Profilaxia pós-exposição da raiva humana em Sergipe, Brasil: evidências epidemiológicas e espaço-temporais para a gestão do risco e a vigilância em saúde

Abstract

Rabies, caused by viruses of the genus Lyssavirus, is transmitted through the saliva of infected mammals, with epidemiological relevance mainly associated with dogs, cats, and bats. In Brazil, rabies-related exposures represent one of the most frequently reported events in the Notifiable Diseases Information System (SINAN), and they constitute the leading cause of notifications in the state of Sergipe. Between 2019 and 2023, Sergipe recorded 28,380 human post-exposure attendances, predominantly involving dogs, followed by cats, and to a lesser extent bats, non-human primates, foxes, and domestic herbivores, reflecting the ecological diversity and multiple risk scenarios across the state. Rabies post-exposure prophylaxis (PEP) is one of the most effective and cost-effective public health interventions and is essential for preventing a disease that, although fully preventable, remains almost invariably fatal once clinical symptoms develop. This study aimed to analyze rabies post-exposure prophylaxis provided in human anti-rabies attendances in Sergipe, Brazil, from 2019 to 2023, with emphasis on the adequacy of prescribed prophylactic conduct according to recommended protocols, the characterization of exposure events, the timeliness of care, and the spatial and spatiotemporal distribution of the disease. This was a descriptive, cross-sectional, and ecological study using municipality-level aggregated data obtained from SINAN, provided by the Epidemiological Surveillance Division of the Sergipe State Health Department. Descriptive analyses were performed using Excel® and JASP®, spatial analyses using GeoDa® and QGIS®, and the identification of high-risk spatiotemporal clusters was conducted in SaTScan® using a discrete Poisson model.The results showed a sociodemographic profile characterized by a balanced distribution between sexes, predominance of individuals of working age, and higher concentration of attendances in urban areas and more populous health regions. Bites were the most frequent type of exposure, with predominance of single, superficial injuries, mainly affecting the lower limbs. Although most individuals sought care on the same day as the exposure, delayed attendances were identified for all aggressor species. Evaluation of prophylactic conduct revealed a significant association between the type of treatment prescribed and its adequacy, with higher proportions of inadequacy observed in records classified as “pre-exposure” and in cases of treatment dispensation, while combined rabies immunoglobulin and vaccine regimens and re-exposure schemes showed the highest levels of adequacy. A reduction in the adequacy of prophylactic conduct was observed in 2022 and 2023. Spatial analysis revealed heterogeneous distribution of attendances and the presence of high-risk spatial and spatiotemporal clusters in specific areas of the state. Despite the high timeliness of care, inconsistencies persist in the implementation of post-exposure prophylaxis, revealing vulnerabilities related to clinical practice, logistics, and health-system management. The findings support the strengthening of epidemiological surveillance, the qualification of health professionals involved in exposure management, and the improvement of healthcare network organization, contributing to the mitigation of the risk of human rabies reintroduction in the state of Sergipe, Brazil.