Made available in DSpace on 2014-06-11T19:32:51Z (GMT). No. of bitstreams: 0 Previous issue date: 2012-02-08Bitstream added on 2014-06-13T20:44:08Z : No. of bitstreams: 1 frias_dfr_dr_jabo.pdf: 1729107 bytes, checksum: 3f0233fa6c43b0d328c863a2e8d85231 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A avaliação dos casos de agressão por animais, sem critérios bem definidos, podem levar à indicação equivocada de tratamento antirrábico humano pós-exposição. O número desses tratamentos, em muitos municípios em todo o Brasil, tem preocupado as autoridades sanitárias. Assim, o presente trabalho objetivou avaliar os registros e a conduta da profilaxia antirrábica humana no Município de Jaboticabal, no período de 2007 a 2010, e propor uma nova metodologia de ação. Foi elaborada uma nova ficha de atendimento antirrábico humano, a ficha referência de atendimento a agressão animal e a ficha de visita zoossanitária, todas com seus respectivos manuais de instrução para preenchimento. Além disso, realizou-se a capacitação dos responsáveis pela aplicação das mesmas e as visitas zoossanitárias. Foram avaliadas as informações das fichas de atendimento e dos resultados de visitas domiciliares e observação dos animais agressores; os dados foram tabulados em Excel e analisados com softwares EpiInfo e Action. Também calculou-se o custo direto das vacinas antirrábicas humanas aplicadas. Em 1.366 fichas analisadas, computou-se um agravo para cada 212 habitantes; das pessoas agredidas, 74,3% receberam tratamento pós-exposição, num total de 1.251 doses de vacina. A análise detalhada dos dados, aliada ao fato de Jaboticabal ser considerada região controlada para a raiva, permite questionar que 894 pessoas podem ter recebido vacina sem necessidade, totalizando 1.094 doses a um custo aproximado de 20 mil reais. Nas visitas zoossanitárias constatou-se que, dentre os animais agressores, 78,1% eram domiciliados; 84,4% estavam sadios nos dias 0 e 10; 55% dos ataques foram provocados, e 73% das agressões ocorreram nas próprias residências. Assim, maior atenção deve ser dispensada ao atendimento a agravos por... / A poor assessment of cases of animal attacks towards humans may lead to inadequate human rabies prophylaxis. The high number of post exposure prophylaxis (PEP) treatments in many Brazilian cities has become a concern for Public Health authorities. The present study aimed to assess the records and the conduct of human PEP in the municipality of Jaboticabal, within 2007-2010, and to propose a new methodology. Versions for the following forms, together with instructions for filling them out, are proposed: human rabies medical attention form, animal attack notification form and a zoossanitary form. The personnel in charge of the health sector were trained for filling out these forms and conducting visits. It was evaluated the analysis of patient’s records and the results of home visitation and animal observation data. Data was organized in Excel spreadsheet and analyzed by EpiInfo and Action softwares. Direct cost of human vaccination was also calculated. In 1,366 analyzed records, there was one animal attack per 212 inhabitants. Among injured people, 74.3% received PEP, resulting in a total of 1,251 vaccines shots. The fact that Jaboticabal is located in a region that have controlled status for rabies, coupled with data analysis, allowed questioning that 894 persons may have received rabies shots unnecessarily, which resulted in a total of 1,094 shots at a cost of approximately 20 thousand reais. During zoossanitary visits, it was observed that among the aggressors, 78.1% were domiciled animals; 84.4% remained healthy between observation days 0 to 10; 55% of attacks were provoked and 73% of aggressions happened inside the domicile. It can be concluded that greater importance should be given to the attention of animal attacks cases. Adequacy should be made to the patient’s records, animal attack notification... (Complete abstract click electronic access below)

Orientador: Adolorata Aparecida Bianco Carvalho / Banca: Angela Cleuza de Fatima Banzatto de Carvalho / Banca: Karina Paes Bürger / Banca: Maria de Lourdes Aguiar Bonadia Reichmann / Banca: Maria Angélica Dias / Resumo: A avaliação dos casos de agressão por animais, sem critérios bem definidos, podem levar à indicação equivocada de tratamento antirrábico humano pós-exposição. O número desses tratamentos, em muitos municípios em todo o Brasil, tem preocupado as autoridades sanitárias. Assim, o presente trabalho objetivou avaliar os registros e a conduta da profilaxia antirrábica humana no Município de Jaboticabal, no período de 2007 a 2010, e propor uma nova metodologia de ação. Foi elaborada uma nova ficha de atendimento antirrábico humano, a ficha referência de atendimento a agressão animal e a ficha de visita zoossanitária, todas com seus respectivos manuais de instrução para preenchimento. Além disso, realizou-se a capacitação dos responsáveis pela aplicação das mesmas e as visitas zoossanitárias. Foram avaliadas as informações das fichas de atendimento e dos resultados de visitas domiciliares e observação dos animais agressores; os dados foram tabulados em Excel e analisados com softwares EpiInfo e Action. Também calculou-se o custo direto das vacinas antirrábicas humanas aplicadas. Em 1.366 fichas analisadas, computou-se um agravo para cada 212 habitantes; das pessoas agredidas, 74,3% receberam tratamento pós-exposição, num total de 1.251 doses de vacina. A análise detalhada dos dados, aliada ao fato de Jaboticabal ser considerada região controlada para a raiva, permite questionar que 894 pessoas podem ter recebido vacina sem necessidade, totalizando 1.094 doses a um custo aproximado de 20 mil reais. Nas visitas zoossanitárias constatou-se que, dentre os animais agressores, 78,1% eram domiciliados; 84,4% estavam sadios nos dias 0 e 10; 55% dos ataques foram provocados, e 73% das agressões ocorreram nas próprias residências. Assim, maior atenção deve ser dispensada ao atendimento a agravos por... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: A poor assessment of cases of animal attacks towards humans may lead to inadequate human rabies prophylaxis. The high number of post exposure prophylaxis (PEP) treatments in many Brazilian cities has become a concern for Public Health authorities. The present study aimed to assess the records and the conduct of human PEP in the municipality of Jaboticabal, within 2007-2010, and to propose a new methodology. Versions for the following forms, together with instructions for filling them out, are proposed: human rabies medical attention form, animal attack notification form and a zoossanitary form. The personnel in charge of the health sector were trained for filling out these forms and conducting visits. It was evaluated the analysis of patient's records and the results of home visitation and animal observation data. Data was organized in Excel spreadsheet and analyzed by EpiInfo and Action softwares. Direct cost of human vaccination was also calculated. In 1,366 analyzed records, there was one animal attack per 212 inhabitants. Among injured people, 74.3% received PEP, resulting in a total of 1,251 vaccines shots. The fact that Jaboticabal is located in a region that have controlled status for rabies, coupled with data analysis, allowed questioning that 894 persons may have received rabies shots unnecessarily, which resulted in a total of 1,094 shots at a cost of approximately 20 thousand reais. During zoossanitary visits, it was observed that among the aggressors, 78.1% were domiciled animals; 84.4% remained healthy between observation days 0 to 10; 55% of attacks were provoked and 73% of aggressions happened inside the domicile. It can be concluded that greater importance should be given to the attention of animal attacks cases. Adequacy should be made to the patient's records, animal attack notification... (Complete abstract click electronic access below) / Doutor

Human rabies is a zoonotic viral disease that affects thousands of people worldwide, especially in the developing countries of Africa and Asia. There are two distinct biotypes of lyssavirus genotype 1 circulating in South Africa: a canine biotype circulating in domestic dogs, bat-eared foxes and black-backed jackals and a mongoose biotype circulating in herpestids. The presence of LBV, MOKV and DUVV has been demonstrated in South African animal species, but apart from two documented cases of Duvenhage infection in humans, no other lyssaviruses other than genotype 1 have been reported to clinically manifest in humans. Since canine rabies is endemic to the KwaZulu Natal province where the majority of human rabies cases occur, dog vaccination campaigns have been implemented to control and prevent rabies in the region. The first outbreak of canine rabies in the province from the 1950s to 1968 was successfully controlled, but after its re-emergence in the 1970s dog vaccination campaigns have been unsuccessful for a variety of reasons, including lack of commitment for implementation of effective control measures and the difficulty of accessing certain areas in the province. In addition to these problems, human rabies emerged in the Limpopo province during 2005/2006. This emergence was potentially due to the introduction of canine rabies from either black-backed jackals or dogs in Zimbabwe, as there was a large increase of canine rabies cases in the province before the human outbreak. Some dog vaccination campaigns and stray dog population control measures were established in the province, but there are still human rabies cases being reported from the region annually. In order to gain a clearer understanding of human rabies in the country, this study was undertaken to elucidate various epidemiological aspects of human rabies in the country, to correlate the existing knowledge of animal rabies cycles to human rabies cycles and also to determine whether or not lyssaviruses other than genotype 1 have been involved in causing human rabies in South Africa. The study confirmed that the domestic dog is the primary vector for human rabies in South Africa, with most cases occurring in the KwaZulu Natal province. Men and young adults under the age of 21 were most affected. Only very small portion of affected people sought and received post-exposure prophylaxis. This was either due to a lack of vaccine and immunoglobulin or a lack of knowledge of the risk of the disease after an animal exposure. The findings from the molecular epidemiology study reinforced the previous findings which correlate most human rabies cases with the coastal KwaZulu Natal canine cluster identified in previous studies. As humans are a dead end host to rabies infection, it was expected that the molecular epidemiology of the human rabies isolates would mimic the molecular epidemiology of the existing animal cycles and this proved to be the case. The human rabies virus isolates all grouped closely to their representative animal cycles, which grouped by respective geographical location. The study also reinforced findings of the establishment of a new Free State canine rabies cycle, originating from the coastal KwaZulu Natal canine rabies cluster. The primary laboratory confirmation test of rabies is the fluorescent antibody test which does not distinguish between genotypes or the two biotypes circulating in South Africa. The study was undertaken, in part, to elucidate the various genotypes and biotypes responsible for human rabies in South Africa, as there is a large diversity of lyssaviruses in South Africa, evidenced by the fact that the first ever reported human rabies case in South Africa was due to a mongoose exposure. Molecular epidemiology is a subfield of epidemiology and thus can be used to reach epidemiological conclusions. No lyssavirus genotypes other than genotype 1 were implicated in the human rabies cases, indicating that the African rabies-related lyssavirus exposures are uncommon and while exposures can happen (as shown in 2006), they are not likely to be of significant public health concern and the focus should be on genotype 1. The findings of the study emphasize the importance of rabies as a zoonotic disease of humans in South Africa, which despite having severe health impact on the local human populations is still greatly underestimated. Moreover, the study summarizes epidemiological data of known human rabies cases for a period of 1983 to 2007 and thereby provides a useful and comprehensive report on the status of the disease in South Africa for last 25 years. The database of human rabies cases established during this study can then assist in the future planning and prioritizing of rabies control and prevention efforts in the country. Copyright / Dissertation (MSc)--University of Pretoria, 2010. / Microbiology and Plant Pathology / unrestricted

This study explored the attitudes of community members toward the Human Rabies in the Vhembe district of the Limpopo Province, South Africa. This study was underpinned by interpretative phenomenological analysis design. Data were collected using individual interviews of 20 participants and 6 focus groups consisting of six community members each. Both sets of interviews were audio recorded and transcribed verbatim. Data were analysed using interpretive phenomenological analysis framework for data analysis. Three super-ordinate themes emerged from data analysis: attitudes toward the Human Rabies, factors influencing attitudes toward the Human Rabies and tackling the Human Rabies. Results indicate that attitudes toward the Human Rabies has a direct influence on adherence to prevention and care approaches. Attitudes can be influenced by addressing training and educational needs and perceptions of prevention and care approaches. Recommendations are made to enhance adherence to prevention and care approaches for management of the Human Rabies. / Health Studies / M.A. (Health Studies)