Abstract

Direct contact with domestic animals and wildlife is linked to zoonotic spillover risk. Patients presenting with animal-bite injuries provide a potentially valuable source of surveillance data on rabies viruses that are transmitted primarily by animal bites. Here, we used passive surveillance data of bite patients to identify areas with high potential risk of rabies transmission to humans across Brazil, a highly diverse and populous country, where rabies circulates in a range of species. We analyzed one decade of bite patient data from the national health information system (SINAN) comprising over 500,000 patients attending public health facilities after being bitten by a domestic or wild animal. Our analyses show that, between 2008 and 2016, patients were mostly bitten by domestic dogs (average annual dog bite patients: 502,043 [436,391–544,564], annual incidence per state: 258 dog bites/100,000 persons) and cats (76,512 [56,588–97,580] cat bites, 41 cat bites/100,000/year), but bites from bats (4,172 [3,351–5,365] bat bites, 2.3/100,000/year), primates (3,320 [3,013–3,710] primate bites, 2.0/100,000/year), herbivores (1,908 [1,492–2,298] herbivore bites, 0.9/100,000/year) and foxes (883 [609–1,086] fox bites, 0.6/100,000/year) were also considerable. Incidence of bites due to dogs and herbivores remained relatively stable over the last decade. In contrast bites by cats and bats increased while bites by primates and foxes decreased. Bites by wild animals occurred in all states but were more frequent in the North and Northeast of Brazil, with over 3-fold differences in incidence between states across all animal groups. Most bites reported from domestic animals and wildlife occurred in urban settings (71%), except for bites from foxes, which were higher in rural settings (57%). Based upon the Ministry of Health guidelines, only half of patients received the correct Post-Exposure Prophylaxis following a bite by a suspect rabid animal. We identified areas and species of high-risk for potential zoonotic transmission of rabies in Brazil and reveal that, despite increasing human encroachment into natural ecosystems, only patients reporting bites by bats increased. Our study calls for future research to identity the socio-ecological factors underlying bites and the preventive measures needed to reduce their incidence and potential risk of rabies transmission.

Highlights

  • Direct contact with wild and domestic animals is a major driver of zoonotic spillover, defined as the “transmission of a pathogen from a vertebrate animal to a human” [1]

  • Between 2008 and 2016, 82.3% of all bite patients in Brazil were attributed to bites from dogs, 12.5% from cats, 1.4% from wild animals, 0.3% from herbivores, 2.7% from other unidentified animals, whilst 0.8% of records did not have information recorded on the species of biting animal

  • The number of people bitten by other species were generally much lower, but on average there were 76,512 cat bites per year [95% CI: 56,588–97,580], incidence: 41 cat bites/100,000 persons, followed by 4,172 bat bites [95% CI: 3,351–5,365] or 2.3 bat bites/100,000 persons, 3,320 primate bites [95% CI: 3,013–3,710] or 2.0 primate bites/100,000 persons, 1,908 herbivore bites [1,492–2,298], or 0.9 herbivore bites/100,000 persons and 883 fox bites [95% CI: 609–1,086] or 0.6 fox bites/100,000 persons (Figure 1)

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Summary

Introduction

Direct contact with wild and domestic animals is a major driver of zoonotic spillover, defined as the “transmission of a pathogen from a vertebrate animal to a human” [1]. Rabies virus (RABV) causes the deadliest known disease and is directly transmitted through the bite of infectious mammals [2, 3]. The largest reservoir for rabies and cause of most human rabies deaths is domestic dogs [4]. Following the widespread control of rabies in domestic dog populations, rabies transmitted by wild animals has become the main source of human deaths in the Americas [5, 6]. Foxes ( the crab-eating fox Cerdocyon thous) and primates ( the marmoset Callithrix jacchus) are considered reservoirs of specific RABV variants [9,10,11,12], while serological studies show evidence of rabies exposure in several other primate and marsupial species but without evidence of clinical infections [13, 14]

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