Clinical aspects of human rabies in the state of Ceará, Brazil: an overview of 63 cases

Abstract

Introduction: Rabies is considered one of the most relevant public health problems owing to its high fatality rate and the high number of deaths worldwide. Methods: We included patients with human rabies who attended a reference hospital in the state of Ceará during 1976-2019. Results: Data were available for 63 out of 171 (36.8%) patients. Of these patients, 48 (76.2%) were attacked by dogs. In recent years, wild animals have been the most common aggressor species (marmosets and bats). Only 39 (70%) patients were initially correctly suspected with rabies. Bites were the most frequent exposure (56; 96%), most commonly on the hands (21; 42%) and the head (9; 18.4%). Only 14 (22%) patients had sought medical assistance before the onset of symptoms, and only one completed post-exposure prophylaxis. The most prevalent signs and symptoms included aggressiveness/irritability (50; 79.4%), fever (42; 66.7%), sore throat/ dysphagia (40; 63.5%), and myalgia (28; 44.4%). Hydrophobia was present in 17 patients (22.0%). Conclusions: Most cases of human rabies in Ceará occurred due to the failure to seek medical assistance and/or the failure of the health system in initiating early postexposure prophylaxis. There is a need for specific information and education campaigns focusing on the cycle of sylvatic rabies as well as prevention measures. Health professionals should undergo refresher training courses on the signs and symptoms of rabies and on the specific epidemiological features of the disease in Brazil.

Knowledge, Attitudes and Practices Regarding Sylvatic Rabies among High-Risk Households in Ceará State, Brazil

“…In the last five years, a large number of rabies virus-infected bats were identified in urban areas in Ceará [5]. Of the 21 registered human rabies cases in Brazil from 2016 to 2019, three (14.3%) were due to exposure by domestic cats, with the involvement of the variant of the hematophagous bat Desmodus rotundus [15]. This spillover from wild to domestic animals is of major concern considering the risk of unvaccinated domestic animals-only 50% of cats are vaccinated-coming into contact with these species.…”

Rabies in the Tropics

“…Historically, the continent had access to rabies biologics via the revolving fund sponsored by PAHO. Nevertheless, limited information and lack of public health education on the wildlife rabies risks prevent exposed individuals from receiving appropriate and life-saving PEP [ 71 ]. Such setbacks within the Americas, a region that served as a model for Africa and Asia towards achieving ZBT, is a major concern for future progress.…”

Zoonsoses E Monitoramento Sentinela Da Cinomose Como Estratégia De Saúde Única No Município De Presidente Figueiredo-Am

“…Há duas variantes do vírus detectadas no Brasil: uma associada ao ciclo urbano, isolada de cães, gatos e humanos e que causa a forma furiosa de raiva e a outra forma é a associada ao ciclo silvestre da doença, isolada de morcegos e outros animais que causa a forma paralítica de raiva (Marcolongo-Pereira et al, 2011). Calcula-se que a raiva leva ao óbito 60.000 pessoas por ano em todo mundo (Duarte et al, 2021). Esse impacto é ainda mais significativo porque pode atingir crianças, idosos, e pessoas na faixa etária produtiva e em especial de zonas rurais, onde a assistência a saúde pode ser mais precária e mais distante.…”