Risk of human exposure to animal bites in China: a clinic-based cross-sectional study

Knowledge, attitudes and practices regarding to rabies and its prevention and control among bite victims by suspected rabid animals in China

Rabies is a major public health problem and the incidence of suspected rabid animal bites remains high in China. This study aimed to assess the knowledge, attitudes, and practices (KAP) about rabies of bite victims in Wuhan, China. A cross-sectional study was conducted among 1015 bite victims visiting rabies prevention clinics. We performed a face-to-face interview to investigate the rabies KAP of these victims using a self-designed questionnaire. Factors associated with the KAP were evaluated using logistic regression models. Only 56.85% of respondents knew that rabies is infectious. More than 20% of respondents thought that it is not necessary to vaccinate dogs and cats against rabies usually. About 70% of participants stated that they never need to be reminded to vaccinate when they were bitten. Lower education level (odds ratio [OR] = 3.77, 95% confidence interval [CI]: 2.65-5.38 for secondary school or less and OR = 1.74, 95% CI: 1.28-2.38 for high school or vocational school, p-trend<0.0001) was independently associated with poor knowledge of rabies. Respondents who had experienced two or more times of animal bites (OR = 0.62, 95% CI: 0.39-0.97) were inclined to have appropriate attitudes about rabies prevention and control. Older respondents were more likely to show proper behaviors towards rabies prevention and control (OR = 0.44, 95% CI: 0.33-0.58 for age group 31-60 and OR = 0.34, 95% CI: 0.21-0.54 for age group >60, p-trend <0.0001). The level of rabies KAP among bite victims in China was suboptimal. It is necessary to conduct interventions focusing on improving public awareness of rabies and ameliorating behaviors of rabies post-exposure prophylaxis.

The wound severity of animal bite victims visiting rabies prevention clinics and the influencing factors in Central China: a cross-sectional investigation

Background

Animal bites are a major public health problem. The more serious the bite wound is, the higher the risk of developing rabies is. This study aimed to investigate the severity of wounds among animal bite victims and identify the influencing factors in Wuhan, China.

Methods

A cross-sectional study was conducted among 1015 animal bite victims visiting rabies prevention clinics. We performed a face-to-face interview to collect information on the exposure category of the bite wound, the type of the offending animal, exposure-to-risk situations, etc. Factors associated with exposure categories were identified by multivariate logistic regression analysis.

Results

Five hundred and sixty-four (55.57%) cases were category III exposures, 418 (41.18%) were category II exposures, and 33 (3.25%) were category I exposures. People who were hurt by their own domestic animals (odds ratio [OR] = 1.55, 95% confidence interval [CI]: 1.14–2.10), and those exposed to animals unvaccinated against rabies (OR = 1.45, 95% CI: 1.08–1.95) had a higher risk for category III exposures. Respondents who did not know the fatality of rabies were more likely to be injured seriously compared to those who knew that rabies is fatal, and the OR was 1.40 (95% CI, 1.05–1.86).

Conclusions

This study showed that factors associated with the severity of bite wounds mainly included types of the offending animal, vaccination status of the animal, and knowledge of rabies fatality. Educational programs and awareness-raising campaigns should be provided to decrease severe animal bites, especially targeting pet owners and those with limited rabies knowledge.

Neglected challenges in the control of animal rabies in China

Complex rabies transmission dynamics, including in dogs, wildlife livestock, and human-acquired rabies, can be observed in China. A temporary decrease in human rabies deaths with a simultaneous increase in animal rabies transmission is a typical example of "sectoral management separation" but not of the recommended "one-health" concept. In contrast to reliance on mass dog vaccination, reliance on postexposure prophylaxis to reduce human rabies burden is costly and ineffective in the prevention of rabies transmission from dogs to humans and other susceptible animal species. To answer the WHO call for the "elimination of dog-mediated human rabies by 2030," China faces the challenge of a lack of a strong political commitment and a workable plan and must act now before the rabies transmission dynamics become increasingly complicated by spreading to other species, such as ferret badgers in the Southeast and raccoon dogs and foxes in the North.