{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T13:34:52Z","timestamp":1791293692733,"version":"4.1.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T00:00:00Z","timestamp":1651795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Vet. Sci."],"abstract":"<jats:p>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 \u2018Information System on Diseases of Compulsory Declaration\u2019 (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 \u201csuspect\u201d or \u201crabid\u201d, 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 \u201csuspect\u201d 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.<\/jats:p>","DOI":"10.3389\/fvets.2022.846994","type":"journal-article","created":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T07:08:22Z","timestamp":1651820902000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Factors Limiting the Appropriate Use of Rabies Post-exposure Prophylaxis by Health Professionals in Brazil"],"prefix":"10.3389","volume":"9","author":[{"given":"Ramiro M.","family":"da Silva","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Megid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Hampson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline Alves Scarpellini","family":"Campos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cintia S.","family":"Higashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fab\u00edola S.","family":"Medeiros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra S.","family":"Pereira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio A.","family":"Benavides","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1080\/01652176.2017.1343516","article-title":"Rabies \u2013 epidemiology, pathogenesis, public health concerns and advances in diagnosis and control: a comprehensive review","volume":"37","author":"Singh","year":"2017","journal-title":"Vet Q"},{"key":"B2","unstructured":"KotaitI\n            CarrieriML\n            TakaokaNY\n          Raiva, aspectos gerais e cl\u00ednica. Manual t\u00e9cnico do Instituto Pasteur, Vol. 8. S\u00e3o Paulo2009"},{"key":"B3","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1038\/nrmicro.2018.11","article-title":"The spread and evolution of rabies virus: conquering new frontiers","volume":"16","author":"Fisher","year":"2018"},{"key":"B4","doi-asserted-by":"publisher","first-page":"17091","DOI":"10.1038\/nrdp.2017.91","article-title":"Rabies","volume":"3","author":"Fooks","year":"2017","journal-title":"Nat Rev Dis Primers"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e2018275","DOI":"10.5123\/S1679-49742019000200001","article-title":"Raiva humana no Brasil: estudo descritivo, 2000-2017","volume":"28","author":"Vargas","year":"2019","journal-title":"Epidemiol Serv Sa\u00fade"},{"key":"B6","doi-asserted-by":"publisher","first-page":"678","DOI":"10.3201\/eid1904.121482","article-title":"Rabies update for Latin America and the Caribbean","volume":"19","author":"Vigilato","year":"2013","journal-title":"Emerg Infect Dis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"A64","DOI":"10.1016\/j.vaccine.2018.11.066","article-title":"On the path to rabies elimination: The need for risk assessments to improve administration of post-exposure prophylaxis","volume":"37","author":"Rysava","year":"2018","journal-title":"Vaccine."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e0007564","DOI":"10.1371\/journal.pntd.0007564","article-title":"An evaluation of Brazil's surveillance and prophylaxis of canine rabies between 2008 and 2017","volume":"13","author":"Benavides","year":"2019","journal-title":"PLoS Negl Trop Dis."},{"key":"B9","unstructured":"CaldasE\n          Rabies Situation in Brasil. VII Seminar on Rabies World Day, S\u00e3o Paulo2015"},{"key":"B10","doi-asserted-by":"publisher","first-page":"95","DOI":"10.5123\/S1679-49742013000100010","article-title":"Notifica\u00e7\u00f5es de atendimento antirr\u00e1bico humano na popula\u00e7\u00e3o do munic\u00edpio de Garanhuns, Estado de Pernambuco, Brasil, no per\u00edodo de 2007 a 2010","volume":"22","author":"Silva","year":"2013","journal-title":"Epidemiol Serv Sa\u00fade"},{"key":"B11","doi-asserted-by":"publisher","first-page":"318","DOI":"10.3389\/fpubh.2020.00318","article-title":"Using surveillance of animal bite patients to decipher potential risks of rabies exposure from domestic animals and wildlife in Brazil","volume":"8","author":"Benavides","year":"2020","journal-title":"Front Public Health."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e0207025","DOI":"10.1371\/journal.pone.0207025","article-title":"Knowledge, attitudes and practices towards dog-bite related rabies in para-medical staff at rural primary health centers in Baramati, western India","volume":"13","author":"Tiwari","year":"2018","journal-title":"PLoS ONE."},{"key":"B13","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1111\/zph.12514","article-title":"Assessing rabies knowledge gaps in human and animal healthcare professionals practicing in Washington, DC\u2014A one health approach","volume":"65","author":"Hennenfent","year":"2018","journal-title":"Zoonoses Public Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e3310","DOI":"10.1371\/journal.pntd.0003310","article-title":"Knowledge, attitudes and practices (kap) about rabies prevention and control: a community survey in Tanzania","volume":"8","author":"Sambo","year":"2014","journal-title":"PloS Negl Trop Dis."},{"key":"B15","unstructured":"Diretoria de Vigil\u00e2ncia Epidemiol\u00f3gica2019"},{"key":"B16","author":"da Mota","year":"2016","journal-title":"Human rabies in Rio Grande do Sul: Rabies Virus Circulation in Non-Hematophagous Bats in the City of Pelotas and Human Anti-Rabies Pre-Exposure Prophylaxis Profile."},{"key":"B17","unstructured":"Minist\u00e9rio da Sa\u00fade. Secretaria da Vigil\u00e2ncia em Sa\u00fade \u2013 SVS. Departamento de Vigil\u00e2ncia de Doen\u00e7as Transmiss\u00edveis \u2013 DEVIT. Coordena\u00e7\u00e3o Geral de Doen\u00e7as Transmiss\u00edveis \u2013 CGDT2020"},{"key":"B18","unstructured":"Minist\u00e9rio da Sa\u00fadeAn\u00e1lise da situa\u00e7\u00e3o epidemiol\u00f3gica da Raiva no Brasil, no per\u00edodo de 2011 a 20162017"},{"key":"B19","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1590\/1678-5150-pvb-6438","article-title":"Cattle rabies: the effect of clinical evolution, viral genetic lineage, and viral load on the severity of histological lesions","volume":"40","author":"Wisser","year":"2020","journal-title":"Pesquisa Veterin\u00e1ria Brasileira."},{"key":"B20","unstructured":"Minist\u00e9rio da Sa\u00fade. Secretaria de Vigil\u00e2ncia em Sa\u00fade. Departamento de Vigil\u00e2ncia Epidemiol\u00f3gica2014"},{"key":"B21","unstructured":"R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria2020"},{"key":"B22","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1590\/S1983-80422013000300019","article-title":"Representa\u00e7\u00e3o social acerca dos animais e bio\u00e9tica de prote\u00e7\u00e3o: subs\u00eddios \u00e0 constru\u00e7\u00e3o da educa\u00e7\u00e3o humanit\u00e1ria","volume":"21","author":"Souza","year":"2013","journal-title":"Revista Bio\u00e9tica."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1001\/jama.284.8.1001","article-title":"Appropriateness of rabies postexposure prophylaxis treatment for animal exposures","volume":"284","author":"Moran","year":"2000","journal-title":"JAMA"},{"key":"B24","unstructured":"HolmquistL\n            ElixhauserA\n          21413205Emergency Department Visits Inpatient Stays Involving Dog Bites, 20082010"},{"key":"B25","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1590\/S1413-81232011000200017","article-title":"Motivos de abandono do tratamento antirr\u00e1bico humano p\u00f3s-exposi\u00e7\u00e3o em Porto Alegre (RS, Brasil)","volume":"16","author":"Veloso","year":"2011"},{"key":"B26","doi-asserted-by":"publisher","first-page":"43","DOI":"10.3390\/tropicalmed2030043","article-title":"The importance of a participatory and integrated one health approach for rabies control: the case of N'Djam\u00e9na, Chad","volume":"2","author":"Lechenne","year":"2017","journal-title":"Trop Med Infect Dis"},{"key":"B27","doi-asserted-by":"publisher","first-page":"13","DOI":"10.3389\/fpubh.2020.00013","article-title":"One Health in Practice: Using Integrated Bite Case Management to Increase Detection of Rabid Animals in Tanzania","volume":"8","author":"Lushasi","year":"2020","journal-title":"Front Public Health"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e94","DOI":"10.2196\/publichealth.7373","article-title":"A Smartphone app (AfyaData) for innovative one health disease surveillance from community to national levels in Africa: Intervention in Disease Surveillance","volume":"3","author":"Karimuribo","year":"2017","journal-title":"JMIR Public Health Surveill"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1590\/1678-5150-pvb-6671","article-title":"Information technology by mobile communication for the notification of canine visceral leishmaniasis","author":"Vasconcellos","year":"2021","journal-title":"Pesquisa Veterin\u00e1ria Brasileira"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e20190247","DOI":"10.1590\/0037-8682-0247-2019","article-title":"Post-exposure human rabies prophylaxis: spatial patterns of inadequate procedures in Cear\u00e1 - Brazil, 2007 to 2015","volume":"53","author":"Cavalcante","year":"2020","journal-title":"Rev Soc Bras Med Trop"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.antiviral.2017.03.023","article-title":"Successful strategies implemented towards the elimination of canine rabies in the Western Hemisphere","volume":"143","author":"Velasco-Villa","year":"2017","journal-title":"Antiviral Res."},{"key":"B32","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1177\/2373379918768329","article-title":"Human rabies postexposure prophylaxis knowledge and retention among health professionals by using an online continuing education module: Arizona, 2012 to 2015","volume":"5","author":"Venkat","year":"2019","journal-title":"Pedagogy Health Promot."},{"key":"B33","doi-asserted-by":"publisher","first-page":"473","DOI":"10.4103\/ijcm.IJCM_510_19","article-title":"Development and evaluation of a mobile app for guiding rabies prophylaxis among health-care professionals in India","volume":"45","author":"Swathi","year":"2020","journal-title":"Indian J Community Med."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e1002002","DOI":"10.1371\/journal.pmed.1002002","article-title":"Mobile phones as surveillance tools: implementing and evaluating a large-scale intersectoral surveillance system for rabies in Tanzania","volume":"13","author":"Mtema","year":"2016","journal-title":"PloS Med"},{"key":"B35","doi-asserted-by":"publisher","first-page":"e0007630","DOI":"10.1371\/journal.pntd.0007630","article-title":"Healthcare demand in response to rabies elimination campaigns in Latin America","volume":"13","author":"Yoder","year":"2019","journal-title":"PloS Negl Trop Dis"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1307","DOI":"10.4269\/ajtmh.16-0785","article-title":"Cost-Effectiveness Evaluation of a Novel Integrated Bite Case Management Program for the Control of Human Rabies, Haiti 2014-2015","volume":"96","author":"Undurraga","year":"2017","journal-title":"Am J Trop Med Hyg."}],"container-title":["Frontiers in Veterinary Science"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fvets.2022.846994\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T07:08:28Z","timestamp":1651820908000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fvets.2022.846994\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,6]]},"references-count":36,"alternative-id":["10.3389\/fvets.2022.846994"],"URL":"https:\/\/doi.org\/10.3389\/fvets.2022.846994","relation":{},"ISSN":["2297-1769"],"issn-type":[{"value":"2297-1769","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,6]]},"article-number":"846994"}}