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Published on: August 18, 2023
Rabies outbreak in Brazil: first case series in children from an indigenous village
Dilceu Silveira Tolentino Júnior1, Maryana Santos Vasconcelos Marques2, Amanda Krummenauer3
1Postgraduate Program in Technology, Environment and Society, Federal University of the Jequitinhonha e Mucuri Valleys, Teófilo Otoni, MG, Brazil. dilceujunior@bol.com.br.
Background:
Human rabies outbreak transmitted by bats continues to be a relevant public health problem not only in the Amazon region. The disease has affected one of the areas with the greatest poverty in southeastern Brazil, a region inhabited by the Maxakali indigenous people.
Case Presentation:
We describe four cases of rabies among indigenous children that occurred in the indigenous village of Pradinho, municipality of Bertópolis, Minas Gerais, Brazil. Cases were notified between April and May 2022, all of whom died on average eight days after the first symptoms. All cases were observed in rural residents under 12 years of age. The probable form of exposure was through bat bites. The predominant symptoms were prostration, fever, dyspnea, sialorrhea, tachycardia, and altered level of consciousness. Half of the cases underwent late and/or incomplete post-exposure rabies prophylaxis, however, the other half underwent pre-exposure rabies prophylaxis, with only one case completing the scheme and another undergoing the adapted Milwaukee Protocol (Recife Protocol). All cases ended in death.
Conclusions:
This was the first rabies outbreak among indigenous people in Brazil. Among the manifested clinical forms in the series, there was a disease atypical presentation in at least one case. We suggest active surveillance and an intercultural educational campaign to prevent new cases.
Insights
A bat-transmitted rabies outbreak in indigenous children in Brazil resulted in four fatalities. This highlights the urgent need for improved surveillance and culturally sensitive public health interventions to prevent future rabies cases.
Area of Science:
- Public Health
- Infectious Diseases
- Epidemiology
Background:
- Human rabies transmitted by bats remains a significant public health concern, particularly in impoverished regions.
- The Maxakali indigenous community in southeastern Brazil was affected by a recent rabies outbreak.
Observation:
- Four indigenous children under 12 years old in Pradinho village, Minas Gerais, Brazil, died from rabies between April and May 2022.
- Exposure was likely due to bat bites, with symptoms including prostration, fever, dyspnea, sialorrhea, tachycardia, and altered consciousness.
- Rabies prophylaxis was inconsistently administered, with some cases receiving late or incomplete post-exposure prophylaxis and others pre-exposure prophylaxis.
Findings:
- This outbreak represents the first documented instance of rabies among indigenous people in Brazil.
- At least one case presented with an atypical clinical manifestation of the disease.
- All reported cases were fatal, underscoring the severity of rabies.
Implications:
- The findings emphasize the critical need for enhanced active surveillance for rabies in vulnerable indigenous populations.
- Developing and implementing culturally appropriate educational campaigns is crucial for rabies prevention.
- This outbreak highlights potential gaps in rabies prevention and control strategies within indigenous communities.
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