ABSTRACT Background: Rabies is a zoonosis usually transmitted to mammals via contact between the saliva of infected animals and either the skin or mucosa of the attacked individual, and post-exposure prophylaxis (PEP) is the only way to avoid the disease. This study aimed to perform a descriptive analysis of PEP after attacks by dogs and cats in the state of São Paulo. Methods: We analyzed the disease compulsory notification forms Human Anti-Rabies Care (CID10: W64), available in the Notifiable Diseases Information System (SINAN), from 2013 to 2017. Treatment adequacy was analyzed according to the parameters established by the Brazilian Health Ministry. Results: A total of 572,889 notifications were reported during the study period, 94.1% (538,975) of which corresponded to dog or cat attacks, with an occurrence of 26.9 cases per 10,000 inhabitants. Among the recommended procedures, the most frequent was the observation of the animals for 10 days (44.4%), which was adopted inappropriately at a lower frequency. Prophylactic conduct was adequate in 68.8% of the cases, but only 55.5% of the individuals received adequate treatment. More than 112 thousand individuals (31,4%) received a correct recommendation for PEP but did not receive adequate treatment, leading to 246,787 doses of the vaccine and 8,888 doses of rabies immunoglobulin administered without following the recommendations of the Ministry of Health. Conclusions: The use of immunobiologicals is excessive, indicating the need for investment in training health professionals to follow the recommendations of the Ministry of Health. Background individual postexposure post exposure (PEP Paulo Methods AntiRabies Anti CID10 CID (CID10 W64, W64 W , W64) SINAN, SINAN (SINAN) 201 2017 Results 572889 572 889 572,88 period 941 94 1 94.1 538,975 538975 538 975 (538,975 269 26 9 26. 10000 000 10,00 inhabitants procedures 44.4%, 444 44.4% 44 4 (44.4%) frequency 688 68 8 68.8 555 55 5 55.5 treatment 11 31,4% 314 31 (31,4% 246787 246 787 246,78 8888 888 8,88 Conclusions excessive CID1 (CID1 W6 (SINAN 20 57288 57 88 572,8 94. 538,97 53897 53 97 (538,97 2 1000 00 10,0 44.4 (44.4% 6 68. 55. 31,4 3 (31,4 24678 24 78 246,7 8,8 (CID 5728 572, 538,9 5389 (538,9 100 0 10, 44. (44.4 31, (31, 2467 7 246, 8, 538, (538, (44. (31 (538 (44 (3 (53 (4 ( (5

ABSTRACT Background: Rabies is an anthropozoonosis that greatly impacts public health and is transmitted by infected mammals. Aggression by animals is notifiable and may result in anti-rabies post-exposure prophylaxis (PEP). This study aimed to characterize anti-rabies PEP notifications in São Paulo state, Brazil. Methods: A descriptive study was conducted using data provided by the SINAN between 2013 and 2017. Results: A total of 572,889 aggressions were recorded during the study period, characterized mostly by dogs (83.5%), single wounds (56.9%), superficial wounds (58.6%), and hands/feet (34.6%). Conclusions: Animal observation was the most frequent recommendation, even in cases of attacks from non-domestic animals. Background mammals antirabies anti rabies postexposure post exposure PEP. . (PEP) state Brazil Methods 201 2017 Results 572889 572 889 572,88 period 83.5%, 835 83.5% , 83 5 (83.5%) 56.9%, 569 56.9% 56 9 (56.9%) 58.6%, 586 58.6% 58 6 (58.6%) handsfeet hands feet 34.6%. 346 34.6% 34 (34.6%) Conclusions recommendation nondomestic non domestic (PEP 20 57288 57 88 572,8 83.5 8 (83.5% 56.9 (56.9% 58.6 (58.6% 34.6 3 (34.6% 2 5728 572, 83. (83.5 56. (56.9 58. (58.6 34. (34.6 (83. (56. (58. (34. (83 (56 (58 (34 (8 (5 (3 (

Resumo O objetivo da presente pesquisa foi avaliar a conduta profilática adotada após agressões por cães e gatos no município de Araçatuba, SP, com base no Manual Técnico de Tratamento Antirrábico Humano e considerando-se as situações de raiva não controlada (1990-1996) e controlada (1997-2010). Foi realizada uma análise retrospectiva dos dados das fichas do SINAN (W64-CID10) preenchidas pelo serviço de atendimento antirrábico no período de 1990 a 2010. Na maioria dos casos os acidentes foram leves (76,9%) e os animais agressores estavam sadios (75,4%), resultando em 53,3% de dispensa do tratamento. Em 64,6% dos casos em que houve indicação de tratamento esta foi considerada inadequada. No período de raiva não controlada houve maior indicação do tratamento com vacina e soro (43,4%) e no de raiva controlada o tratamento com três doses de vacina Fuenzalida e Palácios ou duas doses de vacina de cultivo celular (76,5%). No período de raiva controlada as condutas foram mais adequadas, segundo as recomendações técnicas, do que no período de raiva não controlada (p < 0,0001), embora, em ambos os períodos, tenha se observado uma aplicação excessiva de soro e vacina.

Abstract This study evaluated the prophylactic measures adopted after attacks by dogs and cats in the main city of Northwester São Paulo State, based on the technical manual for post-exposure treatment, considering the not controlled (1990-1996) and controlled (1997-2010) rabies status. A retrospective analysis was done using the data from the SINAN records (W64-CID10) between 1990 and 2010. In most cases, the accidents were mild (76.9%), and biting animals were healthy (75.4%); therefore, no treatment was needed in 53.3% of the cases. In 64.6% of cases, the prescribed PEP treatment was inappropriate. The most indicated PEP treatments consisted of vaccine and RIG (43.4%), and either three doses of mouse brain vaccine or two doses of cell culture vaccine (76.5%), during the not controlled and controlled rabies periods, respectively. The treatment was more appropriate and followed the technical recommendations during controlled rabies periods compared to not controlled (p < 0.0001) periods. However, excessive application of RIG and rabies vaccine was observed in both periods.

Resumo O objetivo da presente pesquisa foi avaliar a conduta profilática adotada após agressões por cães e gatos no município de Araçatuba, SP, com base no Manual Técnico de Tratamento Antirrábico Humano e considerando-se as situações de raiva não controlada (1990-1996) e controlada (1997-2010). Foi realizada uma análise retrospectiva dos dados das fichas do SINAN (W64-CID10) preenchidas pelo serviço de atendimento antirrábico no período de 1990 a 2010. Na maioria dos casos os acidentes foram leves (76,9%) e os animais agressores estavam sadios (75,4%), resultando em 53,3% de dispensa do tratamento. Em 64,6% dos casos em que houve indicação de tratamento esta foi considerada inadequada. No período de raiva não controlada houve maior indicação do tratamento com vacina e soro (43,4%) e no de raiva controlada o tratamento com três doses de vacina Fuenzalida e Palácios ou duas doses de vacina de cultivo celular (76,5%). No período de raiva controlada as condutas foram mais adequadas, segundo as recomendações técnicas, do que no período de raiva não controlada (p < 0,0001), embora, em ambos os períodos, tenha se observado uma aplicação excessiva de soro e vacina.

Abstract This study evaluated the prophylactic measures adopted after attacks by dogs and cats in the main city of Northwester São Paulo State, based on the technical manual for post-exposure treatment, considering the not controlled (1990-1996) and controlled (1997-2010) rabies status. A retrospective analysis was done using the data from the SINAN records (W64-CID10) between 1990 and 2010. In most cases, the accidents were mild (76.9%), and biting animals were healthy (75.4%); therefore, no treatment was needed in 53.3% of the cases. In 64.6% of cases, the prescribed PEP treatment was inappropriate. The most indicated PEP treatments consisted of vaccine and RIG (43.4%), and either three doses of mouse brain vaccine or two doses of cell culture vaccine (76.5%), during the not controlled and controlled rabies periods, respectively. The treatment was more appropriate and followed the technical recommendations during controlled rabies periods compared to not controlled (p < 0.0001) periods. However, excessive application of RIG and rabies vaccine was observed in both periods.

RESUMO: Determinar a ocorrência da brucelose, da tuberculose e a percepção de riscos acerca de ambas as zoonoses foi o objetivo do estudo em rebanhos bovinos leiteiros do município de Paranaíba, Mato Grosso do Sul, Brasil. As visitas ocorreram entre novembro de 2012 e março de 2013, em 42 propriedades georreferenciadas, nas quais foram aplicados questionários aos produtores e realizadas as coletas de sangue para testes sorológicos e de tuberculinização. A ocorrência de focos, tanto da brucelose quanto da tuberculose, nas propriedades foi de 2,38% (1/42), porém, há um baixo conhecimento dos produtores sobre os fatores de risco para essas doenças.

ABSTRACT: The aim of these study was to determine the occurrences of brucellosis and bovine tuberculosis, and the perception of dairy farmers on the risk of these diseases in dairy cattle herds in the municipality of Paranaíba, Mato Grosso do Sul state, Brazil. The total of 42 properties were visited for the application of a questionnaire to dairy farmers, and blood sample collection for serological and tuberculin test, from November 2012 to March 2013. The occurrence of outbreaks, both of brucellosis and tuberculosis, in the properties was 2.38% (1/42). The data showed deficiency in risk perception of these diseases on the part of the farmers.

Introduction Rabies is an important zoonosis that occurs in mammals, with bats acting as Lyssavirus reservoirs in urban, rural and natural areas. Rabies cases in bats have been recorded primarily in urban areas in Northwestern State of São Paulo since 1998. This study investigated the circulation of rabies virus by seeking to identify the virus in the brain in several species of bats in this region and by measuring rabies-virus neutralizing antibody levels in the hematophagous bat Desmodus rotundus. Methods From 2008 to 2012, 1,490 bat brain samples were sent to the Universidade Estadual Paulista (UNESP) Rabies Laboratory in Araçatuba, and 125 serum samples from vampire bats that were captured in this geographical region were analyzed. Results Rabies virus was detected in the brains of 26 (2%) of 1,314 non-hematophagous bats using the fluorescent antibody test (FAT) and the mouse inoculation test (MIT). None of the 176 hematophagous bat samples were positive for rabies virus when a virus detection test was utilized. Out of 125 vampire bat serum samples, 9 (7%) had levels of rabies virus neutralization antibodies (RVNAs) that were higher than 0.5IU/mL; 65% (81/125) had titers between 0.10IU/mL and 0.5IU/mL; and 28% (35/125) were negative for RVNAs using the simplified fluorescent inhibition microtest (SFIMT) in BHK21 cells. The observed positivity rate (1.7%) was higher than the average positivity rate of 1.3% that was previously found in this region. Conclusions The high percentage of vampire bats with neutralizing antibodies suggests that recent rabies virus exposure has occurred, indicating the necessity of surveillance measures in nearby regions that are at risk to avoid diffusion of the rabies virus and possible rabies occurrences.

As pesquisas relativas a agressões por animais baseiam-se em dados de registros de pacientes atendidos nos serviços de vigilância epidemiológica da raiva. Analisaram-se as características de animais agressores, obtidas a partir de dados de 10.616 fichas de envio de amostras para diagnóstico da raiva na região noroeste do Estado de São Paulo, Brasil, entre 1993-2007. Desse total de fichas, 61,5% continham informações sobre agressão e, dentre os animais agressores (25%), a maioria foi de cães (67%), seguidos por gatos (21,8%) e quirópteros (8,1%). Em 92,1% dos relatos as vítimas eram pessoas e 82,3% dos animais eram domiciliados. A maioria dos cães agressores tinha até um ano de idade. Houve associação significante (p < 0,0001) entre agressividade e sexo, sendo os machos mais agressores do que as fêmeas. Dos animais positivos para raiva, 75,9% (183/241) eram agressores. Os dados obtidos são importantes para a instituição de programas de prevenção de mordeduras, baseados no perfil não só da vítima, mas também do animal agressor, além de permitirem estabelecer fatores de risco para ocorrência de agressões.

Epidemiological factors related to animal bites in humans and other animals were obtained from a database with 10,616 records of animal specimens sent for rabies diagnosis in northwest São Paulo State, Brazil, from 1993 to 2007. Of this total, 61.5% contained information on the bites, and among the biting animals (25%), the majority were dogs (67%), followed by cats (21.8%), and bats (8.1%). In 92.1% of the reports the victims were humans, and 82.3% of the animals were home pets. The majority of the biting dogs were less than a year old. There was a significant association (p < 0.0001) between aggressiveness and gender (with male animals more aggressive than females). Of the rabies-positive animals, 75.9% (183/241) were biters. The data are important for establishing bite prevention programs based on the profile of both victims and biting animals, besides identifying risk factors for animal bites.

As pesquisas relativas a agressões por animais baseiam-se em dados de registros de pacientes atendidos nos serviços de vigilância epidemiológica da raiva. Analisaram-se as características de animais agressores, obtidas a partir de dados de 10.616 fichas de envio de amostras para diagnóstico da raiva na região noroeste do Estado de São Paulo, Brasil, entre 1993-2007. Desse total de fichas, 61,5% continham informações sobre agressão e, dentre os animais agressores (25%), a maioria foi de cães (67%), seguidos por gatos (21,8%) e quirópteros (8,1%). Em 92,1% dos relatos as vítimas eram pessoas e 82,3% dos animais eram domiciliados. A maioria dos cães agressores tinha até um ano de idade. Houve associação significante (p < 0,0001) entre agressividade e sexo, sendo os machos mais agressores do que as fêmeas. Dos animais positivos para raiva, 75,9% (183/241) eram agressores. Os dados obtidos são importantes para a instituição de programas de prevenção de mordeduras, baseados no perfil não só da vítima, mas também do animal agressor, além de permitirem estabelecer fatores de risco para ocorrência de agressões.

Epidemiological factors related to animal bites in humans and other animals were obtained from a database with 10,616 records of animal specimens sent for rabies diagnosis in northwest São Paulo State, Brazil, from 1993 to 2007. Of this total, 61.5% contained information on the bites, and among the biting animals (25%), the majority were dogs (67%), followed by cats (21.8%), and bats (8.1%). In 92.1% of the reports the victims were humans, and 82.3% of the animals were home pets. The majority of the biting dogs were less than a year old. There was a significant association (p < 0.0001) between aggressiveness and gender (with male animals more aggressive than females). Of the rabies-positive animals, 75.9% (183/241) were biters. The data are important for establishing bite prevention programs based on the profile of both victims and biting animals, besides identifying risk factors for animal bites.

Descreve-se a epidemiologia da raiva animal na região de Araçatuba, noroeste do estado de São Paulo, durante o período de 1993 a 2007, com base nos resultados dos diagnósticos realizados em laboratórios da região, utilizando as técnicas de imunofluorescência direta e inoculação intracerebral em camundongos. De 10.579 amostras analisadas, 4,9% foram positivas (518/10.579). Os casos em cães corresponderam a 67% (346/518) do total e ocorreram entre 1993 a 1997. Dentre as demais amostras positivas, 16% do total (84/518) foi detectado em bovinos e 9,7% (50/518) em morcegos. Dos 42 municípios da região, 23 (55%) apresentaram pelo menos um caso positivo da doença, sendo que 13 deles registraram casos em morcegos. Foram identificados três ciclos distintos da raiva na região Noroeste do Estado de São Paulo, o ciclo urbano caracterizado predominantemente pela raiva canina (1993 a 1997) e os ciclos aéreo e rural, a partir de 1998 com predominância de casos em quirópteros nas áreas urbanas e em herbívoros.

The epidemiology of animal rabies in the region of Araçatuba, in the northwest of São Paulo State, from 1993 to 2007, is described according to the results from diagnoses made at laboratories in the region, using the fluorescent antibody and mouse inoculation tests. Out of 10,579 samples analyzed, 4.9% were positive (518/10,579). Dogs accounted for 67% of the cases (346/518) and these occurred between 1993 and 1997. Among the other positive samples, 16% (84/518) were in cattle and 9.7% (50/518) were in bats. Among the 42 municipalities in the region, 23 (55%) presented at least one rabies-positive case, while 13 of them had cases in bats. Three distinct cycles of rabies were identified in the northwestern region of the State of São Paulo: the urban cycle characterized predominantly by canine rabies (1993 to 1997); and the aerial and rural cycles starting in 1998, with predominance of cases in bats in urban areas and in herbivores.

No período de 1994 a 2004, a população canina de Araçatuba, São Paulo, Brasil, registrou duas importantes zoonoses: a raiva e a leishmaniose visceral. Analisaram-se as mudanças ocorridas nessa população durante esse período, utilizando resultados de censos caninos e de coletas censitárias de sangue realizados em 1994, 1999 e 2004. A relação cão/10 habitantes variou significativamente, passando de 1,7 em 1994 para 2,0 em 1999 e para 1,8 em 2004. A porcentagem de cães com até um ano de idade passou de 20% para 32,5% e o número de eutanásias realizadas também aumentou após 1999, com a introdução da leishmaniose visceral. O número de cães e a estrutura etária variaram nos diversos setores do município e aqueles com maior porcentagem de animais com até dois anos de idade apresentaram maior ocorrência de casos de leishmaniose visceral humana e canina. Tais resultados decorrem de ações de controle adotadas nos setores com casos humanos de leishmaniose visceral, porém, o aumento da população canina mais jovem pode resultar em aumento da susceptibilidade destes cães à doença, favorecendo a manutenção da mesma na área.

From 1994 to 2004, the canine population in Araçatuba, São Paulo State, Brazil, suffered two major canine zoonoses: rabies and visceral leishmaniasis. Changes in the dog population during this period were evaluated using canine census data from 1994 and 2004 and the results of blood samples for diagnosis of canine visceral leishmaniasis in 1999. The ratio of dogs per 10 inhabitants varied from 1.7 in 1994 to 2.0 in 1999 and 1.8 in 2004. The percentage of puppies less than 1 year of age increased from 20% to 32.5%, and the number of euthanized dogs also increased after 1999, when visceral leishmaniasis began to appear. The number of dogs and percentage of puppies varied between different areas of the city, and neighborhoods with a higher percentage of young animals showed more cases of both human and canine leishmaniasis. This result may be due to control measures applied in these areas in response to cases of human and canine visceral leishmaniasis, but the increase in the younger canine population can be accompanied by increased susceptibility in these animals, thus favoring maintenance of the disease in the area.

No período de 1994 a 2004, a população canina de Araçatuba, São Paulo, Brasil, registrou duas importantes zoonoses: a raiva e a leishmaniose visceral. Analisaram-se as mudanças ocorridas nessa população durante esse período, utilizando resultados de censos caninos e de coletas censitárias de sangue realizados em 1994, 1999 e 2004. A relação cão/10 habitantes variou significativamente, passando de 1,7 em 1994 para 2,0 em 1999 e para 1,8 em 2004. A porcentagem de cães com até um ano de idade passou de 20% para 32,5% e o número de eutanásias realizadas também aumentou após 1999, com a introdução da leishmaniose visceral. O número de cães e a estrutura etária variaram nos diversos setores do município e aqueles com maior porcentagem de animais com até dois anos de idade apresentaram maior ocorrência de casos de leishmaniose visceral humana e canina. Tais resultados decorrem de ações de controle adotadas nos setores com casos humanos de leishmaniose visceral, porém, o aumento da população canina mais jovem pode resultar em aumento da susceptibilidade destes cães à doença, favorecendo a manutenção da mesma na área.

From 1994 to 2004, the canine population in Araçatuba, São Paulo State, Brazil, suffered two major canine zoonoses: rabies and visceral leishmaniasis. Changes in the dog population during this period were evaluated using canine census data from 1994 and 2004 and the results of blood samples for diagnosis of canine visceral leishmaniasis in 1999. The ratio of dogs per 10 inhabitants varied from 1.7 in 1994 to 2.0 in 1999 and 1.8 in 2004. The percentage of puppies less than 1 year of age increased from 20% to 32.5%, and the number of euthanized dogs also increased after 1999, when visceral leishmaniasis began to appear. The number of dogs and percentage of puppies varied between different areas of the city, and neighborhoods with a higher percentage of young animals showed more cases of both human and canine leishmaniasis. This result may be due to control measures applied in these areas in response to cases of human and canine visceral leishmaniasis, but the increase in the younger canine population can be accompanied by increased susceptibility in these animals, thus favoring maintenance of the disease in the area.

Esse trabalho objetivou estimar a reposição de cães em área endêmica para leishmaniose visceral, onde a eutanásia de animais soropositivos é indicada como medida de controle, e avaliar os motivos que levaram a aquisição ou não de novos animais. Houve a reposição em 44,5% dos casos, principalmente devido à necessidade de companhia ou guarda. O principal motivo para a não-reposição foi o temor da leishmaniose visceral.

This study aimed to estimate the dog replacement rate in an area endemic for visceral leishmaniasis, in which slaughter of seropositive animals was indicated as a control measure, and to evaluate the reasons why new animals were or were not acquired. The animals were replaced in 44.5% of the cases, and this was done mainly because of the need for a companion or guard dog. The main reason for not replacing the dog was fear of visceral leishmaniasis.