Bite Injuries among Vaccination Staff Participating in a Mass Canine Rabies Vaccination Campaign, Haiti 2016–2017

Rudy T Kirkhope,Andrew D Gibson,Marco A N Vigilato,Pierre Dilius Augustin,Natael Fénelon,Kelly Crowdis,Emily G Pieracci,Ewan T Macleod,Ryan M Wallace

doi:10.4269/ajtmh.21-0241

Abstract

ABSTRACT.Elimination of dog-transmitted human rabies worldwide will require large-scale dog vaccination campaigns. However, this places participating vaccinators at increased risk. Data from the 2016–2017 Haitian mass rabies vaccination campaign was analyzed to determine dog bite incidence among vaccinators. A survey was then developed for completion by all identifiable bitten vaccinators covering demographics; experience and training; bite episode details; attitudes toward dogs and rabies; and medical care. A parallel group of unbitten vaccinators was also surveyed. Dog bite incidence was 0.03% (43/127,000) of all dogs vaccinated. The capture, vaccinate, and release method of vaccination carried a significantly higher risk of dog bite (0.35%, 6/1,739 vaccinations) than other methods (P < 0.001). Twenty-seven bitten vaccinators, and 54 control vaccinators were included in the survey analysis. No differences were found between groups in demographics, experience, or training. However, bitten vaccinators were significantly more likely than the control group to have experienced a dog bite before the study period (P < 0.001). This may be associated with a lesser appreciation of dogs, and/or a poorer ability to interpret dog behavioral signals within this group. Although 98% of the control group indicated they would seek medical care for a dog bite, only 35% of bitten vaccinators sought such care. On a yearly basis, for the Haitian campaign, a full series of postexposure rabies vaccinations for all bite victims would prove more cost-effective than preexposure vaccination of all vaccinators. These findings may prove useful for the planning and safety of future mass dog vaccination campaigns.

Highlights

Despite recognition of its public health significance by the WHO as early as 1950, rabies remains prevalent throughout most of the world.[1,2] Recent studies suggest a global burden of between 1.7 and 3.7 million disability adjusted life years, 26,000 to 159,000 deaths, and 8.6 to 120 billion US dollars yearly.[3,4,5] all mammals are susceptible, the most significant reservoir species in relation to public health are those belonging to the family Canidae
A survey was developed for completion by all identifiable bitten vaccinators covering demographics; experience and training; bite episode details; attitudes toward dogs and rabies; and medical care
No differences were found between groups in demographics, experience, or training

Summary

Introduction

Despite recognition of its public health significance by the WHO as early as 1950, rabies remains prevalent throughout most of the world.[1,2] Recent studies suggest a global burden of between 1.7 and 3.7 million disability adjusted life years, 26,000 to 159,000 deaths, and 8.6 to 120 billion US dollars yearly.[3,4,5] all mammals are susceptible, the most significant reservoir species in relation to public health are those belonging to the family Canidae. This burden is almost entirely borne by developing countries, where the rate of canine vaccination is low, and life-saving rabies biologics are often unavailable or inaccessible.[6,7] In an effort to reduce human and animal suffering as a result of rabies, the WHO, World Organization for Animal Health and the Food and Agriculture Organization of the United Nations have declared a goal to eliminate dog-mediated human rabies deaths by the year 2030 (“Zero by 30”)

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