19An outbreak of human rabies transmitted by hematophagous bats occurred in 2018 in the 20 state of Pará, Brazil, eastern Amazon, after 14 years with no record of the disease. It is 21 necessary to understand the epidemiological characteristics of these attacks to protect the 22 local population. This study aimed to characterize attacks of humans by vampire bats in 23 the municipality of São João da Ponta, Pará state, Brazil, from 2013 to 2015. All 24 individuals attacked by bats who sought medical care during the study period (n=5) were 25 identified in the Notifiable Diseases Information System (SINAN) database and answered 26 a questionnaire about the circumstances of the attack. Using snowball sampling, seed 27 cases identified other individuals who were attacked in the same period but did not seek 28 medical care (n=61), totalizing 66 people attacked in the same period. The interviewees 29 were male (92.4%), adults between 20 and 50 years old (69.6%) and had completed 30 elementary education (86.3%). Most were rural residents (92.4%) and crab fishermen 31 (79.3%). The interviewees (92.4%) identified the mangrove of the Mãe Grande de Curuçá 32 extractive reserve as an area conducive to attacks by vampire bats, where groups of 33 fishermen sometimes concentrate for days for crab fishing, often living in improvised 34 dwellings without walls and covered by tarps or straw (88.8%). The wounds were single 35 bites (71.2%) and were located on the lower limbs (93.9%). Overall, 42.4% of participants 36 had been bitten more than four times throughout their life (range 1-23 attacks). 37Participants were unaware of the risk of contracting rabies by the bite (95.4%). Using São 38 João da Ponta as a model, this study shows that bat attacks are an essentially occupational 39 problem in the study region. Indeed, for each reported attack, there are 12.2 unreported 40 cases. It is necessary to develop strategies to reach this population for prophylactic 41 treatment. 42 43 Author Summary 44 45 Different from which occurs worldwide in relation to rabies transmission, in Amazon 46 region, vampire bat is involved on direct transmission of rabies virus to humans when 47 searching for bloodmeal. It is common in the state of Pará, Eastern Amazon, large areas 48 inhabited near forests and mangroves. People living there use forest natural resources as 49 a way of income and sustenance and these working conditions is what our study points 50 out as an important factor for aggressions predisposition. Here this subject is shown as an 51 occupational problem. This study also quantified for the first time underreported human's 52 aggressions by bats in Amazon, using the snowball sampling, which valued the 53 relationship between individuals to reach the target population. Based on these results, 54 rabies surveillance may direct actions for prevention and health education for these 55 individuals, including changes in notifications forms and suggesting pre-exposure 56 prophylaxis in vaccination calendar of the Brazilian Ministry of Health...