Factors limiting the appropriate use of rabies post-exposure prophylaxis by health professionals in Brazil

da Silva, R. M., Megid, J., Hampson, K. , Campos, A. A., Higashi, C. S., Medeiros, F. S., Pereira, A. S. and Benavides, J. A. (2022) Factors limiting the appropriate use of rabies post-exposure prophylaxis by health professionals in Brazil. Frontiers in Veterinary Science, 9, 846994. (doi: 10.3389/fvets.2022.846994) (PMID:35601400) (PMCID:PMC9120864)

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Post-exposure prophylaxis (PEP) is necessary to prevent the fatal onset of rabies but requires optimization to avoid overuse in populations at risk of rabies. In Brazil, the incidence of dog bites remains high, with almost half of dog-bite patients not receiving the PEP recommended by the Ministry of Health guidelines between 2008 and 2017. In this study, we aimed to identify the factors that limit the appropriate prescribing of PEP by interviewing health professionals responsible for PEP administration and completion of the ‘Information System on Diseases of Compulsory Declaration’ (SINAN) form reporting human anti-rabies care for patients seeking health care after a dog bite. We conducted 147 questionnaires (45 questions each) in three Brazilian states (i.e., Rio Grande do Sul, Santa Catarina, Rio Grande do Norte) including questions related to the criteria used by professionals to classify a dog as “suspect” or “rabid”, knowledge on PEP prescription guidelines, SINAN and communication with veterinarians. Our analyses showed that most health professionals delivering PEP in these three states struggle to identify a rabies “suspect” dog according to the Ministry of Health guidelines, and to indicate the adequate PEP regimen, with only 11% of professionals prescribing the appropriate PEP under various dog-bite patient scenarios. PEP knowledge score was higher among professionals trained on PEP guidelines and working in facilities with the highest incidence of dog bites. In contrast, PEP knowledge scores did not vary significantly between states, and were not correlated to the professional's level of experience, the number of colleagues available at the health unit or the professional's confidence on prescribing appropriate PEP. Our results suggest that knowledge gaps in PEP administration among health professionals of Brazil can be reduced by implementing training programs to differentiate among rabies risk scenarios, prescribe the corresponding appropriate PEP and improve communication between health and veterinary authorities.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Benavides, Dr Julio and Hampson, Professor Katie
Authors: da Silva, R. M., Megid, J., Hampson, K., Campos, A. A., Higashi, C. S., Medeiros, F. S., Pereira, A. S., and Benavides, J. A.
College/School:College of Medical Veterinary and Life Sciences > School of Biodiversity, One Health & Veterinary Medicine
Journal Name:Frontiers in Veterinary Science
Publisher:Frontiers Media
ISSN (Online):2297-1769
Copyright Holders:Copyright © 2022 da Silva, Megid, Hampson, Campos, Higashi, Medeiros, Pereira and Benavides
First Published:First published in Frontiers in Veterinary Science 9: 846994
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
301620The Science of Rabies EliminationKatie HampsonWellcome Trust (WELLCOTR)207569/Z/17/ZInstitute of Biodiversity, Animal Health and Comparative Medicine