Pattern of animal bite, adherence and delays in initiating post exposure prophylaxis for rabies prevention

Abstract

Background: Rabies infection is a disease of public health importance. It is one of the neglected tropical diseases with almost 100% case fatality rate after onset of symptoms. The only proven approach in preventing rabies following exposure is Post Exposure Prophylaxis (PEP). Majority of death from rabies occurs among those who did not receive or complete PEP for rabies. Delays in initiating PEP also contribute to death from rabies. The aim of this study is to determine the pattern of animal bite, delays in initiating PEP and adherence to PEP for rabies prevention. Methods & Materials: Data on clients reporting for PEP for rabies prevention in a tertiary hospital setting in Ghana was collected from 2013 to 2016. Demographics, place and source of exposure were collected. Information on adherence to the PEP protocol was also collected. Results: Of the 1030 participants, 52.9% (545) were males while 47.1% (485) were females. The median age was 22 years (interquartile range = 27 years). Majority of the cases were between the age group 1-10 years accounting for 29.2%. 5.6% were >59 years old. Dog bites accounted for 96.5% (n = 994). Cats, Non-human primates, human bites respectively accounted for 1.8% (n = 18), 1.2% (n = 12) and 0.6% (n = 6) of all bites. Majority of bites occurred at home accounting for 66.2% (n = 646). 31.6% (n = 308) and 2.3% (n = 22) of bites occurred on the streets and neighbors/friends homes respectively. 18.7% initiated PEP within 24 hours of bite. 37.8%, 31.7% initiated PEP within 1–2 days, and 3-7 days respectively. 11.7% however initiated treatment after one week. With regards to compliance to PEP schedules, 95.2% (n = 976) completed all five doses of intramuscular post exposure prophylaxis. With regards to trends, majority of dog bites occurs between November and March. Conclusion: Bites from suspected rabies infected animals remain a problem in southern Ghana. There are significant delays in initiating PEP for rabies prevention. Most animal bite victims are children ten years and below and occurred at home.