As a teenager, Marciano Menezes da Silva, now 28, became the first Brazilian and the second person in the world to survive human rabies, in September 2008.
After being bitten on the ankle by a bat while sleeping at his home in rural Floresta (435 km from Recife), he did not receive the proper initial treatment — doses of vaccine and anti-rabies serum.
About a month later, she started to show the first symptoms, including dizziness, severe headache and weakness in her legs.
Marciano was referred to the Oswaldo Cruz University Hospital, in Recife, and underwent a treatment created in 2004 by the American physician Rodney Willoughby, which involves inducing the patient into a coma and using antivirals.
After more than a hundred days in hospital, he was discharged, but he lives with the sequelae of the disease. Marciano does not walk, has motor difficulties, speech disorders and takes drugs to control seizures.
Despite having a mortality of almost 100%, rabies is a treatable disease whose prophylaxis is available in the SUS (Unified Health System). Therefore, Marciano says: “Whoever is bitten, seek medical attention”.
He participated in the seminar on Vaccination Against Human Rabies, promoted by leaf sponsored by Sanofi, which brought together experts to talk about the risks of this disease.
In the case of rabies, there are two types of prophylaxis: pre-exposure and post-infection. The first, consisting of three doses of the vaccine, with intervals of seven and 21 days between them, is intended for people who are directly exposed to the virus, such as biologists and residents of rural areas.
Veterinarian with specialization in public health Helio Langoni explains that, unlike other vaccines, rabies does not guarantee long-term protection.
Therefore, professionals must take the serology test annually to confirm if they are really protected, but, according to Langoni, there is still a lot of negligence.
“There are people who don’t [a profilaxia] or who take the vaccine once and work for ten years without worrying about the serological evaluation”, he says. He cites practices such as that at Unesp (Universidade Estadual Paulista), where he is a professor, which only accepts interns upon presentation of a vaccination card and an immunological test.
According to Marco Antônio Natal Vigilato, a veterinarian and Public Health advisor at PAHO (Pan American Health Organization), the lack of care is related to the perception of risk of the disease in the country.
As the number of cases of rabies in dogs has decreased significantly in recent decades, there is a feeling that the disease is not a problem — in 1999, Brazil had 1,200 cases of canine rabies, whereas in 2020 it was only one, according to more current data. of the Ministry of Health.
See the seminar video below
“The person ends up not looking for the health service when they are bitten”, says Vigilato. He agrees that the lack of care extends to health professionals, who may not carry out an adequate assessment and compromise the treatment of patients.
In the case of rabies, delay in starting therapy can be the difference between life and death. As Langoni explains, if the virus reaches the central nervous system, the picture gets more complicated.
For the debaters, animal vaccination campaigns associated with other control measures, such as prophylaxis for those at higher risk of contracting the disease, resulted in a reduction in cases of human rabies.
Even with the improvement, pediatrician and epidemiologist José Geraldo Leite Ribeiro draws attention to the transmission from wild animals. “It still happens. If dogs or cats are in the habit of playing with bats and we lower our covers, the possibility of contamination exists.”
Vigilato adds: “Healthy bats have to be flying, so be careful if you find one in the wardrobe or under the bed”.
In 2020, due to the pandemic, the vaccination campaign for dogs and cats was postponed, although it is available in health services.
Leite Ribeiro reinforces the importance of epidemiological control. “Dogs and stray cats, nobody takes them to be vaccinated. If the municipality does not have a control policy, that vaccination coverage based on estimates may not be so good.”
The seminar was mediated by journalist and veterinarian Sílvia Corrêa.