Epidemiology of Animal Bites and Pattern of Referral for Post ExposureProphylaxis among Patients Attending a Tertiary Care Hospital inBengaluru - A Cross-Sectional Study

Introduction

Rabies is a zoonotic disease caused by Lyssavirus type 1 of Rhabdoviridae family.¹,. It is transmitted through the saliva of rabid animals. It is commonly spread to humans through bites and scratches of dogs, cats, monkeys and cattle. It is a devastating disease with near 100% fatality rate. To date, only three people who have been stricken with rabies have survived on record.. The mortality due to rabies is highly under reported around the world. As per WHO, every year 59000 people die from rabies around the world. India is endemic for rabies with about 20000 deaths per year.. Most of rabies deaths occur among those who delayed, did not receive, or complete rabies post exposure prophylaxis (PEP).

Hence, the only way to prevent deaths due to rabies is the timely utilization of post-exposure prophylaxi).. However, rabies immunoglobulins (RIG) or Anti Rabies Serum (ARS) needed for PEP of Category 3 bites is unequally distributed. Even in some centres where it is available, there is lack of trained manpower for the administration. Therefore, such cases are referred to higher centres for further management.

Objectives

1. To describe the epidemiology of animal bite patients attending a Tertiary care Centre in Bengaluru.

2. To assess the pattern of referral to tertiary care hospital for post exposure prophylaxis of animal bites.

Materials and Methods

A cross sectional study was conducted in the Anti Rabies Clinic (ARC) an Victoria hospital in Bengaluru. It was a record-based study using the details recorded in the case record book present in ARC from June 2021 to December 2021. The book consisted of details of the victims of animal bite attending ARC which included the socio-demographic details, manner of the bite, details of the animal, details of wound and its treatment, details of any previous exposure, referral of the case and management done at ARC.

All data collected was entered in MS Excel and subjected to statistical analysis. Results were interpreted using various charts and tables and conclusions wers drawn about the pattern of animal bites and referral of the cases.

Results

• A total of 1824 new patients attended the ARC from the month of June 2021 to December 2021 of which 86.8% of cases were Category 3 and 13.2% of cases were Category 2 bites.

• Majority of the patients i.e 71.7% were referred from other hospitals. 

Discussion

In our study, the victims of the animal bite were mainly adult males followed by adult female patients which is comparable to the study conducted in 2011 in Iran where 75.9% of the reported animal bite victims were males.⁴ Overall, more than 2/3rd of the patients were males. It shows that men are more prone to animal bites than women in the area concerned. About 1/3rd of the patients were of pediatric age group which was analogous to the study conducted in Kashmir in 2018, where 26.1% of the patients were below 18 years of age.⁵ This shows that children are also in substantial danger of contacting rabies through animal bites in the study area. The animal to which people were most exposed was dog, followed by cats and other animals which was similar to the reports of the study conducted in Kashmir in 2018 reporting 73.3% of dog bites.⁵ More than 2/3rd of the cases were from stray animals which is an indicator of increased number of stray dogs in the area.

More than 2/3rd of the patients were referred by other hospitals. Among them, 85% were referred only for RIG which shows the scarcity of RIG in peripheral institutions. It could also be due to the high cost of immunoglobulins in private institutions. Majority of the patients were referred by govt institutions which shows the lack of manpower at those establishments. About 1/4th of the referred cases had a delay in the treatment i.e more than 24 hours after the bite which is in contrast to the findings of the study conducted in Ghana in 2016 where only 18.6% cases were given PEP within 24 hours of the bite.³ It shows that, even though there is referral system, not all patients are aware of the facilities available at the tertiary care center and they are not referred promptly by the health care workers at peripheries.

Conclusion

Our study showed that more than 3/4th of the cases were bitten by stray animals whose immunization status was unknown. About 85% of referred cases were referred exclusively for RIG from Government Primary Health Centre (PHCs) and Community Health Centres (CHCs). One fourth of the cases had a delay in administration of RIG which included the cases referred from centers outside Bengaluru limits.

There is a need for adopting strategies to encourage prompt initiation and adherence to PEP. As majority of the bites are caused by stray animals, adequate measures should be taken by the Government for immunization of the animals and sterilization wherever deemed necessary. General public as well as health care providers should be made aware of the hazard of rabies and the need for early and mandatory post exposure prophylaxis.. RIG should be made available in peripheral health centers. Health care workers at Primary health centers should be educated to administer RIG through training programs by experts.

Conflicts of Interest

Nil