The situation of Brazilian program for surveillance of accidents caused by venomous animals

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The situation of Brazilian program for
surveillance of accidents caused by venomous
animals

• Daniel Nogoceke Sifuentes,
• Hui Wen Fan, Andreia Careli Dantas
• Coordination of Anthropozoonosis
• Secretariat of Health Surveillance
• Brazilian Ministry of Health

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8,547,403.5 km2169,799,170 population26
states and 1 Fed. Dist. 5,567
municipalities80 living in urban areas
Brazil General Information
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PROGRAM HISTORY

• 1901 Production of snake antivenoms in Brazil
• 1970s decade National Program for
  Self-Sufficiency in Biological Products
• 1986 National Program for Snakebites Control
• 2006 Four public manufacturers, nine types of
  antivenoms

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Technical Group for Surveillance of accidents
caused by Venomous Animals Coordenation for
Surveillance of Vector Transmited Diseases and
Antropozoonosis General Coordenation of
Transmitable Diseases Epidemiologic Surveillance
Department Health Surveillance Secretariat Ministr
y of Health
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SURVEILLANCE PROGRAM FOR ENVENOMINGS CONTROL
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SURVEILLANCE PROGRAM FOR ENVENOMINGS CONTROL
INFORMATION SYSTEM
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AV distribution according to notification of use
Web-based Information System
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ACCIDENTS CAUSED BY VENOMOUS ANIMALS. BRASIL, 2007
Source SINAN/SVS/MS (updated at 23/07/2008)
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OPHIDISM
71
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OPHIDISM IN BRAZIL, 1987-2006
Notification (year)
Sources MS/FNS Programa Nacional de Ofidismo
(until 2000) Sinan/SVS/MS (since
2001)
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SCORPIONISM
Photos Denise Candido
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SCORPIONISM IN BRAZIL, 1989-2006
Notification (year)
Sources MS/FNS Programa Nacional de Ofidismo
(until 2000) Sinan/SVS/MS (since
2001)
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ARANEISM
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ARANEISM IN BRAZIL, 1989-2006
Notification (year)
Sources MS/FNS Programa Nacional de Ofidismo
(until 2000) Sinan/SVS/MS (since
2001)
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ENVENOMINGS BY POISONOUS ANIMALS IN BRAZIL,
1987-2007
Sources MS/FNS Programa Nacional de Ofidismo
(until 2000) Sinan/SVS/MS (since
2001)
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DISTRIBUTION OF ENVENOMINGS CAUSED BY POISONOUS
ANIMALS, BRAZIL, 2007
Snakes
Spiders
Scorpions
28,711 snake bites 15 cases/100,000 pop 114
deaths (0.40)
19,634 spider bites 10 cases/100,000 pop 9 deaths
(0.05)
36,558 scorpion stings 16 cases/100,000 pop 50
deaths (0.14)
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Deaths and lethality by envenomings. Brazil,
2001-6
Nº of deaths
Lethality
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Accidents caused by contact with Lonomia sp.
Saturnidae caterpillars, 2007
Where
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SURVEILLANCE PROGRAM FOR ENVENOMINGS CONTROL
ANTIVENOM PRODUCTION
INFORMATION SYSTEM
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ANTIVENOMS MANUFACTURERS IN BRAZILSTRATEGY OF
MANY PRODUCERS
270,000 ampoules
190,000 ampoules
58,000 ampoules
6,000 ampoules
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Bothrops AV Crotalus AV Bothrops-Crotalus
AV Bothrops-Lachesis AV Coral (Micrurus)
AV Tityus scorpion AV Arachnidae AV (Tityus,
Phoneutria, Loxosceles) Loxosceles AV Lonomia
caterpillar AV
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SURVEILLANCE PROGRAM FOR ENVENOMINGS CONTROL
ANTIVENOM PRODUCTION
INFORMATION SYSTEM
ANTIVENOM DISTRIBUTION
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AV distribution Scheme
Descentralization - distribution to 27 states ?
3.156 municipalities (58)
Centralization - Ministry of Health in
acquisition
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Principles for a rational distribution

• Based on epidemiological data
• Seasonal variation
• Geographical distribution
• According to manufacturer conditions
• Transport/ Storage
• Decentralized
• Nº health centres ? as many as possible
• Access to treatment as soon as possible (lt 6h)

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CASE-FATALITY RATE OF SNAKE BITES ACCORDING TO
TIME BETWEEN ACCIDENT AND AV TREATMENT Brazil,
2005 HUGE CHALLENGE!!
plt 0,001 Source Sinan/SVS/MS (since 2001)
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Conditions of transport and storage
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ANTIVENOM MENSAL DISTRIBUTION AND UTILISATION.
Brazil, 2007
Nº ampoules
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PLANNING ANTIVENOM DISTRIBUTION

• Antivenom supply (cases X mean ampoules)
  (stock remaning)

Cases number of accidents previewed for a given
period, e.g., one month Mean ampoules weighted
number of ampoules used, considering severity of
envenoming Stock strategic quantity of
antivenom that should be available in case of
unexpected increase or sub register of accidents,
losses of AV (misuse, expiring date, storage and
handle conditions) and deviations. Remaining
number of ampoules not used in the previous
period
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COST OF AV ACQUIRED BY BRAZILIAN MINISTRY OF
HEALTH - 2005
466,760 ampoules
?
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SURVEILLANCE PROGRAM FOR ENVENOMINGS CONTROL
ANTIVENOM PRODUCTION
INFORMATION SYSTEM
ANTIVENOM DISTRIBUTION
ANTIVENOM USE
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PRINCIPLES OF ANTIVENOM THERAPY

• earliness in antivenom therapy
• Specificity of antivenoms
• Diagnosis of envenoming based on clinical
• and epidemiological features
• Geographical distribution of animals
• Venoms actions / Local and systemic aspects of
  envenomings
• Amount of AV based on severity of envenoming

VITAL BRAZIL 1865-1950
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ANTIVENOM MISUSE FOR SNAKE BITES IN BRAZIL,
2001-6
Lachesis (bushmaster) SABL
Crotalus (rattlesnake) SAC, SABC
Bothrops (lanced-head pit viper) SAB, SABL, SABC
Elapidae-Micrurus (coral snake) SAEL
US 554,180.17 440,952.41
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Bothrops (lanced-head pit viper) snake bites
amount of antivenom recommended and
administered. Brazil, 2005
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SURVEILLANCE PROGRAM FOR ENVENOMINGS CONTROL
ANTIVENOM PRODUCTION
INFORMATION SYSTEM
ANTIVENOM DISTRIBUTION
EDUCATIONAL ACTIVITIES
ANTIVENOM USE
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http//portal.saude.gov.br/portal/saude/visualizar
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Capacitate, Train, Accompany Health professionals
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MANUAL DE CONTROLE E MANEJO DE ESCORPIÕES
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Bandeirantes/Paraná, maio 2007
Education, Prevention Population
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Education, Prevention Population Different
realities
São Domingos/Goiás, jan 2005
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• For the success of envenomings surveillance
  program its necessary
• An information system that gives reliable data
• Antivenoms of good quality and sufficient amount
  of production
• Rational logistics of antivenom distribution
• Continuous monitoring antivenom use and
  Capacitating medical assistance
• Efficient environmental education for prevention
  and controlling the incidence of each of the
  types of accidents, to reduce the impact of
  diseases as public health issues and thus
  antivenoms requirements.

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THANK YOU. daniel.sifuentes_at_saude.gov.br (55 61)
3213 8151