Hospitalization for dog bites in Poland between 2006-2020.

INTRODUCTION AND OBJECTIVE: Owning a dog or spending time around a dog have many benefits, but also pose a risk of being bitten or attacked. Currently, publications on dog bites and related factors come from both high-income countries and low- and middle-income countries. So far, no attempt has been made to assess this phenomenon in Poland. The aim of this study was to determine the number of such events and evaluate hospital medical assistance provided to dog bite victims in Poland in the period of 15 years between 2006-2020. MATERIAL AND METHODS: This cross-sectional study was based on the data from the Nationwide General Hospital Morbidity Study and cases with the code W54 (ICD-10) as the cause of hospitalization. As part of the analysis, victim demographical data, with an emphasis on city- and country-dwellers, as well as treatment variables were assessed. RESULTS: Between 2006-2020, 4,145 cases of hospitalizations for dog bites were found, of which approx. 42% occurred in 2020 during the COVID-19 pandemic and lockdowns. Most of the victims were children aged 0-9, and this is especially common among boys living in the countryside. It was found that regardless of the place of residence, there was a systematic decrease in hospitalization of men as they were older. In women, however, the decrease in hospitalization concerned only the age groups 0-39. Among older women, the percentage of hospitalization increased, especially among rural women aged 60 and over. CONCLUSIONS: Hospital discharge records report a small number of dog bites. These are only the tip of the iceberg. The problem has a multi-factorial nature and requires epidemiological monitoring and further research on correlates and determinants, as well as preventive measures.

Animal bite wounds and their management in tropical Australia.

OBJECTIVE: To define the microbiologic characteristics of animal bites in tropical Australia and the appropriateness of current Australian antimicrobial guidelines for their management. METHODS: This retrospective audit examined hospitalizations in tropical Australia after an animal bite or animal-associated penetrating injury between 2013 and 2020. The primary outcome was a composite of death, intensive care unit admission, amputation, quaternary center transfer, or unplanned rehospitalization. RESULTS: A wide variety of animals were implicated, but snakes (734/1745, 42%), dogs (508/1745, 29%), and cats (153/1745, 9%) were the most common. Hospital presentation after 24 hours (odds ratio (OR) (95% confidence interval (CI)): 68.67 (42.10-112.01)) and a cat-related injury (OR (95% CI): 22.20 (11.18-44.08)) were independently associated with an increased risk of infection. A pathogen not covered by the relevant antimicrobial regimen recommended in Australian guidelines was identified in only 12/1745 (0.7%) cases. The primary outcome occurred in 107/1745 (6%) and was independently associated with tissue trauma (OR (95% CI): 9.29 (6.05-14.25), p<0.001), established deep infection at presentation (OR (95% CI): 2.95 (1.31-6.61), p=0.009) and hospital presentation after 24 hours (OR (95% CI): 1.77 (1.12-2.79), p=0.01). CONCLUSIONS: A wide variety of animals bite humans in tropical Australia, but empiric antimicrobial regimens recommended in current national guidelines cover almost all the microbiologic isolates from the resulting wounds.

Rabies Elimination in Rural Kenya: Need for Improved Availability of Human Vaccines, Awareness and Knowledge on Rabies and Its Management Among Healthcare Workers.

Background: In Africa, rabies causes an estimated 24,000 human deaths annually. Mass dog vaccinations coupled with timely post-exposure prophylaxis (PEP) for dog-bite patients are the main interventions to eliminate human rabies deaths. A well-informed healthcare workforce and the availability and accessibility of rabies biologicals at health facilities are critical in reducing rabies deaths. We assessed awareness and knowledge regarding rabies and the management of rabies among healthcare workers, and PEP availability in rural eastern Kenya. Methodology: We interviewed 73 healthcare workers from 42 healthcare units in 13 wards in Makueni and Kibwezi West sub-counties, Makueni County, Kenya in November 2018. Data on demographics, years of work experience, knowledge of rabies, management of bite and rabies patients, and availability of rabies biologicals were collected and analyzed. Results: Rabies PEP vaccines were available in only 5 (12%) of 42 health facilities. None of the health facilities had rabies immunoglobulins in stock at the time of the study. PEP was primarily administered intramuscularly, with only 11% (n = 8) of the healthcare workers and 17% (7/42) healthcare facilities aware of the dose-sparing intradermal route. Less than a quarter of the healthcare workers were aware of the World Health Organization categorization of bite wounds that guides the use of PEP. Eighteen percent (n = 13) of healthcare workers reported they would administer PEP for category I exposures even though PEP is not recommended for this category of exposure. Only one of six respondents with acute encephalitis consultation considered rabies as a differential diagnosis highlighting the low index of suspicion for rabies. Conclusion: The availability and use of PEP for rabies was sub-optimal. We identified two urgent needs to support rabies elimination programmes: improving availability and access to PEP; and targeted training of the healthcare workers to improve awareness on bite wound management, judicious use of PEP including appropriate risk assessment following bites and the use of the dose-sparing intradermal route in facilities seeing multiple bite patients. Global and domestic funding plan that address these gaps in the human health sector is needed for efficient rabies elimination in Africa.