[Practical aspects of human rabies prevention]

Area of Science:

• Public Health
• Epidemiology
• Infectious Diseases

Background:

• Human rabies remains a concern in Brazil, despite a decreasing trend in reported cases since the 1980s.
• Inadequate rabies control programs in animal populations, particularly domestic animals like dogs and cats, contribute to a high demand for post-exposure prophylaxis.

Purpose of the Study:

• To analyze the current rabies situation in Brazil.
• To evaluate the appropriate post-exposure prophylaxis (PEP) for human rabies, considering accident specifics, animal involved, geographic risk, and immunobiologic availability.

Main Methods:

• Bibliographic review of recent literature.
• Analysis of official technical reports from global and Brazilian health authorities (WHO, Brazil Ministry of Health, São Paulo State Department of Health).

Main Results:

• Human rabies cases have decreased since the 1980s.
• High rates of post-exposure therapy are linked to insufficient animal rabies control.
• The Fuenzalida-Palácios vaccine is commonly used; safer, modern vaccines are restricted to private clinics or specific patient groups in public centers.
• Equine rabies immunoglobulin is available and safe, with human rabies immunoglobulin reserved for cases of anaphylaxis risk.

Conclusions:

• While human rabies incidence is declining, the high volume of post-exposure treatments highlights challenges in animal rabies prevention.
• Access to modern, safer rabies vaccines and immunoglobulins in public health settings requires improvement for optimal human rabies prophylaxis.