Human Anti-Rabies Treatment in the Mucuri Valley, Brazil, 2017 2019

Research Article

Austin J Public Health Epidemiol. 2023; 10(3): 1149.

Human Anti-Rabies Treatment in the Mucuri Valley, Brazil, 2017 – 2019

Dilceu Silveira Tolentino Júnior*; Kellyn Kessiene Cavalcante; Ananda Caldeira Tolentino Amaral; Heberson Teixeira da Silva; Manuella Botelho Laure Nogueira; Gustavo Teixeira Martins; Eliseu Miranda de Assis; Roberto Carlos de Oliveira; Carlos Henrique Alencar

Faculty of Medicine, Federal University of the Jequitinhonha and Mucuri Valleys, Teófilo Otoni, Minas Gerais, Brazil

*Corresponding author: Dilceu Silveira Tolentino Júnior Faculty of Medicine, Federal University of the Jequitinhonha and Mucuri Valleys, Teófilo Otoni, Minas Gerais, Brazil. Email: [email protected]

Received: May 26, 2023 Accepted: June 27, 2023 Published: July 04, 2023


Background: We aimed to describe the profile of people involved in accidents with potentially rabid-transmitting animals, and characterize the spatial distribution and temporal trend of post-exposure human anti-rabies treatments.

Methods: We carried out a descriptive cross-sectional study including all post-exposure human anti-rabies care and the respective prophylactic conducts reported in the Notifiable Diseases Information System of the Brazilian Ministry of Health that took place in the 23 municipalities of Mucuri Valley, Minas Gerais State, Brazil, in the period from 2017 to 2019.

Results: 3,691 notifications of human anti-rabies care were registered, with an average of 102.5 per month. Canine and feline species were the main aggressors. There was a progressive increase of the notifications in the period, and a heterogeneous spatial distribution of incidence with a greater concentration of care in the municipalities located in the north of the region.

Conclusions: Our data show a higher incidence of cases when compared to other regions of Brazil. In addition, they can serve as a parameter to stimulate new research in the area and support the decision-making of public health managers in the region, aiming at the timely prevention and control of these neglected conditions.

Keywords: Incidence; Post-exposure prophylaxis; Rabies; Health services; Brazil


Rabies is an anthropozoonosis characterized as progressive and acute encephalitis that has high case fatality. It is transmitted to humans by the inoculation of the rabies virus present in the saliva and secretions of an infected animal, mainly by biting and scratching. All mammals are susceptible to the rabies and, therefore, are possible transmitters [1].

According to the World Health Organization, there are 55,000 estimated human deaths due to rabies per year worldwide, and approximately 40% are children under 15 years old [2]. Geographically, it is observed that about 99% of deaths occur in Asia and Africa and dog is the main transmitter [3]. In Brazil, from 2010 to 2020, 38 cases of human rabies were recorded. Of these, the dog was the aggressor animal in nine, bats in 20, non-human primates in four, and felines in another four, and in one of these, it was not possible to identify the aggressor animal [4].

The reduction in the number of human rabies cases in Brazil is due to the structuring of a surveillance system with a group of actions of animal vaccination and post-exposure vaccination in humans [5]. Since 2013, there is no human rabies cases reported in the state of Minas Gerais, despite the reports of anti-rabies care are among the three most reported in the country [6]. Due to difficulties to implement agricultural defense actions, some regions of the state have frequently registered cases of rabies in cattle, as is the case of the 23 municipalities that compose the Mucuri Valley region. The last case of human rabies in Mucuri Valley took place in 1999 in the municipality of Fronteira dos Vales. However, until 2004 there were still cases of rabies in dogs and cats in this region [7].

Comprehensive national epidemiological studies on human rabies prophylaxis are scarce [8]. Among the studies carried out so far, the studies by Mota et al. (2016) [9] in Rio Grande do Sul, by Benedetti et al. (2020) [10] in Roraima; by Rigo & Honer (2005) [11] in Campo Grande, by Veloso et al. (2011) [12] in Porto Alegre and by Nascimento et al. (2019) [6] in Rio de Janeiro. Between 2007 and 2015, studies in Ceará evaluated the completeness of notifications, the profile, the temporal trend, and the prevalence of inadequate post-exposure anti-rabies care [13-16]. And there was a prescription of 95.8% for inappropriate conduct, which also suggested the need to improve the quality of health service records. On the other hand, some studies point to levels above 90% of adequately indicated care in the cities of Porto Alegre (2006), Curitiba (2010), and Maringá (1997) [12,17,18].

Among the limited number of studies carried out on the subject in Minas Gerais, the study by Oliveira et al. (2012) [19] described and evaluated aspects of human anti-rabies care in Minas Gerais, from 1999 to 2004. Two other published studies were carried out in the capital Belo Horizonte, the first was conducted by Oliveira (2013) [20] who evaluated the spatial-temporal distribution of cases of canine aggression between 2007 and 2011; and the second by Cabral (2015) [21] who showed that among the post-exposure care associated with accidents with dogs between 2011 and 2012, the human anti-rabies care was inadequate in 32.7%, excessive in 21.2% and insufficient in 11.5%. To date, there are two studies published on the subject in Minas Gerais, one deals with the assessment of the potential risk of human rabies from canine aggression in Muzambinho - MG between 2005 and 2009, and the other on the compliance of human anti-rabies care in the south of Minas Gerais in 2015 [22,23].

Post-exposure human anti-rabies care in the municipalities of Mucuri Valley follows the Technical Standards for Human Rabies Prophylaxis [24,25]. The teams perform the primary care of each case, notify and, when necessary, prescribe and refer the patient to a referral unit or hospital to access the vaccine or serum. Since the Ministry of Health has recommended the centralization of vaccines, alteration of the vaccination schedule of 5 to 4 doses, and use of the intradermal route, preferably, for strategic reasons of the economy given the shortage of immunobiological [26,27].

Among the factors that possibly interfere with the efficiency of post-exposure human anti-rabies care in this region, we highlight the lack of knowledge for prophylaxis by part of the affected population, difficulty in accessing health services, operational problems caused by the lack of basic items such as: teams duly trained to conduct the prophylactic scheme; doctors in some units to prescribe the specific therapy, the vaccine in some reference units, the active surveillance of those who are absent from treatment, forecasting and provision of material resources that make timely and adequate care unfeasible. Furthermore, there is a considerable number of municipalities in the region that remain silent on human anti-rabies care since the lack of adequate notification of professionals involved in surveillance and rabies control can lead to failures in these activities [19,28].

Considering that the studied region has faced weaknesses due to the reduced availability of the human rabies vaccine, combined with the heterogeneous pattern of animal vaccination coverage in recent years and the deficient physical-operational structure installed in its health equipment, it was necessary to seek to understand the characteristics of people involved in accidents with animals potentially transmitting rabies, in addition to characterizing the spatial distribution and temporal trend of post-exposure human anti-rabies care that took place Mucuri Valley, Minas Gerais, Brazil, from 2017 to 2019.


This is a descriptive cross-sectional study with a quantitative approach. All post-exposure human anti-rabies attendance and the respective prophylactic measures adopted were reported to the Notifiable Diseases Information System, of the Brazillian Ministry of Health.

The Mucuri Valley mesoregion is one of the 12 political-administrative divisions that make up the State of Minas Gerais in Brazil. It is located in the northeast region of the state and borders the states of Bahia and Espírito Santo to the east, the Jequitinhonha Valley mesoregion to the north and west, and the Rio Doce Valley mesoregion to the south. It comprises 23 municipalities with a population of approximately 397,096 inhabitants [29]. It is considered one of the poorest regions of the state, with a medium municipal Human Development Index (HDI) of 0.68. This mesoregion concentrates the largest number of illiterate adults over 25 years of age (33.42%) and has a rate of 34.4% of people with the lowest per capita household income in the state (less than US$ 29,20), according to the Minas Gerais Social Responsibility Index [30].

Teófilo Otoni is the largest municipality in the mesoregion with approximately 141,502 inhabitants, in an area of 3,242 km² and a population density of 43.64 per km², 445 km away from the state capital; the smallest municipality in the mesoregion is Umburatiba, with about 2,718 inhabitants. Teófilo Otoni is also the headquarters of the Regional Health Superintendence of the State of Minas Gerais, which is responsible for managing, planning, and supervising the health of 23 municipalities, which have a population of approximately 507,788 inhabitants (Figure 1).