Rabies Postexposure Prophylaxis, Marseille, France, 1994–2005

Soula, G; Adamou, Hamadou; Soavi, Marie-José; Delmont, J.; Rotivel, Y.; Parola, Philippe; Brouqui, Philippe

doi:10.3201/eid1409.071322

Cited by 7 publications

(10 citation statements)

References 8 publications

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“…Although PEP is still cost-effective even when only 1% of cases treated are actually exposed to rabies, it is ideal to ensure that PEP is not given indiscriminately to those with little or no possibility of exposure to the virus. As a result of recent shortages, more judicious use of PEP has been recommended in Western Europe and North America [21,22], but the issue is also pressing in countries with endemic canine rabies, where shortages are commonplace and unnecessary administration directly affects availability for those in genuine and urgent need of PEP [5]. …”

Section: Discussionmentioning

confidence: 99%

Evaluating the cost-effectiveness of rabies post-exposure prophylaxis: A case study in Tanzania

Shim

Hampson

Cleaveland

et al. 2009

Vaccine

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Although fatal if untreated, human rabies can be prevented through post-exposure prophylaxis (PEP), which involves a course of vaccination and immunoglobulin administered immediately after exposure. However, high costs and frequent lack of rabies vaccine and immunoglobulin lead to about 55,000 deaths per year worldwide. Using data from a detailed study of rabies in Tanzania, we calculate a cost-effectiveness ratio for PEP when the WHO-recommended Essen regimen, a 5-dose intramuscular vaccination schedule, is adopted. Our analyses indicate a cost-effectiveness ratio for PEP of $27/quality-adjusted life year (QALY) from a health care perspective and $32/QALY from a societal perspective in Tanzania. From both perspectives, it is “very cost-effective” to administer PEP to patients bitten by an animal suspected to be rabid. Moreover, PEP remains “very cost-effective” provided that at least 1% of doses are administered to people who were actually exposed to rabies.

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Section: Discussionmentioning

confidence: 99%

Evaluating the cost-effectiveness of rabies post-exposure prophylaxis: A case study in Tanzania

Shim

Hampson

Cleaveland

et al. 2009

Vaccine

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“…A incidência anual de busca por profilaxia pós-exposição varia amplamente entre os países: na França, é de 20/100,000 29 ; nos Estados Unidos, há relatos variando de 10,6/100,000 a 16/100,000, embora a estimativa de pessoas agredidas seja bem maior (297,9/100,000) 30 ; na Turquia, 467/100,000 31 , e na Índia, 1.700/100,000 32 . No Brasil, estima-se que 138.277 pessoas sejam anualmente agredidas por cães e que 72% destas recebam tratamento profilático 33 , mas esses percentuais variam entre as Regiões do país; como exemplo, em Campo Grande (MS) esse percentual foi de 52,2% 28 .…”

Section: Resultsunclassified

“…Em um município, por exemplo, 88% dos atendimentos estão relacionados a esse animal. Outros estudos internacionais 29,30 . Percebe-se que as ações são executadas, mas carentes de informações adequadas.…”

Section: Resultsunclassified

“…Isso se agrava pelo fato cultural de o cidadão não dar a devida importância aos casos de agressão. O tratamento deve ser iniciado o mais breve possível, mas há registros de que o tempo médio entre a injúria e a consulta fica em torno de 2-6 dias, sem variação entre os sexos 29 . Não foram localizadas vacinas nem soro antirrábico humano em uma unidade.…”

Section: Resultsunclassified

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Raiva humana transmitida por cães no Maranhão: avaliação das diretrizes básicas de eliminação da doença

Saraiva

Thomaz²,

Caldas³

2014

Cad. saúde colet.

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Cad. Saúde Colet., 2014, Rio de Janeiro, 22 (3): 281-91 ResumoObjetivou-se avaliar as diretrizes básicas do programa de eliminação da raiva humana transmitida por cães (RHTC) no Maranhão. Realizou-se estudo transversal de avaliação normativa nos municípios com casos de RHTC no Estado do Maranhão por meio de consulta a dados primários e secundários de cinco municípios com casos notificados de RHTC de 2006 a 2010. As diretrizes investigadas foram: a) treinamento de profissionais de saúde; b) educação em saúde dirigida à comunidade; c) profilaxia pós-exposição (PPE); e d) vacinação em massa de cães. Muitos profissionais nunca participaram de treinamento sobre RHTC ou o fizeram havia muitos anos. Mais de 70% da população entrevistada jamais recebeu instruções sobre a doença, e quase 100% não sabiam como proceder frente a uma agressão por cão. Verificaram-se deficiências nas ações de PPE e irregularidades nas redes de frio. A cobertura de vacinação animal foi superior a 80% nos municípios, exceto um. Conclui-se que há deficiências no cumprimento das diretrizes básicas para a eliminação da RHTC no Maranhão, podendo resultar em novos casos humanos no Estado.Palavras-chave: raiva; cães; avaliação em saúde. AbstractThe aim of this study was to investigate the basic guidelines of the program for the elimination of dog-transmitted human rabies (DTHR) in Maranhão. The study was a cross-sectional one and involved a normative assessment of municipalities with DTHR cases in the State of Maranhão. The primary and secondary data related to five municipalities in which cases of DTHR were reported between 2006 and 2010. Guidelines related to the following areas were investigated: (a) training of health professionals; (b) community-oriented health education; (c) post-exposure prophylaxis (PEP); and (d) mass vaccination of dogs. Many of the professionals had never had training on DTHR or had only had training many years ago. More than 70% of the people interviewed had never received any instructions about the disease, and almost 100% did not know what to do if attacked by a dog. PEP measures were found to be deficient, and irregularities were observed in cold chains. Vaccination coverage of animals was greater than 80% in all municipalities except one. Our findings show that basic guidelines for elimination of DTHR in Maranhão are not being followed and that new human cases may occur in the state as a result.

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“…(8) The post-exposure prophylaxis for rabies in some cases may not be necessary, depending on a risk assessment performed by a health professional, for making a more judicious treatment of post-exposure prophylaxis, of not vaccinating patients when observation of the animal attacker by the owner or veterinarian is possible, as verified in a study conducted in Marseille, France from 1994 to 2005, representing a savings of 177,600 Euros. (9) Due to the above, the objective of this study was to evaluate the appropriateness of prophylactic anti-rabies treatment in the first post-exposure care visit, occurring in the year of 2010, in the State of Paraná, in southern Brazil.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2013

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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.

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Rabies Postexposure Prophylaxis, Marseille, France, 1994–2005

Cited by 7 publications

References 8 publications

Evaluating the cost-effectiveness of rabies post-exposure prophylaxis: A case study in Tanzania

Evaluating the cost-effectiveness of rabies post-exposure prophylaxis: A case study in Tanzania

Raiva humana transmitida por cães no Maranhão: avaliação das diretrizes básicas de eliminação da doença

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

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