Epidemiologia da raiva humana no estado do Ceará, 1970-2019

Objective: To describe the epidemiology of cases of human rabies in Ceará State, Brazil, 1970-2019. Methods: We analyzed secondary data from the State Department of Health and the reference hospital. Results: Of 171 cases, 75.7% occurred in males, 60.0% in <19 year-olds, and 56.0% in urban areas. Rabies was transmitted by dogs in 74.0%, marmosets in 16.7% and bats in 7.3%. Between 1970 and 1978, there was an increase of cases (by Joinpoint Regression Program, annual percentage change [APC] = 13.7 – 95%CI 4.6;41.5), and 1978-2019 a decrease (APC = -6.7 – 95%CI -8.8;-5.9). There was a reduction of transmission by dogs (71 cases, last case in 2010) and an increase by sylvatic animals (5 cases since 2005). Conclusion: This study demonstrates changes of transmission dynamics of rabies during the last years, with reduction of transmission by dogs and relative increase of transmission by sylvatic animals.Objetivo: Descrever os casos de raiva humana no estado do Ceará, Brasil, no período 1970-2019. Métodos: Estudo descritivo, sobre dados secundários da Secretaria da Saúde e do hospital de referência do Ceará. Resultados: Dos 171 casos, 75,7% ocorreram em homens, 60,0% nas idades até 19 anos e 56,0% em áreas urbanas. O cão foi agente transmissor em 74,0% dos casos, sagui em 16,7% e morcego em 7,3%. Entre 1970 e 1978, houve crescimento do número de casos (pelo Joinpoint Regression Program, percentual da mudança anual [APC] = 13,7 – IC95% 4,6;41,5); e entre 1978 e 2019, redução (APC = -6,7 – IC95% -8,8;-5,9). Houve redução da transmissão por cães (71 casos; último caso em 2010) e aumento relativo por mamíferos silvestres (5 casos a partir de 2005). Conclusão: O estudo evidencia mudança na dinâmica da transmissão da raiva no período observado, com redução da transmissão por cão e incremento de casos por animais silvestres

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

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 wildlife-mediated 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 post-exposure prophylaxis due to logistic problems. Even after onset of symptoms, in all cases, the suspected diagnosis was not rabies at first. In four cases, transmission occurred by marmosets (Callithrix jacchus), one by a hematophagous bat (Desmodus rotundus), and another by a domestic dog, though the identified viral strain was sylvatic. All patients died.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

Transmissão da Raiva por Sagui (Callithrix jacchus) no Estado do Ceará, Brasil.: Uma Revisão

Rabies is a serious infection caused by a virus belonging to the family Rhabdoviridae, genus Lyssavirus. The disease is characterized by an acute lethal encephalitis and the transmission occurs by inoculating the rabies virus in the saliva of mammals infected by biting, licking scratch or mucous membranes. According to its transmission mechanism and its epidemiological cycle, the disease can be classified as: urban, rural, wild aerial and terrestrial wild. Anger involving wild animals is a serious danger to pets as well as humans. The main reservoirs of wildlife rabies in Brazil, are the white tuft of marmosets (Callithrix jacchus). In Ceará, the maintenance cycle of anger among marmosets has been a major issue for public health authorities. This work aimed to make a brief epidemiological approach Rabies transmission by Marmosets in Ceará state, Brazil, as the history of the number of rabies cases in C. jacchus, confirms its epidemiological significance and reinforces the growing need for public health surveillance in the Ceará.A Raiva é uma grave zoonose causada por um vírus pertencente à família Rhabdoviridae, gênero Lyssavirus. A doença é caracterizada por uma encefalite aguda e letal e a transmissão ocorre pela inoculação do vírus rábico, presente na saliva de mamíferos infectados, através de mordedura, arranhadura ou lambedura de mucosas. De acordo com o seu mecanismo de transmissão e seu ciclo epidemiológico, a doença pode ser classificada em: urbana, rural, silvestre aérea e silvestre terrestre. A Raiva envolvendo animais silvestres é um grave perigo para animais domésticos, assim como para os seres humanos. Dentre os principais reservatórios da Raiva silvestre no Brasil, encontram-se os saguis de tufo branco (Callithrix jacchus). No Ceará, a manutenção do ciclo de Raiva entre os saguis tem sido um tema importante para as autoridades de saúde pública. Este trabalho teve como objetivo fazer uma breve abordagem epidemiológica da transmissão da Raiva por Saguis no Estado do Ceará, Brasil, visto que o histórico do número de casos de raiva em C. jacchus, confirma a sua importância epidemiológica e reforça a necessidade crescente de vigilância em saúde pública no Ceará

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

Rabies transmitted by sylvatic populations has become an increasing concern in Brazil. A total of 113 participants with a history of contact with sylvatic populations were interviewed in 27 municipalities of Ceará State in northeast Brazil. Questionnaires included questions on knowledge, attitudes and practices (KAP) regarding sylvatic rabies. Most of the respondents (92%) knew about rabies and confirmed at least one species that transmitted the disease (79.6%). Of these respondents, 69% mentioned monkeys, and 67.2% mentioned dogs. However, 16% of the respondents listed an incorrect species. In general, knowledge on the symptoms and signs and on prevention measures was weak. The majority raised pets (93.8%), most commonly dogs and cats, and, of all the pets, 85.7% were claimed to be vaccinated against rabies. A total of 67.3% reported the appearance of free-living wild animals around their houses, mostly marmosets and wild canids; 18.3% reported that sylvatic populations had attacked animals or humans. Seventy-three percent had raised or still were raising wild animals as pets, mostly capuchin monkeys (79.5%) and marmosets (24.1%). This is the first KAP study on sylvatic rabies in Brazil. The data indicate important knowledge gaps and risk behavior within a high-risk population. There is a need for strengthening and improving sylvatic rabies surveillance and control, combined with the intensification of education and information campaigns

Coccidioides posadasii Infection in Bats, Brazil

To analyze the eco-epidemiologic aspects of Histoplasma capsulatum in Brazil, we tested 83 bats for this fungus. Although H. capsulatum was not isolated, Coccidioides posadasii was recovered from Carollia perspicillata bat lungs. Immunologic studies detected coccidioidal antibodies and antigens in Glossophaga soricina and Desmodus rotundus bats