Epidemiology of Animal Bite Cases of Children Attending Tertiary Care Center of Bangalore Medical College and Research Institute, Bengaluru: A Retrospective Study

Introduction

Rabies is an acute, highly fatal viral illness, belongs to Lyssavirus type 1. It is mainly a zoonotic infection of warm-blooded animals, mainly dogs, cats, monkeys. It is transferred to man typically by bites or licks of rabid animals.¹

Rabies causes 59,000 human deaths yearly in over 150 countries, with 95% of cases occurs in Asian and African countries. As endemic disease in India, rabies accounting for 36% of world’s deaths.² Actual demices of rabies is not fully known, although as per the available information, in India it causes 18,000–20,000 deaths annually. About 30%–60% of rabies cases and deaths occurs under the age of 15 years children in india. This is because the bites that occur in children go missed and not reported. ³

In 99% of the cases, inland dogs are accountable for virus spread on humans. Paradoxically, all these complications can be avoided by active vaccination. But for an effective prevention, it’s vital to know the burden of animal bites, especially among children. Even though many surveys has been taken out in India, the real picture of animal bites in Indian children is still unknown.

The objective of this study is to estimate the burden of animal bite cases of children up to 15 years of age attending the ARC of tertiary care centre.

Methodology

A record-based retrospective study taken from February to March 2022 from registers maintained in the ARC of a tertiary care hospital. A semi-structured questionnaire was prepared to gather the data. All the records from January to December 2021 were look-through and all the epidemiological information was collected from the registers maintained at the clinic. The noted category of bites was noted. Data were entered in an excel sheet and analyzed with SPSS software. Required statistical tests were used to analyse the data. The data was depicted in the form of tables, charts, graphs wherever required.

Results

A sum of 656 records were reviewed, of which 228 were referred cases from surrounding areas.

Age-wise distribution:

In the study, out of 656 cases, 27% falls on 0–5 years age, followed by 65.5% falls on 6–12 years and 15.9% on 13–15 years age group as shown in table 1. It shows that the children between 6–12 years were more prone to an animal bite.

Gender-wise distribution:

Male children accounted for 70.30% of the cases and 29.70% were female children, details are depicted in Figure 1. Male children were more exposed to the outer environment, thereby increasing the chances of being bite victims of animals.

Time distribution:

It was observed that, 39.56% of bites were happened at evening hours, followed by 28.3% during the morning hours (Figure 2). It signifies that the majority of victims had been exposed to animals while traveling to or from school or at home.

Animal type and category of bite:

It was observed that 98.50% of the victims were bitten by a dog of which 68% were stray dogs, 6 cases by monkeys and 4 cases by cats (Table 2). Among these cases, 95.70% were Category III wounds as Figure 3

Bite status and bite location:

Most common offending animals were stray dogs and the victims were boys >5 years of age mostly. Provoked bites accounted for the majority of exposures. Around three-fourths of the cases reported to the health care center have done wound toileting in a time interval of fewer than 30 minutes from the bite. Many cases got a bite at the lower limb, while children <5 years got a bite on the head and neck, and trunk as shown in table 3.

Monthly distribution of cases:

The cases were increased during April and May which points to school vacation. Since, most of these cases are school going children as shown in figure 4.

Vaccination status:

Only 29.40% of victims completed the Intradermal antirabies vaccine schedule with all 4 doses, while the status of 34.8% of cases was unknown since these cases were referred for rabies immunoglobulin (figure 5).

Discussion

In the current study, out of 656 cases, the majority of cases belonged to the 6–12 years age group. This study shows that school-going children were more prone to animal bites and the majority were male children residing in urban areas. Children are more prone to animal bites because most children are more fond of animals and have a mindset to provoke them. Children also have less ability to protect themselves. 

Similarly, a study carried by Samantha et al. in West Bengal, out of 308 children, 68.83% of victims falls in between 5–12 years age group, and male children constituted about 60.78% of the cases with a male:female ratio of 2.08:1.4. A study carried by Mehindiratta et al. in urban Delhi, out of 37950 cases, 53% belonged to the 5–12 years age group. They also reported that children aged 5–12 years were the most vulnerable group.⁵

This study, depicts that most of bite cases were reported in April and May which is the vacation period for school-going children. This signifies that the children are mostly exposed to animals during vacations, may be because most of them remain outdoors, especially while playing.

Conclusion

In this study, majority of cases falls in between 6–12 years age group and are more exposed to an animal bite. A male predominance was observed. Most of the cases had bite during the morning and evening hours while traveling to and from school. On analysing monthly distribution, most cases are reported during school vacations in April and May. During vacations, children will go out for playing and are fond of animals, therefore they will provoke animals and get bitten by animals than adults.

So for active protection from rabies, there needs to be better awareness in schools and parents, concerning bites of animal, early management of wound, and preventive methods followed to protect from the adverse effect of the rabid animal bite. Corporations also should make sure in cleaning food litter from roads regularly and controlling stray dog populace to avoid the deadly infection rabies.

Conflicts of Interest

Nil