Evaluation of treatments human rabies post-exposure prophylaxis in a city of Paraíba

Abstract Introduction Rabies is a zoonotic infection transmitted by virus inoculation through saliva and secretions of infected animals. The study evaluated the conduct of the post-exposure care of human rabies, between 2006 and 2013 in Cuité-Paraíba. Method: We evaluated 184 records included in the SINAN (Sistema de Informações de Agravos de Notificação). We used the chi-square test and calculated the prevalence ratio (PR) and confidence intervals (CI). Results Analysis show that 53.3% of the accidents happened with females, and 39.1% were between 20 and 59 years old. Bite was the most common assault (72.3%) and 41.5% of the aggressions resulted in severe lesions. Dogs were responsible for 66.1% of the aggressions. Attacks were also committed by cats, primates and foxes. There was association between the aggressor species and sex of individuals (p=0.019). We observed a higher frequency of aggressions by dogs in men (PR=1.587, CI=1.039-2.422) and by cats in women (PR=1.415, CI = 1.080 to 1.855). There was an association between aggression by dogs in the lower limbs (p=0.008, PR=2.065, CI=1.138-3.749) and by cats on hand/foot (p=0.001, PR=2.045, CI=1.340-3.123). Most of the care (59.8%) consisted of observation + vaccine and 59.2% followed the Ministry of Health protocol. Conclusion It is essential to improve methods for prescribing and recording of injuries treatment.

摘要 狂犬病是一种经由感染动物的唾液及分泌物通过病毒接种途径传播的人畜共患病。本研究针对2006年至2013年巴西帕拉伊巴州奎特市（Cuité-Paraíba）的人类狂犬病暴露后处置情况展开评估。
方法：本研究纳入了巴西法定传染病监测信息系统（Sistema de Informações de Agravos de Notificação，简称SINAN）中的184份病例记录，采用卡方检验（chi-square test）计算患病率比（prevalence ratio, PR）与置信区间（confidence interval, CI）。
结果：分析显示，53.3%的暴露事件发生于女性群体，39.1%的病例年龄介于20至59岁之间。咬伤是最常见的暴露方式（占比72.3%），41.5%的暴露事件造成了严重损伤。犬类为66.1%的暴露事件的攻击源，此外猫、灵长类动物与狐狸也可引发此类暴露。攻击者物种与受害者性别存在显著统计学关联（p=0.019）。研究观察到，男性遭受犬类攻击的频率更高（PR=1.587，CI=1.039~2.422），而女性遭受猫类攻击的频率更高（PR=1.415，CI=1.080~1.855）。犬类攻击导致的下肢损伤与猫类攻击导致的手/足部损伤分别存在显著关联（犬类攻击：p=0.008，PR=2.065，CI=1.138~3.749；猫类攻击：p=0.001，PR=2.045，CI=1.340~3.123）。多数暴露后处置措施（59.8%）为伤口观察联合疫苗接种，59.2%的处置方案符合卫生部（Ministry of Health）指南。
结论：完善损伤处置的处方开具与记录规范至关重要。