Avaliação da profilaxia no primeiro atendimento pós-exposição ao vírus da raiva

Abstract

Objective: To evaluate primary care prophylactic post-exposure anti-rabies treatment.Methods: This was a cross-sectional, descriptive and analytical study, with data from the Information System for Notification of Diseases. It analyzed 39,087 visits, excluding 1,091 (2.79%) cases of re-exposure and pre-exposure, resulting in 37,996 post-exposure visits. A logistic regression analysis was performed for adjustment of the treatment. Results: A predominance of Caucasians (83.93%), male (54.58%), primary school educational level (66.13%), ages between 20-59 years (45.0%) , followed by 0 to 12 years (32.88%), and residents in the urban area (91.97%) was observed. Among the visits, 15,500 (41.56%) were considered inadequate, 10,587 (28.11%) were deficient or the patient did not receive the necessary treatment, and 5,013 (13.44%) patients received more than what was necessary for rabies prophylaxis. Conclusion: The post-exposure prophylaxis for rabies was considered inadequate and requires a better approach on admission, and attention in completing the notification in the data record. ResumoObjetivo: Avaliar o tratamento profilático do primeiro atendimento anti-rábico pós-exposição. Métodos: Estudo transversal, descritivo e analítico, com dados do Sistema de Informação de Agravos de Notificação. Analisados 39.087 atendimentos, excluídos 1.091 (2,79%) casos de re-exposição e pré-exposição, resultando em 37.996 atendimentos pós-exposição. Realizada análise de regressão logística para adequação de conduta. Resultados: Observou-se predomínio da raça branca (83,93 %), sexo masculino (54,58 %), ensino fundamental (66,13%), idades entre 20-59 anos (45,0%), seguido por 0 a 12 anos (32,88%) e residentes na zona urbana (91,97%). Considerou-se 15.500 (41,56%) atendimentos inadequados 10.587 (28,11%) atendimentos deficitários, ou o paciente não recebeu o tratamento necessário, e 5.013 (13,44%) pacientes receberam atendimento mais do que o necessário para a profilaxia antirrábica. Conclusão: A profilaxia pós-exposição da raiva foi considerada inadequada necessitando de uma melhor abordagem na admissão e atenção no preenchimento dos registros de dados.

Avaliação do tratamento antirrábico humano pós-exposição, associado a acidentes com cães

“…Os estudos realizados no Brasil quanto à inadequação da conduta antirrábica apontaram taxas variando entre 3,8% a 24,7% (Frias et al, 2011). No Brasil, Veloso et al, (2011), encontraram 41,9% dos atendimentos adequados; Busatto et al, (2014), identificou 75,2% dos atendimentos com conduta adequada; Moriwaki et al, (2013) Quanto aos atendimentos que receberam tratamento em excesso, a principal conduta foi vacina 634 (21,1%). As condutas em excesso mais significativas foram: (0,6%) atendimentos receberam vacina e era para ser prescrito dispensa de tratamento, conforme protocolo do Ministério da Saúde, refletindo assim, sobre o risco de eventos adversos vacinais, aumento dos gastos públicos com a administração de vacinas, e recursos humanos da área de saúde.…”

An evaluation of Brazil’s surveillance and prophylaxis of canine rabies between 2008 and 2017

“…Previous studies have performed descriptive analysis to summarize the SINAN database at national and state level [18–21], but the accuracy of the SINAN database as a tool for the surveillance of rabies and for the appropriate use of PEP has not been evaluated. In Brazil, dog bite incidence was high between 2002 and 2009 with 425 000 bites estimated per year [19,22]. The reduction of canine rabies cases over the last decade in Brazil should cause a concommittant decline in bites from rabid dogs and potential savings in PEP administration, but this has not been realized.…”

Human rabies post-exposure prophylaxis: a review of the treatment of accidents involving domestic cats

“…Comparing the procedures adopted by the health service and those recommended by the Ministry of Health, it was observed that the behaviors excessively adopted by the health service represented 10.3%, while 18.6% were classified as insufficient (Table 3). Moriwaki et al (2013) observed that 13.4% of the conducts were excessive and 28.1% were insufficient; Fernandes (2013) found that 16% of the procedures were insufficient and 7% were excessive; Cabral et al (2018) observed that 21.2% of the conducts were excessive and 11.5% were insufficient.…”