Características dos atendimentos antirrábicos humanos pós-exposição e seus padrões espaciais e temporais no estado do Ceará, 2007 a 2015

Abstract

Post-exposure anti-rabies prophylaxis is indicated for people exposed to the rabies virus. This study aims to characterize the profile and prophylactic behaviors of post-exposure human rabies treatments, in addition to their spatial and temporal patterns in the state of Ceará, from 2007 to 2015. The study was based on secondary data, human rabies of the Notification of Injury Information System (Sinan), and without individual identification. Data processing and analysis were performed in four steps. In stage 1, the socio-demographic and epidemiological characteristics of those affected by post-exposure human anti-rabies consultations were described. In stage 2, the prophylactic procedures were evaluated and classified as adequate or inadequate, according to Technical Norms recommended by the Ministry of Health, and the factors associated with post-exposure care were identified. In step 3, the temporal trends of the rabies treatments were evaluated, using the regression models by inflection points. And, in step 4, the spatial distribution of inadequate antirabies conduits was measured using the local Moran index. Stata, Joinpoint and ArcGis were used for data analysis and processing. In the period from 2007 to 2015, there were 231,694 notifications of rabies treatments in Ceará, with one peak in 2015 (40.35 visits per 10,000 inhabitants, APC = 5.5, 95% CI 2.7 to 8.3, p = 0.005). The age group with the highest proportion of visits was 20 to 59 years (12.9%). The predominant aggressor species was canine (70.0%), with bite being the most frequent type of aggression (85.2%), located mainly in the hands / feet (37.6%). Of the total of aggressions by dogs and cats, 86.5% were only observable; however, the predominant type of treatment was the observation of the aggressor animal and the vaccine (49.9%). Of the notifications, 222,036 (95.8%) presented inadequate conducts, and an increasing tendency of their incidence coefficient (APC = 13.6, 95% CI: 9.4 to 18.1, p <0.001) from 2007 to 2011. Significantly higher values (p <0.05) were observed in two clusters with a high incidence of inadequate care, one located in the northeast region of the state, Guaramiranga (222.3), Jaguaruana (115.0), Itaiçaba (89.2), Russas (85.0), Cruz (83.5), Palhano (80.4), Quixeré (66.8), Aracati (50.9), and Beberibe (46.7); and another in the northwest of the state, in the municipalities of Jijoca de Jericoacoara (131.5), Ibiapina (66.4), Bela Cruz (62.7) and Camocim (38.7). The canine species presented an increasing trend from 2007 to 2011 (APC = 14.3, p <0.001) and the highest prevalence ratios occurred in bite exposure (PR = 1.03, 95% CI 1.02 to 1.03) and multiple injuries (RP = 1.07, 95% CI: 1.06 to 1.07). It was concluded, therefore, that inappropriate prophylactic behaviors occurred more in the interval between 2007 and 2011, with a heterogeneous distribution in the municipalities of Ceará. The high indication of antirabies treatment suggests that the observation of the aggressor animal and a careful evaluation of the epidemiological profile can reduce the unnecessary prescription of human rabies vaccine and the wastage of resources, being fundamental the continuous attendance to the Technical Norms for the conduction of the antirabies prophylaxis of appropriate form.