[Practical aspects of human rabies prevention]
OBJECTIVE: To analyze the rabies situation in Brazil, and to study the indication and the most adequate postexposure therapy for human rabies prophylaxis according to the following factors: kind of accident; animal that causes the accident; rabies situation in the geographic area; possibility of observation or laboratorial analyses of the animal; availability of immunobiologics METHODS: Bibliographic review of the last years and analyses of the main technical official reports in the world, including those from the World Health Organization, from Brazil Health Ministry, the State Department of Health of São Paulo, and so on. CONCLUSIONS: The number of cases of human rabies in Brazil has been decreasing since the eighties; however the number of post exposure therapy is very high due to the inadequate program of rabies control in animals, mainly dogs and cats. The most common vaccine used is the Fuenzalida-Palácios. More modern and safe vaccines are only available in private clinics. In public health centers, it is available exclusively for special patients like the immunodeficient ones or those who present adverse reaction to the Fuenzalida- Palácios. The other drug used in preventive therapy is the equine rabies immunoglobulin which is presently a safe product. The option to this drug is the human rabies immunoglobulin - very expensive and not easily available. This drug is not indicated in Brazilian public health centers, unless there is risk of anaphylaxis for the patient with the use of the equine immunoglobulin
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Instituto Pasteur, São Paulo, SP, Brazil.