Integration of human rabies surveillance and preventive measures in the State of Ceará, Northeast Brazil

Abstract

Aim:To analyze the One Health approach regarding rabies surveillance, control, and prevention in Brazil's Ceará State, exemplified by a detailed description of rabies cases that occurred over 18 years. Methods:We described in depth the history, case development, surveillance, and prevention measures of all cases of human rabies, 2004-2021. We analyzed patient charts and reviewed technical reports of the State Health Secretariat, in addition to analysis of personal notes from field missions. Results:All six cases occurred in rural areas. The affected people came from resource-poor communities. The state rapid response team performed comprehensive actions and seminars in collaboration with the Municipal Health Secretariats and other stakeholder groups. Patients and their relatives were not aware about the risk of wildlifemediated rabies. A high number of wild animals (marmosets) kept as pets were collected in the communities. Only one patient presented at a primary health care center before the onset of symptoms but did not receive any postexposure prophylaxis due to logistic problems. Even after onset of symptoms, in all cases, the suspected diagnosis Conclusion: Rabies in Ceará is a wildlife-mediated disease of the most vulnerable rural populations. There is a need for ongoing integrated surveillance and control measures, information and education campaigns, and professional training, especially focusing on wildlife-mediated rabies. An integrated One Health approach -as exemplified by the presented rabies control program in Ceará -is critical for human rabies elimination.

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

“…The disease is associated with all four determinant groups described by One Health as causing disease 33 : First, as a zoonosis, animal health plays an important role; second, populational and social factors such as poverty, inadequate living conditions, access to education, and human behavior are interlinked with the disease; third, the health care system, surveillance, professional training, and access to health care are pivotal factors; and finally, environment and climate change can be considered as ad-ditional driving factors for the dynamics of virus transmission. As shown by our group previously and exemplified by the last 6 cases that occurred in Ceará 34 , intensified operational and implementation research efforts at this last mile are needed to identify bottlenecks in the control programs that are specific for each setting.…”

“…On the day she was attacked, she sought health services, but no recommendation for post-exposure prophylaxis was given by the health professional 31 . Human cases still occur and are related to the lack of awareness of the population followed by inadequate healthcareseeking behavior, and by the failure of the health care system, leading to missed opportunities to save lives 14,34 . There is a clear need to update professionals working in rabies surveillance and treatment.…”