaluate the adopted conduct in human anti-rabies treatment, specifically after aggressions of dogs and cats, in all regions of the state of São Paulo, during the period from 2013 to 2017. A descriptive study was carried out using the information available at SINAN (CID10-W64) and the epidemiological profile of the notifications and the prophylaxis performed on the victims attacked by dogs and cats were evaluated. 572,889 notifications were registered in the period, with an average of 114,578 cases per year and an incidence rate of 2.62 cases per 1.000 inhabitants. There was no significant difference (p=0,213) regarding the distribution of aggressions in the state. The highest percentage of aggressions was by the canine species followed by felines and bats, with only 0.87%. The victims were predominantly male and the most affected age group was of 20 to 39 years old. The most frequent aggression was biting caused by dogs. The characteristics of the lesions were unique and superficial in hands/feet, followed by lower limbs. Among the indicated conducts, the most frequent was observation of the animal for 10 days and it was considered inappropriate the less frequently. In individuals involved in accidents with bats, primates and herbivores, serum plus vaccination was most frequently applied. The prophylactic conduct adopted was adequate in 68.8% of notifications, but the treatment was adequate in only 55.5% of individuals, with a significant difference (p <0.0001) between then and, resulting in 246,787 vaccine and 8,888 rabies immunoglobulin doses administered in disagreement to the prophylactic scheme recommended by the Ministry of Health. Measures should be adopted in order to minimize the number of accidents with dogs and cats, to improve the conditions for the observation of the aggressive animals and to optimize resources, as were as the adoption of the correct post-exposure prophylaxis which should guaranty rabies protection for the individual and to the society, avoiding unnecessary expenses.
Rabies is an anthropozoonosis of great impact on public health, known since antiquity, whose etiological agent belongs to the genus Lyssavirus. It is transmitted to mammals by the contact of the saliva of infected animals, leading to severe, progressive and generally lethal encephalomyelitis. Humans attacks by animals, especially dogs and cats, are compulsorily notifiable and may result in rabies post-exposure treatment. In Brazil 38 cases of human rabies have been reported in the past decade and only one individual has been cured. The objective of the present study is to describe the profile of post-exposure human anti-rabies care, after aggression by different animal species and to evaluate the adopted conduct in human anti-rabies treatment, specifically after aggressions of dogs and cats, in all regions of the state of São Paulo, during the period from 2013 to 2017. A descriptive study was carried out using the information available at SINAN (CID10-W64) and the epidemiological profile of the notifications and the prophylaxis performed on the victims attacked by dogs and cats were evaluated. 572,889 notifications were registered in the period, with an average of 114,578 cases per year and an incidence rate of 2.62 cases per 1.000 inhabitants. There was no significant difference (p=0,213) regarding the distribution of aggressions in the state. The highest percentage of aggressions was by the canine species followed by felines and bats, with only 0.87%. The victims were predominantly male and the most affected age group was of 20 to 39 years old. The most frequent aggression was biting caused by dogs. The characteristics of the lesions were unique and superficial in hands/feet, followed by lower limbs. Among the indicated conducts, the most frequent was observation of the animal for 10 days and it was considered inappropriate the less frequently. In individuals involved in accidents with bats, primates and herbivores, serum plus vaccination was most frequently applied. The prophylactic conduct adopted was adequate in 68.8% of notifications, but the treatment was adequate in only 55.5% of individuals, with a significant difference (p <0.0001) between then and, resulting in 246,787 vaccine and 8,888 rabies immunoglobulin doses administered in disagreement to the prophylactic scheme recommended by the Ministry of Health. Measures should be adopted in order to minimize the number of accidents with dogs and cats, to improve the conditions for the observation of the aggressive animals and to optimize resources, as were as the adoption of the correct post-exposure prophylaxis which should guaranty rabies protection for the individual and to the society, avoiding unnecessary expenses.
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Palavras-chave
Hidrofobia, Imunização, Prevenção, Ferimentos e lesões, Hydrophobia, Immunization, Prevention, Wounds and injuries