Despite dogs being responsible for most attacks, bats (Desmodus rotundus) caused the most human rabies deaths in Pará, Brazil from 2000-2015. While human anti-rabies treatment had the highest number of notifications at over 450,000, there was likely underreporting of bat attacks due to their remote locations. The data showed a need for improved monitoring and tracking of patients to complete treatment and reduce the 20% that did not finish it.

1. The human anti-rabies care is notifiable HARM higher
occurrence in the State of Pará. In an evaluation Notifiable
Diseases Information System - SINAN, from 2000 to 2015, is of
1,049,519 notifications of all harms, 454,302 harms of care
records (32.89% 𝑥 annual ̅ 30,287), followed by Dengue with 271
103 hits (19.63% 𝑥 annual ̅ 18,074) Cervical Discharge Syndrome
in Women 140,084 (10.14% 𝑥 ̅ annual 9339), Venomous Bites
98,959 (7.16% 𝑥 annual ̅ 6597), Leprosy 85,071 (6.16% 𝑥 annual ̅
5,671) and other health problems 331 865 (24.02%; 𝑥 annual ̅
22,124) ( Graphic 1).
In the same period, the canines represent the aggressor species most
frequently with 78.84% (358,151) of records, followed by feline
10.72% (48,689), bats 5.16% (23,448), non-human primates 1.79%
(8154), fox 0.04% (192), other species 2.02% (9197) and ignored /
white 1.42% (6,471) (Chart 2).
Although bats occupy the third position in frequency of attacks, it was
the species, particularly Desmodus rotundus, responsible for the largest
number of cases of human rabies in the state, with 40 deaths from 2004
to 2005 covering the municipalities of Portel, Augusto Correa and
Viseu, this after 6 deaths in Juruti in 1975; considered the first report of
human rabies caused by vampire bats in Brazil and not in the SINAN
databases, since the system was only introduced in the 90s in order to
collect and process reporting harms data in throughout the
country. However, as a result of updates
to Programming Systems between SINAN DOS,
SINAN W and SINAN NET, only from 2000 can
analyze databases continuously and without data loss. A human death
record also occurred in Floresta Araguaia-2004, by contact
with sick cattle anger (Figure 1).
Graphic 1: Number of notifcations and percentage
of the five largest harms registered in the state of
Pará
Graphic 2: Number of notifications and percentage
of notifications according to the aggressor species
despite the dogs represent the largest number of
occurrences, the attacks by blood-sucking bats (D.
rotundus) were responsible for the most human
deaths.
Graphic 3: Despite the high number of
notifications ignored record and/or white,
46,59% of the calls do not interrupt the anti-
rabies treatment.
Graphic 4: As to the reasons which lead to
interruption of anti-human rabies treatment,
abandonment is record high of 16,94%.
Graphic 5: The active search for missing
patients to anti human rabies by the Health
Unit has represented low records (5,35%),
which can cause possible cases of human
rabies.
Rabies in the Americas (Reunião Internacional da Raiva nas Américas)
23 a 28/10/2016XXVII RITA
Despite the anti-rabies care be higher registration harms in the state, it is considered that there
is a significant lack of notifications regarding attacks by bats due to large anthropic dispersion
for hard to reach areas resulting from Amazonian dimensions of Pará. The SINAN data point
to need to adopt strategies such as continuous monitoring, periodic and proper care of the anti-
rabies call chips at the level of county and state, supervisions aimed at greater activity in
relation to the active search for missing patients to treatment; thus reducing the proportion of
abandonment and minimize the frequency ignored and/or white and notifications, which
interfere with the actual statistical analysis of anti-rabies care. Flaws in SINAN program can
be linked to high numbers of notifications records with blank variables and/or ignored.
FIGURE 1 - Pará state map – Location of
cases of deaths in humans from rabies in the
state of Pará – Brazil.
Juruti
Portel
In these records observed that the frequency of interruption of any type
of human anti-rabies treatment indicated was 20.38% (92,609), not
interrupted 46.59% (211,667) and ignored/white 33.02% (150,026)
(Figure 3), while the abandonment represented 16.94% (76,970) of the
reason for interruption of treatment, the Health Unit indicated 3.02%
(13,729) Transfer 0.42% (1,914) and ignored / white 79.61% (361,689)
(Graph 4). Of treatment interruptions the Health Unit searched for the
patients only 5.35% (24,306) of the absentees, did not seek to 8.08%
(36,715) and ignored / White 87.57% (393,281) (Graph 5).
Silva NWF, Andrade JAA, Lima RJS, Abrel EMN,
Begot AL, Esteves FAL, Brito RMO, Baptista ZMF
Secretaria de Estado de Saúde do Pará – SESPA, Belém-Pará-Brasil
GOVERNO DO
ESTADO DO PARÁ
Em memória de Reynaldo José da Silva Lima
Augusto
Correa
Viseu
GOVERNO DO
ESTADO DO PARÁ
EVALUATION OF HUMAN ANTI-RABIES
NOTIFICATION FROM 2000 TO 2015 IN THE STATE OF
PARÁ- BRASIL
Floresta do
Araguaia
Human anti-rabies
care
Dengue
Cervical discharge
syndrome in women
Accidents caused by
poisonous animals
Hanseniasis
Other health
problems
number of
notifications
454.302 271.103 140.084 98.959 85.071 331.865
% 32,89% 19,63% 10,14% 7,16% 6,16% 24,02%
Ignored / white Canine Feline Cheiroptera Primate Fox Other species
Number of notifications 6471 358151 48689 23448 8154 192 9197
% 1,42% 78,84% 10,72% 5,16% 1,79% 0,04% 2,02%
ignorate/white Yes No
Number of notification stopping treatment 150.026 92.609 211.667
% 33,02% 20,38% 46,59%
Ignorate/White abandonment health unit indicated transfer
Number of notification 361.689 76.970 13.729 1.914
% 79,61% 16,94% 3,02% 0,42%
Ignorate/white Yes No
Number of
notification
393.281 24.306 36.715
% 86,57% 5,35% 8,08%