Client access to care in the control of rabies in a tertiary hospital

Background@#Rabies continues to circulate in low levels through the years. It is continuing to be a public health problem in the Philippines.1,2 The Philippine government created programs, which provided guidelines and tasked several agencies in a collective effort to prevent and control rabies with the aim of declaring the Philippines rabies-free by 2020. Despite this, increase in cases have been noted.2,3,4@*Objectives@#This study aimed to describe demographics and explore the level of access to care as perceived by the animal bite patients in terms of accessibility, availability, and affordability of vaccine, animal bite treatment center and health worker influencing the control of rabies, which could be useful in the improvement of strategies in the management thereof@*Results@#The study included 71 respondents. 69% were adults and majority live within Baguio City, within the 5km radius from the ABTC. 81.7% can easily obtain ARV from the conveniently accessible ABTC, which is manned by effective health workers. Majority claimed that the vaccine are readily available on the spot and they predominantly paid about Php 1000-2000. Only 14.1% were able to have free vaccine and less than half of the respondents had no problem with affording hospital costs. 18.3% claimed that opening hours of ABTC are in conflict with their schedule.@*Conclusion@#The access to care in the control of rabies is important to the health care delivery system. Improvement in the control of rabies underscoring the factors such as distribution, coverage, health care workers, price and supply are avenues to advance efforts in the achievement of the program goal

Health-seeking behavior and compliance to post exposure prophylaxis among animal bite victims in India

Background: In rabies endemic countries, where every animal bite is potentially a suspected rabid exposure, the exposed individuals should seek early and proper health care. It is also essential to complete the full course of postexposure vaccination to protect against rabies. Objectives: The study aimed at determining the health-seeking behavior of animal bite victims; assessing the perceived risk of rabies transmission from different animals and knowledge on its prevention and finding out the compliance to complete course of rabies vaccination and associated factors. Methods: A multi-centric, health facility-based survey was conducted during May 2017 to January 2018 in six regional-representative states involving 18 health facilities. Study participants were animal bite victims attending the health facilities. The data from all the study participants across the country were compiled and analyzed using descriptive statistics and Chi-square test to find out the association of factors influencing compliance. Results: Among a total of 529 animal bite victims, 83.6% sought postexposure prophylaxis coming directly to health facility; others visited nonallopathic/traditional healers/veterinarians/Auxiliary Nursing Midwifery before coming to health facility. The perceived risk of disease transmission and knowledge on the prevention of rabies was insufficient among the exposed victims. All participants were started with anti-rabies vaccination; the compliance rate for the full course of intramuscular rabies vaccination was 65.9% and for intra-dermal rabies vaccination, it was 85.1%. Among Category III exposures, only 46.2% received rabies immunoglobulin. Conclusions: Health-seeking behavior and compliance to complete course of anti-rabies vaccination is unsatisfactory, which has to be improved to prevent rabies.

Appraisal of surveillance of human rabies and animal bites in seven states of India

Background: The key to understanding the burden of animal bites and rabies lies in accurate and timely data with the help of proper surveillance system across the country. Such a surveillance system needs to be evaluated also for a programmatic purpose. Objectives: The present study was conducted to appraise the surveillance system of human rabies and animal bites in seven states of India and also to describe the characteristics of human rabies cases in the states. Methods: The record-based study was conducted from July to December 2017. The survey team collected information about the surveillance status of human rabies from the infectious diseases hospitals and animal bites from integrated disease surveillance programme (IDSP) offices of the respective states for 2012�16. At the national level, also number of animal exposures and the human rabies cases were collected from the Central Bureau of Health Intelligence and IDSP and compared for concordance. Results: There was a gross underreporting of human rabies from the states to Government of India, and there was no concordance in the reports of animal bites between the IDSP offices of the states and NCDC, New Delhi, India. There was a gradual decline in the reported cases of human rabies from the states during the 5-year period of 2012�16, attributable to improvement in the overall rabies postexposure prophylaxis services. The documentation of information of the human rabies cases was poor in the infectious disease hospitals. Conclusion: The surveillance system on human rabies and animal bites in India has to be improved under the national rabies control program to eliminate rabies by the year 2030.

Anti-rabies prophylaxis among children attending ARV clinic in a tertiary care center, Solapur, India

Background: Children are more prone to dog bites and they are more likely to be injured by dog bites than adult. Although most of the bites are by pet animal and provoked, they may be more severe. The present study was conducted in tertiary care center to study the profile and pattern of dog bites cases in children. Objectives: The objective of this study was to study the profile of animal bites cases and observe different practice of wound washing after bite. Materials and Methods: A cross-sectional analytical study was conducted among <15-year-old children attending ARV clinic in a tertiary care center from July 2016 to December 2016. After receiving verbal informed consent, a pre-designed and pre-tested questionnaire was used to collect the data from children or their parents. Results: Higher proportion of animal bite cases (38.9%) was seen in 5–10 years of age group among all the children with male predominance (73%). The most common site for bite was lower limb, i.e., 49.3%. Among all the children, 44.7% of children did not wash the wound after bite. Among all the category-III animal bite patients, 84.3% received inj. anti-rabies serum. Conclusion: Dog bites are more in male children; information, education, and communication activities regarding prevention of rabies are necessary.

Caracterización clínico-epidemiológica de mordeduras en personas mayores en la provincia de los Andes, región de Valparaíso, Chile / Clinical-epidemiological characterization of bites in the elderly in the Andes province, Valparaíso region, Chile

Introducción: las mordeduras constituyen un relevante problema de salud, con amplio espectro clínico, pudiendo causar la muerte. Existe escasa información del tema en personas mayores (PM). Método: análisis de base de datos realizada a partir de formularios de notificación de mordeduras de centros de salud y de Protocolos de Denuncia de Animal Mordedor en la provincia de Los Andes, Chile. Objetivo: caracterizar epidemiológicamente las mordeduras en personas mayores ocurridas en la provincia de Los Andes, V región,(2005-2007). Resultados: de los 2358 casos de mordeduras notificados, 234 casos ocurrieron en PM (9,92 por ciento del total de casos), con un promedio de edad de 70,09 ± 7,896 años (rango = 60-95 años). La tasa de mordeduras para PM fue de 657,1 por 100000 hbtes (2005), 745,8 por 100000 hbtes (2006) y 627,6 por 100000 hbtes (2007). De éstos, la mayoría se produjo en el sexo femenino (56,8 por ciento) (p 0,016). El animal mordedor más frecuente fue el perro (75,6 por ciento) en ambos sexos. La complicación más frecuente fue la herida (74,4 por ciento), seguida por enfermedad por arañazo de gato (2,1 por ciento) y fractura (1,3 por ciento). Hubo 1 caso de artritis y 1 de celulitis por mordedura de araña. Conclusiones: las mordeduras en personas mayores son causa de morbilidad importante. Es relevante mejorar los sistemas de registro y vigilancia, y las medidas de educación en la tenencia responsable de animales para lograr una disminución de casos. Se requieren más estudios para determinar otras complicaciones y consecuencias de mordeduras en PM no visualizadas en este estudio.(AU)

Introduction: bites are a relevant health problem, with a varied clinical spectrum, which can cause death. There is limited information about bites in old people (OP). Methods: database analysis made with bites notification forms by health centers and Animal Bites Reporting Protocols in the province of Los Andes, Chile. Objective: typify bites epidemiologically in old people in the province of Los Andes, V region (2005 to 2007). Objective: typify bites epidemiologically in elderly people in the province of Los Andes, V region (2005 to 2007). Results: 234 out of 2358 cases of reported bites occurred in OP (9.92 percent of all cases), with an average age of 70.09 ± 7.896 years (range = 60-95 years). The bite rate for OP was 657.1 per 100000 inhabitants (2005), 745.8 per 100000 inhabitants (2006) and 627.6 per 100000 inhabitants (2007). Of these, most of them occurred in females (56.8 percent) (p 0.016). The most frequent biting animal was the dog in both genders (75.6 percent). The most frequent complication was injury (74.4 percent), followed by cat scratch disease (2.1 percent) and fracture (1.3 percent). There was 1 case of arthritis and 1 case of cellulitis due to spider bite. The most frequent complication was the wound (74.4 percent), followed by cat's scratch disease (2.1 percent) and fracture (1.3 ). There was 1 case of arthritis and 1 case of cellulitis due to spider bite. Conclusions: bites in old people are a cause of relevant morbidity. It is relevant to improve the registration and surveillance systems, and the education measures in responsible animal tenure to achieve a reduction of of cases. More studies are required to determine other complications and consequences of bites in OP not visualized in this study.(AU)

Rising pattern, Seasonal predisposition and Trend analysis of Animal bite Cases Attending the Anti-rabies Clinic of a Tertiary Care Hospital

Background: India is responding to achieve the target of zero human death from dog-mediated rabies by 2030. Objectives: To study the rising pattern, seasonal predisposition and trend analysis of animal bite cases attending the anti-rabies clinic of a tertiary care hospital. Methodology: This retrospective cross-sectional study was conducted in the anti-rabies clinic of Department of Community Medicine, Government Medical College, Srinagar, Jammu & Kashmir. Data were collected from the animal bite register maintained at the said clinic. Data were entered into Microsoft Excel spreadsheet and analysed with the application of mean, proportion and trend analysis. Results: Total number of animal bite cases were 49508 in last 14 years (2004-2017). The rising case pattern has been observed since the year 2009.The maximum number of cases being 7324 in the year 2016 followed by 6548 in the year 2017 respectively. The seasonal predisposition of animal bite cases was seen in the month of March and June. On-trend analysis, forecasting for 2018, 2019 and 2020 showed 7570, 8108 and 8645 cases respectively. Conclusion: We conclude that the animal bite cases are on an increase in the future years and applicable management measures with intersectoral coordination ought to be started vigorously in endemic areas.

Compliance to Anti-rabies Vaccination in Post-exposure Prophylaxis.

Complete post-exposure prophylaxis is necessary to prevent rabies among all animal bite victims. It is essential for the bite victims to complete the full course of vaccination as recommended for complete protection. The present study was conducted to determine the compliance rate for anti-rabies vaccination by both intramuscular route and intradermal route and to determine the major constraints. The study was done at two municipal corporation hospitals in Bangalore, India. The compliance rate for intramuscular rabies vaccination was 60.0% and for intradermal rabies vaccination 77.0%. The major constraints were loss of wages, forgotten dates, cost incurred and distance from the hospital. Hence, the present study showed that the compliance to anti-rabies vaccination for post-exposure prophylaxis is low and is a cause of concern, as animal bite victims who do not complete the full course of vaccination are still at risk of developing rabies.

Acute Wound and Management

Acute wounds are a common presenting complaint of patients in the primary care setting. These can result from a variety of mechanisms ranging from lacerations and abrasions to stings, bites or burns. The management of acute wounds involves a proper evaluation with history, physical examination, and adequate management with local wound care, and consideration for the need for specialist review or systemic treatment. The general principles of wound management and special wounds like bite wounds and stings will be discussed.

Demographics of animal bite victims & management practices in a tertiary care institute in Mumbai, Maharashtra, India.

Background & objectives: Rabies is an important public health problem worldwide and more than 55,000 people die annually of the disease. The King Edward Memorial Hospital, Mumbai, is a tertiary referral centre where a rabies clinic runs 24 hours. In view of lack of information about the demographics of the disease in an urban environment the present study was carried out. Methods: Data on 1000 consecutive animal bite victims presenting to the institute in 2010 were collected over a 15 wk period. An electronic database was specially created for capturing information and was modelled on the information available from the WHO expert consultation on rabies, 2005. Economic burden from the patients’ perspective was calculated using both direct and indirect costs. Results: The victims were largely males (771 subjects). The dog was the major biting animal (891, 89.1%).Bites were mainly of Category III (783, 78.3%). One twenty three subjects used indigenous treatments only for local wound care. Of the Category III bites, only 21 of 783 (2.7%) patients were prescribed human rabies immunoglobulin (HRIG) which was primarily for severe bites or bites close to or on the face. A total of 318 patients did not complete the full Essen regime of the vaccine. The median cost to the patient per bite was ` 220 (3.5 USD). Interpretation & conclusions: Our findings showed that the use of HRIG was low with less than 2 per cent of the Category III patients being prescribed it. As vaccine and HRIG continue to remain expensive, the intradermal vaccine, shorter regimes like the Zagreb regime and monoclonal antibodies may offer safer and cost-effective options in the future. Further studies need to be done in different parts of the country.

Study of profile of animal bite victims attending anti-rabies clinic at Jodhpur.

Background: Worldwide, more than 55,000 people die of rabies every year. 40% of people who are bitten by suspect rabid animals are children under 15 years of age. Dogs are the source of 99% of human rabies deaths. Rabies cases are not rare in Jodhpur. Jodhpur is situated in the North-Western part of Rajasthan. Jodhpur has an overall population of about 3.685 Million (Census-2011) and a literacy Rate of 67 %. Aims & Objective: The present study was undertaken to determine the age and sex wise distribution of animal bite cases and to find out the distribution of victims on the basis of type of animal exposure and site of bite wounds. Material and Methods: The present study was conducted from 1st January 2010 to 31st December 2010. The animal bite patients attending the Anti-Rabies Clinic, M. G. Hospital, Jodhpur. The present study is a Hospital based study, carried out by interview and examination of the animal bite victims. The present study was carried out by interview and examination of the animal bite patients (Interview of attendants if the bite victim is a very young children) attending the ARC, M.G. Hospital, Jodhpur. Results: The study shows that maximum number of animal bite cases 1901 (44.75%) were in the adult males. In case of both the male and female children (less than 15 years age group) maximum number of animal bites 600 (42.46%) and 180 (41.66%) were on the trunk, whereas in case of adult males and adult females the most common site of the bite was lower limbs. Category III bite (exposure) was more common in 3088 (72.69%) cases. The most common biting animal is dog in 4062 (95.62%) cases. Maximum number 831 (19.56%) of animal bite cases have occurred in the 6 to 10 years age group children. Conclusion: The study shows that adult males have higher incidence of animal bite than the adult females. This is due to the more outdoor activity of the males. The most common biting animal is dog and the most common site of bite is lower limbs in adults. The study also shows that Category III bites (exposure) were more common.

Community-based Evaluation of Health-seeking Behavior of People with Animal Bite Injuries in a District of Sri Lanka / 国際保健医療

<b>Introduction</b><br> Of the 55,000 deaths per year due to rabies, 56% occur in Asia and 44% in Africa. Despite the existence of the national rabies control program in Sri Lanka, rabies is still prevalent, suggesting that animal bite victims may have failed to observe the proper first aid measures and seek immediate medical treatment. The purpose of this study is to describe the health-seeking behavior among animal bite victims of a selected population in Kandy District, Sri Lanka. The influences of subjects’ demographic characteristics to these behaviors were studied.<br><b>Methods</b><br> We conducted face-to-face interviews in May 2006 among households with family members having history of animal bite injuries. Data on health-seeking behaviors such as first aid measure application, immediate medical consultation, and completion of post-exposure prophylaxis (PEP) were obtained. The association between behaviors and demographic characteristics were evaluated using Chi-square test or the Fisher’s exact test.<br><b>Results</b><br> Of the 6968 sample population, 357 (5.1%) had history of animal bites one year prior to the survey. Most of the subjects performed first aid measures (n=297, 83.2%) and sought medical treatment (n=319, 89.4%) within 24 hours (n=295, 82.6%) of the injury. Only 9.8% (n=35) of the subjects completed the PEP. There was no association between health-seeking behavior and demographic characteristics. Two subjects died having symptoms that resembled rabies without completing the necessary PEP, and two animal specimens were sent for laboratory testing that confirmed one case of feline rabies one year prior to the study.<br><b>Conclusion</b><br> In general, the health-seeking behaviors of the subjects were not influenced by their demographic characteristics which may contribute to greater difficulties in controlling rabies. To strengthen the rabies control program, effective education of both the public and health sectors by thorough and adequate wound washing, and strict adherence with the recommended treatment schedule is of paramount importance.