Animal Bite Treatment Research Articles

Lack of documentation in animal bite cases and its impact on rabies biologicals utilization.

Rabies has significant health and economic consequences for both humans and animals. Annually, India witnesses 17.4 million dog bites, yet only 3 million individuals receive post-exposure prophylaxis (PEP). There is a shortage of anti-rabies vaccine in India as quoted in many news reports. In India, lack of documentation of previous vaccination against animal bites is there, hence resulting in the re-administration of the anti-rabies vaccine, leading to a significant biological loss (anti-rabies vaccine). A cross-sectional, retrospective study was conducted. Data was collected, and analyzed from June 2021 to June 2023 a period of 2 years. Majority of the patients reported within the first 24 hours after being bitten while approximately one-third reported after 24 hours. Majority were Category 3 bites and unprovoked. Males, lower-middle class, and bites on lower extremities were common among 4291 patients attending the clinic. Out of 217 re-exposure cases, 185 did not have any documentation regarding their previous treatment of animal bites. Among 4291 patients attending the clinic, majority were Category 3 bites on the lower extremities. 85.25% of re-exposure cases had to be administered a full course of treatment due to a lack of documentation leading to rabies as a biological wastage. This avoidable wastage can be a resource for treating more patients.

Traditional healing practices for treatment of animal bites among tribes of India: A systematic review

Traditional healing practices for treatment of animal bites among tribes of India: A systematic review

Rabies post-exposure prophylaxis delivery to ensure treatment efficacy and increase compliance

ObjectivesSince rabies is lethal once symptoms appear, its prevention including community awareness, mass dog vaccination and post-exposure prophylaxis (PEP) is crucial. Although safe and potent rabies vaccines have long been available, the global rabies burden is still high and access to adequately-delivered PEP remains challenging. Here we offer healthcare providers up-to-date, simple, exhaustive, visual guidance on how to perform PEP steps correctly. ProtocolPEP consists of 1) washing the wound with water and soap for 15 min, 2) assessing the need for rabies biologicals based on specific criteria; 3) administering, if required, rabies immunoglobulin or monoclonal antibodies deep in and around all wounds; 4) starting, if necessary, the WHO-recommended intradermal 1-week vaccination regimen; 5) informing patients adequately throughout the PEP process to increase compliance and avoid dangerous misconceptions about animal bite treatment and rabies risk. DiscussionThe intradermal 1-week vaccination regimen recommended by WHO is as safe as other regimens but carries important cost-, dose- and time-sparing benefits. As fundamental as the correct administration of rabies biologicals is clear doctor-patient communication and sharing of up-to-date knowledge among healthcare professionals. ConclusionsThis resource will help ensuring that no life is lost to rabies, an incurable yet preventable disease.

Avicenna's pharmacopeia for the treatment of animal bites.

Envenomation is a common medical problem. The Canon of Medicine written by Avicenna is one of the reliable sources of Persian medicine. The present study aims to identify Avicenna's clinical pharmacology approach and the pharmacopeia used for the treatment of animal envenomations and also to evaluate the related data in light of the current medicine. The Canon of Medicine was searched using related Arabic keywords for the contents about the treatment of animal bites. A literature search was conducted in scientific databases including PubMed, Scopus, Google Scholar, and Web of Science to obtain relevant data. Avicenna recommended one hundred and eleven medicinal plants for the treatment of bites of vertebrate and invertebrate venomous animals including snakes, scorpions, spiders, wasps, and centipedes. He mentioned different methods of administrating these drugs including oral drugs, lotions, sprayed drugs, slow-dissolving tablets in the mouth, and enemas. Moreover, he paid special attention to pain relief in addition to specific treatments for animal bites. In the Canon of Medicine, Avicenna recommended several medicinal plants alongside analgesics for the management and treatment of animal envenomations. The current research elucidates the clinical pharmacology and pharmacopeia of Avicenna for the treatment of animal envenomations. Further research is encouraged to evaluate the efficacy of these therapeutic agents for the treatment of animal bites.

Using Integrated Bite Case Management to estimate the burden of rabies and evaluate surveillance in Oriental Mindoro, Philippines.

Despite national elimination efforts, dog-mediated rabies remains endemic in the Philippines. Free provision of post-exposure prophylaxis (PEP) through the widespread establishment of Animal Bite Treatment Centers (ABTCs) has improved accessibility; however, the resulting upsurge in PEP demand is not sustainable, and human rabies deaths continue. Dog vaccination coverage also remains inadequate, and it is unclear whether surveillance is effective. Here, we used Integrated Bite Case Management (IBCM) to collect enhanced rabies surveillance data in Oriental Mindoro Province over a 3-year period (2020-2022). Adapting a probabilistic decision tree model, we estimated the burden of rabies, evaluated surveillance performance, and analyzed the costs and benefits of current rabies prevention and control practices in the province. The incidence of bite patients receiving PEP was high in Oriental Mindoro Province (1,246/100,000 persons/year), though < 3% of presenting patients were deemed high-risk for rabies exposure (24/100,000 persons/year). Using a decision tree model, we estimated that around 73.8% of probable rabies-exposed patients sought PEP (95% Prediction Interval, PrI: 59.4%-81.1%) and that routine surveillance confirmed < 2% of circulating animal rabies cases, whereas IBCM resulted in a nearly fourfold increase in case detection. Furthermore, we estimated that an average of 560 (95% PrI 217-1,090) dogs may develop rabies annually in the province, equating to 3-5 cases per 1,000 dogs per year. On average, 20 to 43 human deaths were averted by PEP each year in Oriental Mindoro at an annual cost of $582,110 USD (i.e., $51.44 USD per person) or $20,190 USD (95% PrI $11,565-79,400) per death averted. While current practices for PEP provisioning in the Philippines have improved access, a large proportion of people exposed to rabies (> 26%, 95% PrI 18.8%-40.1%) are still not seeking healthcare. Integrating an intersectoral surveillance system, such as IBCM, into national policy could greatly improve case detection if well implemented, with further benefits extending to guidance for PEP administration, potentially reducing unnecessary expenditure on PEP, and situational awareness to inform control of rabies through mass dog vaccination.

One Health Surveillance for Rabies: A Case Study of Integrated Bite Case Management in Albay Province, Philippines

Canine rabies is a significant public health concern and economic burden in the Philippines. Animal Bite Treatment Centers (ABTCs) that provide post-exposure prophylaxis (PEP) to bite patients have been established across the country, but the incidence of bite patient presentations has grown unsustainably, whilst rabies transmission in domestic dogs has not been controlled. Moreover, weak surveillance leads to low case detection and late outbreak responses. Here we investigated the potential for Integrated Bite Case Management (IBCM) to improve rabies detection in Albay province. Using information obtained from animal bite histories combined with phone follow-ups and field investigations, we demonstrated that IBCM resulted in a fourfold increase in case detection over 13 months of study compared to the prior period. Bite patient incidence across Albay was very high (&amp;gt;600/100,000 persons/year) with PEP administered mostly indiscriminately. Clinic attendance reflected availability of PEP and proximity to ABTCs rather than rabies incidence (&amp;lt;3% of patient presentations were from “probable” or confirmed rabies exposures) and is therefore not a suitable indicator of rabies burden. Further analysis of the IBCM data suggests that rabies transmission is mostly localized with focal cases from the previous month and current cases in neighbouring villages being most predictive of future rabies occurrence. We conclude that investigations of suspicious biting incidents identified through IBCM have potential to foster intersectoral relationships, and collaborative investments between public health and veterinary services, enabling the One Health ethos to be applied in a more sustainable and equitable way. Triage of patients and investigations of suspect dogs offer an effective tool for improved PEP provisioning and reduction of unnecessary expenditure, whilst targeted field investigations should lead to increased and earlier detection of rabid dogs. Given the enduring risk of re-introductions from neighbouring populations, enhanced surveillance is critical to achieving and maintaining rabies freedom.

Awareness of rabies among MBBS interns of a government medical college of North India: a cross-sectional study

Background: Rabies is a major public health issue across the world. In India, however, it is still regarded as a disease with a low public health priority in the medical community. The disease is completely preventable if comprehensive post-exposure prophylaxis (PEP) is started as soon as possible. The majority of deaths are driven by ignorance and a lack of affordable care. It is quintessential for the medical fraternity to have adequate awareness of rabies and especially among the interns. Objectives of the study were to assess the awareness of interns regarding epidemiology, prevention and management of rabies.Methods: An observational cross-sectional study was conducted among interns of King George's medical university, Lucknow, U. P. Informed consent was taken, and interns were enrolled. A semi-structured pre-tested questionnaire was used to assess the awareness regarding the epidemiology, immunization of rabies and animal bite management.Results: Out of the total 160 interns who gave consent, 97% (152) were aware of the transmission mode of the rabies virus, while only a mere 37% (59) knew about the most specific prodromal symptom of rabies. Similarly, although 96% (154) of them knew who required preexposure prophylaxis, only 39% (62) knew the correct preexposure prophylaxis schedule. Regarding the first-aid animal bite treatment, 94% (150) of the interns got the answer right, but just 26% (42) of them knew which animal bite did not require PEP for Rabies in India.Conclusions: There were significant gaps in knowledge regarding animal bite injuries and immunization among interns.

Transcriptome Analysis of Chloris virgata, Which Shows the Fastest Germination and Growth in the Major Mongolian Grassland Plant

Plants in Mongolian grasslands are exposed to short, dry summers and long, cold winters. These plants should be prepared for fast germination and growth activity in response to the limited summer rainfall. The wild plant species adapted to the Mongolian grassland environment may allow us to explore useful genes, as a source of unique genetic codes for crop improvement. Here, we identified the Chloris virgata Dornogovi accession as the fastest germinating plant in major Mongolian grassland plants. It germinated just 5 h after treatment for germination initiation and showed rapid growth, especially in its early and young development stages. This indicates its high growth potential compared to grass crops such as rice and wheat. By assessing growth recovery after animal bite treatment (mimicked by cutting the leaves with scissors), we found that C. virgata could rapidly regenerate leaves after being damaged, suggesting high regeneration potential against grazing. To analyze the regulatory mechanism involved in the high growth potential of C. virgata, we performed RNA-seq-based transcriptome analysis and illustrated a comprehensive gene expression map of the species. Through de novo transcriptome assembly with the RNA-seq reads from whole organ samples of C. virgata at the germination stage (2 days after germination, DAG), early young development stage (8 DAG), young development stage (17 DAG), and adult development stage (28 DAG), we identified 21,589 unified transcripts (contigs) and found that 19,346 and 18,156 protein-coding transcripts were homologous to those in rice and Arabidopsis, respectively. The best-aligned sequences were annotated with gene ontology groups. When comparing the transcriptomes across developmental stages, we found an over-representation of genes involved in growth regulation in the early development stage in C. virgata. Plant development is tightly regulated by phytohormones such as brassinosteroids, gibberellic acid, abscisic acid, and strigolactones. Moreover, our transcriptome map demonstrated the expression profiles of orthologs involved in the biosynthesis of these phytohormones and their signaling networks. We discuss the possibility that C. virgata phytohormone signaling and biosynthesis genes regulate early germination and growth advantages. Comprehensive transcriptome information will provide a useful resource for gene discovery and facilitate a deeper understanding of the diversity of the regulatory systems that have evolved in C. virgata while adapting to severe environmental conditions.

Miejsce amoksycyliny z kwasem klawulanowym w leczeniu ran kąsanych

Miejsce amoksycyliny z kwasem klawulanowym w leczeniu ran kąsanych

Reconstruction of animal bite injuries to the head and neck.

The aim if this review is to provide an update on the existing literature of animal bite treatment strategies and provide a systematic approach to animal bites from presentation to reconstruction. Dog bites cause 80-90% of animal bites with 26.8-56.5% occurring in the head and neck. Infection rates may be as low as 5.7-9.7%. Primary closure alone is sufficient in 69.8% of dog bites within the first 24 h. Animal bite injuries to the head and neck are common, especially in the younger population. Dogs cause a majority of these bite injuries. Injuries can include simple lacerations or punctures, avulsions with tissue present, or avulsions with loss of tissue. The most common locations are the cheek, nose, and lips. It is important to gather the vaccination status of the animal and patient and to administer tetanus/rabies prophylaxis if indicated. Antibiotics are typically prescribed for 3-5 and 7-14 days for uninfected and infected wounds, respectively. These wounds require evaluation, irrigation, and occasionally debridement or repair in the operating room. The type of repair is determined based on the location and extent of injury and can range from primary closure to microsurgical replantation, skin grafts, flaps, or even facial transplantation.

Animal Bite Patterns and Implementation of Rabies Prevention and Control Program in Animal Bite Treatment Center

Animal Bite Patterns and Implementation of Rabies Prevention and Control Program in Animal Bite Treatment Center

Miejsce amoksycyliny z kwasem klawulanowym w leczeniu ran kąsanych

Miejsce amoksycyliny z kwasem klawulanowym w leczeniu ran kąsanych

Characteristics and factors associated with post-exposure prophylaxis (PEP) treatment of dog and cat bites among left-behind children: a cross-sectional study in two cities of China

ObjectiveAnimal injury is a significant cause of morbidity and mortality worldwide. Dog bites account for tens of millions of injuries annually and the highest risk is among children. However, children...

On the path to rabies elimination: The need for risk assessments to improve administration of post-exposure prophylaxis

BackgroundCosts of rabies post-exposure prophylaxis (PEP) often remain high in regions where rabies has been controlled in dogs, presenting a challenge for sustaining rabies elimination programmes. We investigated the potential for bite patient risk assessments to improve PEP provision and surveillance in settings approaching elimination of dog-mediated rabies. MethodsWe conducted a longitudinal study of patients presenting to animal bite treatment centres (ABTCs) on the island province of Bohol in the Philippines to investigate the health status of biting dogs and to quantify current expenditure on PEP. ResultsIncidence of bite patients presenting to ABTCs was high (>300/100,000 persons/year) and increasing, resulting in substantial health provider costs. Over $142,000 was spent on PEP in 2013 for a population of 1.3 million. From follow up of 3820 bite patients we found that >92% were bitten by healthy dogs (alive 14 days after the bite) and just 1.4% were bitten by probable or confirmed rabid dogs. The status of dogs that bit 6% of patients could not be determined. During the course of investigations of bites by suspect dogs, we were able to obtain samples for case confirmation, identify exposed persons who had not sought PEP as well as in-contact dogs at risk of developing rabies. We calculate that expenditure on PEP could at least be halved through more judicious approaches to provision of PEP, based on the histories of biting animals determined through risk assessments with bite patients. ConclusionsWe conclude that a One Health approach to surveillance based on Integrated Bite Case Management could improve the sustainability and effectiveness of rabies elimination programmes while also improving patient care by identifying those genuinely in need of lifesaving PEP.

The evaluation of Animal Bite Treatment Centers in the Philippines from a patient perspective

BackgroundThe Philippines has built an extensive decentralised network of Animal Bite Treatment Centers (ABTCs) to help bite victims receive timely rabies post-exposure prophylaxis (PEP) at little cost. This study surveyed patients in the community and at ABTCs of three provinces to assess animal bite/scratch incidence, health-seeking behaviour and PEP-related out-of pocket expenses (OOPE).Methodology and principal findingsDuring community surveys in 90 barangays (neighbourhoods), 53% of households reported at least one animal bite /scratch injury over the past 3 years, similar across urban and rural barangays. Overall bite/scratch incidences in 2016–17 were 67.3, 41.9 and 48.8 per 1,000 population per year for Nueva Vizcaya, Palawan and Tarlac respectively. Incidences were around 50% higher amongst those under 15 years of age, compared to -those older than 15. Household awareness of the nearest ABTCs was generally over 80%, but only 44.9% sought proper medical treatment and traditional remedies were still frequently used. The proportion of patients seeking PEP was not related to the distance or travel time to the nearest ABTC. For those that did not seek medical treatment, most cited a lack of awareness or insufficient funds and almost a third visited a traditional healer. No deaths from bite/scratch injuries were reported. A cohort of 1,105 patients were interviewed at six ABTCs in early 2017. OOPE varied across the ABTCs, from 5.53 USD to 37.83 USD per patient, primarily dependent on the need to pay for immunization if government supplies had run out. Overall, 78% of patients completed the recommended course, and the main reason for non-completion was a lack of time, followed by insufficient funds. Dog observation data revealed that 85% of patients were not truly exposed to rabies, and education in bite prevention might reduce provoked bites and demand for PEP. An accompanying paper details the ABTC network from the health provider’s perspective.

The evaluation of operating Animal Bite Treatment Centers in the Philippines from a health provider perspective.

BackgroundThe Philippine government has an extensive network of 513 Animal Bite Treatment Centers (ABTCs) to supply rabies post exposure prophylaxis (PEP), reaching over 1 million bite victims in 2016. The network was evaluated using a review of existing national and provincial data, key informant interviews and surveys in sample ABTCs to determine the cost-effectiveness of this network in preventing human rabies deaths.Methodology and principal findingsOne urban and one rural ABTC in each of three selected provinces were studied in more detail. PEP delivery generally followed national guidance based on best practices, but there was evidence of operational challenges in supplying all ABTCs with adequate biologics and recently trained staff. Funding was contributed by different levels of government and in some clinics, patients paid for a significant fraction of the total cost. From a health provider perspective including both fixed and variable costs, the average PEP course delivered cost USD 32.91 /patient across urban ABTCs (with higher patient throughput) and USD 57.21 /patient across rural ABTCs. These costs suggests that PEP provision in the Philippines cost USD 37.6 million in 2016, with a cost per life saved of USD 8,290. An analysis of the 2,239 suspected rabies deaths from 2008 to 2016 showed no significant decline, and from 2014–16 an average of 8,534 years of life were lost annually. The incidence of rabies deaths from 2014–16 was not clearly related to the provision of ABTCs (per 100,000 population) or human population density, but deaths were more common in higher income provinces.Conclusions/SignificanceIn the context of comprehensive rabies control (including dog vaccination and public awareness) ways to reduce this high expenditure on PEP should be explored, to most cost-effectively reach the elimination of human rabies deaths. This paper is accompanied by another containing data on the operation of ABTCs network from a patient perspective.

Management and treatment of animal bites.

Animal bites account for 1% of ED visits and more than $50 million in healthcare costs annually in the United States. Managing bite wounds can be challenging and providers must consider the patient's tetanus status, species of animal inflicting the bite, and infection risk. This article describes treatment and care of bites and when rabies prophylaxis is indicated.

Protecting children from rabies with education and pre-exposure prophylaxis: A school-based campaign in El Nido, Palawan, Philippines.

BackgroundRabies remains endemic in the Philippines. A study was conducted in El Nido, Palawan, Philippines to: (i) detect the true incidence of animal bites in school children aged 5–14 years using active surveillance and compare these data to estimates from the existing passive surveillance system, (ii) evaluate the impact of rabies prevention education and pre-exposure prophylaxis (PrEP) on animal bite incidence, and (iii) assess the health economic impact of the interventions.Methodology and principal findingsA cohort of 4,700 school children was followed-up for any suspect rabies exposures between January 2011 and December 2012. Data on animal bite incidence from the study cohort were compared to that obtained from a review of consultation records at the Animal Bite Treatment Center (ABTC). PrEP was offered to children in all 27 public elementary schools in El Nido (in January to February 2012). Teachers were given a manual for integrating rabies in the public elementary school curriculum during the school year 2012–13. Active surveillance of the cohort revealed a higher incidence of suspect rabies exposures than that from passive surveillance. Despite a decrease in the number of Category III bites, there was no significant decrease in overall bite incidence as a result of the interventions. However, there was an increase in rabies awareness among school children in all grade levels. There was also a high level of acceptability of PrEP. Children who received PrEP and subsequently were bitten only needed two booster doses for post-exposure prophylaxis, resulting in substantial cost-savings.Conclusions/significanceThe true burden of animal bites remains underestimated in ABTC records. PrEP is advantageous in selected population groups, i.e. school-aged children in rabies endemic areas with limited access to animal and human rabies prevention services. Educating school children is beneficial. Strengthening veterinary interventions to target the disease at source is important.

Maxillofacial injuries due to animal bites.

Animal bites are a significant public health problem, with the majority of bites coming from dogs, cats and humans. These may present as punctures, abrasions, tears, or avulsions. The force and relative bluntness of the teeth also increases the possibility of a crush injury with devitalized tissue .The clinical presentation and appropriate treatment of infected bite wounds vary according to the animal and causative organisms. These wounds have always been considered complex injuries contaminated with a unique polymicrobial inoculum. This article reviews animal bite wound incidence, bacteriology, risk factors for complications, evaluation components, recommended treatment and prevention based on advanced PUBMED search of the English language literature from the years 1970 to present. As the bite wounds are frequently located on the face, an oral and maxillofacial surgeon needs to be familiar with the treatment of animal bites, pitfalls in management and to educate patients on ways to avoid future bite injuries. The management of animal bites is an evidence poor area and most recommendations are based on small case series, microbiological data and expert opinion. The main controversies include whether wounds should or should not undergo primary closure and the use of prophylactic antimicrobials.

Infections Resulting from Animal Bites

Animal bites are a major public health problem. This article reviews the epidemiology and treatment of animal bites. The epidemiology, clinical presentation, and treatment of infections caused by Pasteurella multocida and Capnocytophaga canimorsus (DF-2) are reviewed in detail.