Rabies outbreak in Brazil: first case series in children from an indigenous village

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...

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Bibliographic Details
Published in:	Infectious diseases of poverty Vol. 12; no. 1; pp. 1 - 78
Main Authors:	Tolentino Júnior, Dilceu Silveira, Marques, Maryana Santos Vasconcelos, Krummenauer, Amanda, Duarte, Magda Machado Saraiva, Rocha, Silene Manrique, de Brito, Mariana Gontijo, de Santana, Ludmila Ferraz, de Oliveira, Roberto Carlos, de Assis, Eliseu Miranda, de Sousa Cavalcante, Kellyn Kessiene, Alencar, Carlos Henrique
Format:	Journal Article
Language:	English
Published:	London BioMed Central Ltd 24-08-2023 BioMed Central BMC
Subjects:	Animal bites Bats Brazil Cardiac arrhythmia Case Report Cerebrospinal fluid Consciousness Dyspnea Epidemics Fever Health services Hypotension Immunoglobulins Indigenous peoples Indigenous population Kinases Low income Muscle pain Outbreak Outbreaks Poverty Prophylaxis Public health Rabies Rural populations Television programs for children Vaccines Brazil Colombia Amazon Basin Peru
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Summary:	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. Graphical abstract Keywords: Rabies, Outbreak, Indigenous population, Low income, Brazil
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	2049-9957 2095-5162 2049-9957
DOI:	10.1186/s40249-023-01130-y