An investigation into the prevalence of dog bites to primary school children in Trinidad

Analysis of dog bite surveillance data, Volta Region, Ghana, 2020

Introduction

Dog bite is the second most common injury sustained by humans after snake bites, and it is amongst the top 12 causes of non-fatal injuries worldwide. Globally, 59,000 human deaths occur annually due to rabies, and 95% of these deaths occur in Asia and Africa. Dog bites remained a public health concern in Ghana, with three out of every 1000 incidence resulting in human rabies. Analysis of the surveillance data is key in understanding the burden of dog bites in the Volta region. This study describes the epidemiology of dog bites in the Volta Region, Ghana, to inform policy on prevention and control.

Methods

We conducted a descriptive analysis of secondary data on dog bites. We obtained aggregate data from 2015 to 2019 from the District Health Management Information System (DHMIS). Variables extracted were gender, age, and location. Data were entered into a Microsoft Excel cleaned, reviewed, and analyzed. We used descriptive statistics to summarize results into frequency and proportion and displayed results in tables, graphs, and maps.

Results

During the study period, 4737 dog bite cases were identified from a population of 1,907,529 (incidence of 248 per 100,000). Twelve (0.25%) humans were confirmed for rabies with a 100% case fatality rate. Males accounted for 2455 (51.8%) of dog bite cases. The age group between 10 and 19 years (21.9%) was most affected. About 35.0% (1640/4737) were administered with the anti-rabies vaccine, and 25.3% (1200/4737) were administered anti-tetanus toxoid. Keta district (550 per 100000) reported the highest incidence of dog bites. Dog bite cases were highest in the third and fourth quarters of 2016 and the first quarter of 2017.

Conclusion

The incidence of dog bites and rabies was high in the Volta region. Children and adolescents were mostly affected. There was a low coverage rate of anti-rabies vaccine and anti-tetanus toxoids usage. We recommended that the Regional Health Directorates and the Regional Veterinary Department develop robust strategies to control stray or free-roaming dogs in the Volta region.

Are children and dogs best friends? A scoping review to explore the positive and negative effects of child-dog interactions

Personal wellbeing is greatly influenced by our childhood and adolescence, and the relationships formed during those phases of our development. The human-dog bond represents a significant relationship that started thousands of years ago. There is a higher prevalence of dog ownership around the world, especially in households including children. This has resulted in a growing number of researchers studying our interactions with dogs and an expanding evidence base from the exploration of child-dog interactions. We review the potential effects of child-dog interactions on the physical, mental, and social wellbeing of both species. A search of the SCOPUS database identified documents published between January 1980 and April 2022. Filtering for key inclusion criteria, duplicate removals, and inspecting the references of these documents for additional sources, we reviewed a total of 393 documents, 88% of which were scientific articles. We were able to define the numerous ways in which children and dogs interact, be it neutral (e.g., sharing a common area), positive (e.g., petting), or negative (e.g., biting). Then, we found evidence for an association between childhood interaction with dogs and an array of benefits such as increased physical activities, a reduction of stress, and the development of empathy. Nonetheless, several detrimental outcomes have also been identified for both humans and dogs. Children are the most at-risk population regarding dog bites and dog-borne zoonoses, which may lead to injuries/illness, a subsequent fear of dogs, or even death. Moreover, pet bereavement is generally inevitable when living with a canine companion and should not be trivialized. With a canine focus, children sometimes take part in caretaking behaviors toward them, such as feeding or going for walks. These represent opportunities for dogs to relieve themselves outside, but also to exercise and socialize. By contrast, a lack of physical activity can lead to the onset of obesity in both dogs and children. Dogs may present greater levels of stress when in the presence of children. Finally, the welfare of assistance, therapy, and free-roaming dogs who may interact with children remains underexplored. Overall, it appears that the benefits of child-dog interactions outweigh the risks for children but not for dogs; determination of the effects on both species, positive as well as negative, still requires further development. We call for longitudinal studies and cross-cultural research in the future to better understand the impact of child-dog interactions. Our review is important for people in and outside of the scientific community, to pediatricians, veterinarians, and current or future dog owners seeking to extend their knowledge, and to inform future research of scientists studying dogs and human-animal interactions.

Epidemiology of Dog Bite Incidents in Chile: Factors Related to the Patterns of Human-Dog Relationship

Dog bites are one of the main public health problems. They produce important consequences for those who suffer them (physical and psychological injuries, secondary infections, sequelae, risk of transmission of zoonoses and surgeries, among others). The objective of this study was to characterize epidemiologically the incidents of bites in Chile and the patterns of human-dog relationship involved. The records analyzed in this article were obtained from bitten patients who attended the main public health facilities in Chile during the period 17 September 2017 and 17 September 2018: In the period studied, 17,299 animal bites were recorded; however, only 7220 (41.74%) cases were analyzed in which the offending species could be identified. Of the bites analyzed, 6533 were caused by dogs (90.48%). Of these, 41.05% were caused by medium-sized dogs. Most bites were caused by dogs of mixed breeds (55.99%), followed by dogs of the German Shepherd breed (8.50%). Most of the dogs that bit were known to the victim (99.95%) and most of the attacks occurred indoors (57.48%). Although dog bite records have improved in Chile, it would be useful to also include background information on the context in which the incident occurred, which would be very useful for developing effective bite prevention programs.

Incidence of Animal-Bite Injuries Registered in Public Hospitals of Post-Conflict Swat District, Pakistan in 2014

The Swat district, a conflict-hit territory due to Taliban militancy, had a damaged local health infrastructure. Animal-bite injuries leading to rabies is one of the major health concerns in developing countries, especially within conflict zones. The current prospective epidemiological study was conducted to estimate the cumulative incidence of animal-bite injuries, to summarize characteristics of bite victims and biting animals, and to collect information about post-exposure prophylaxis (PEP) practices in Swat district, Pakistan, during 2014. A questionnaire was designed to collect data about the sociodemography of the patients, bite incident situation (provoked or unprovoked), injury pattern, animal type, PEP, and vaccination. Descriptive analyses were conducted using bar graphs, frequency tables, and chi-square tests were used to determine associations. The cumulative incidence of animal-bite injuries was 39 per 100,000 people during the study period (May-August 2014). The majority of incidents were reported from rural regions (77.7%) and were males (76.6%) younger than 10 years (37.3%). Dogs were the most frequent biting animal (86.8%) followed by rats (4.7%). About 77.7% patients washed their wound before arrival at hospital. After an eclipse phase of 10 days, 44 (10.1%) animals developed sign of rabies. The current study has highlighted a topic of interest for health, education, veterinary, and local government policy makers regarding prevention of animal bites, benefits of PEP, vaccination of human and domestic animals, control of stray dogs, and eradication of rabies in developing countries with damaged healthcare structures.

Epidemiology and preclinical management of dog bites among humans in Wakiso and Kampala districts, Uganda: Implications for prevention of dog bites and rabies

In rabies endemic areas, appropriate management of dog bites is critical in human rabies prevention. Victims must immediately wash bite wound for 15 minutes with water, soap, and a disinfectant before seeking medical care. This study investigated the epidemiology of dog bites and the determinants of compliance to these pre-clinical guidelines requirements among dog bite victims from high rabies-burden areas of Wakiso and Kampala, Uganda. An explanatory sequential mixed-methods study design was used. Quantitative data were collected from 376 dog-bite patients at two healthcare facilities. Qualitative data were also collected through 13 in-depth interviews with patients, healthcare workers, herbalists, and veterinarians. Qualitative data were analyzed using a deductive thematic approach. Generalized linear models were used to determine factors associated with compliance. Nearly half (190, 51%) of the patients were from Wakiso District and 293 (77.9%) had grade II wounds. Most of the wounds (171, 45.5%) were on the legs. Two-thirds of the bites occurred in public places. Only 70 (19%) of the bite patients had complied with pre-clinical guidelines. Nearly half of the patients had applied substances that were not recommended e.g. herbs (47/193), antiseptics (46/193), "black stone" (25/193), and unknown creams (10/193). Factors negatively associated with compliance included: being aged 15 years or older, adjPR = 0.70 (0.47-0.92) and knowing the dog owner, adjPR = 0.65 (0.36-0.93). However, attainment of secondary or higher education, adjPR = 1.76 (1.24-3.79), being in employment, adjPR = 1.48 (1.09-2.31), perception that the dog was sick, adjPR = 1.47 (1.02-2.72) and knowledge about the dog's subsequent victim(s) adjPR = 0.35 (0.17-0.70) were positively associated with compliance. High occurrence of dog bites in public places by free-roaming dogs suggests the need for deliberate promotion of responsible dog ownership. Additionally, targeted health education may be required to improve the low compliance to pre-clinical guidelines.

Ouch! A cross-sectional study investigating self-reported human exposure to dog bites in rural and urban households in southern Ontario, Canada

This study investigated self-reported dog bites in humans in rural and urban households in southern Ontario, Canada. Our objectives were to determine, and compare, the incidence of dog bites in rural and urban households, and to describe the profile of bite victims, biting dogs, and the proportion of biting dogs that respondents self-reported as being not up to date on rabies vaccination. We conducted a cross-sectional observational study using an online questionnaire. The 2,006 respondents, each representing one household, included 1,002 rural and 1,004 urban residences. The incidence risk of at least one person in the household being bitten over the previous year in rural households (6.09% per year) was less than in urban households (10.76% per year). In 53.20% of households from which at least one person had been bitten within the past year, only a single person had been bitten. Mostly, victims were 25 to 34 years old (21.67%), male (54.19%), and playing with or interacting with the biting dog at the time of the incident (59.11%). Most biting dogs were 3 to 5 years old (32.02%), males (53.69%), and unleashed (76.85%). Based on self-reporting by respondents, 83.33% of respondent-owned biting dogs were vaccinated against rabies at the time of the biting incident. Irrespective of dog ownership, the odds of an individual in a rural household being bitten by a dog were 0.53 (95% CI: 0.38-0.73) the odds for an individual in an urban household. Dog bites constitute a serious, yet preventable, public health concern that requires targeted, community-specific efforts. Public health organizations could consider findings in developing messaging, particularly as we highlight biting dogs reported by their owners as not up to date on rabies vaccination.

Childhood horse and donkey bites; a single tertiary health center experience in a rural area

Background:

The aim of this study was to examine the characteristics of patients presenting to a pediatric emergency department in a rural province of Turkey due to horse and donkey bites and to analyze whether these features differ from those of more common animal bites in rural areas.

Materials and Methods:

The records of patients presenting to the pediatric emergency department of a tertiary hospital due to horse and donkey bites over a 3-year period were examined retrospectively. Demographic data, month of presentation, animal species involved (horse or donkey), the body area bitten, treatment applied to the wound site, whether tetanus and rabies vaccinations were administered, and whether or not antibiotics were prescribed on discharge from the emergency department were recorded from these files.

Results:

The annual incidence of horse and donkey bites was determined as 7.8/100,000. Thirty-six patients, 24 (66.7%) boys and 12 (33.3%) girls, with a mean age of 95.6 ± 33.9 (48–190) months, were included in the study. Twenty-six patients (72.2%) were bitten by donkeys, and 10 (27.8%) by horses. Bites were most common in September (30.6%). The most commonly bitten areas were the back and/or upper extremities. Rabies vaccination was administered in all cases. Amoxicillin–clavulanic acid was prescribed in 28 (77.8%) cases.

Conclusion:

Horse and donkey bites are frequently observed in rural areas. The inhabitants of such areas should therefore be educated concerning horse and donkey bites. Health workers encountering such bites should behave in the same way as in more common animal bites in terms of patient management. Our results will be instructive for other developing countries similar to Turkey.

How many people have been bitten by dogs? A cross-sectional survey of prevalence, incidence and factors associated with dog bites in a UK community

Background

Dog bite studies are typically based on hospital records and may be biased towards bites requiring significant medical treatment. This study investigated true dog bite prevalence and incidence at a community-level and victim-related risk factors, in order to inform policy and prevention.

Methods

A cross-sectional study of a community of 1280 households in Cheshire, UK, surveyed 694 respondents in 385 households. Data included dog ownership and bite history, demographics, health and personality (Ten Item Personality Inventory (TIPI) brief measure). Multivariable logistic regression modelled risk factors for having ever been bitten by a dog, accounting for clustering of individuals within households.

Results

A quarter of participants (24.78%, 95% CI 21.72 to 28.13) reported having ever been bitten by a dog during their lifetime, with only a third of bites described requiring further medical treatment and 0.6% hospital admission. Incidence of dog bites was 18.7 (11.0–31.8) per 1000 population per year. Males were 1.81 times more likely to have been bitten in their lifetime than females (95% CI 1.20 to 2.72, P=0.005). Current owners of multiple dogs were 3.3 times more likely (95% CI 1.13 to 9.69, P=0.03) to report having been bitten than people not currently owning a dog. Regarding all bites described, most commonly people were bitten by a dog that they had never met before the incident (54.7%). Individuals scoring higher in emotional stability had a lower risk of having ever been bitten (OR=0.77 for 1 point change in scale between 1 and 7, 95% CI 0.66 to 0.9, P=0.001).

Conclusion

This study suggests that the real burden of dog bites is considerably larger than those estimated from hospital records. Further, many bites do not require medical treatment and hospital-based bite data are not representative of bites within the wider population. Victim personality requires further investigation and potential consideration in the design of bite prevention schemes.

Systematic Review: Interventions to Educate Children About Dog Safety and Prevent Pediatric Dog-Bite Injuries: A Meta-Analytic Review

Objective

Dog-bite injury posits a significant threat to children globally. This review evaluated efficacy of cognitive/behavioral interventions for improving children's knowledge and behaviors around dogs.

Methods

Manuscripts published before January 3, 2014 evaluating cognitive/behavioral interventions for dog-bite prevention among children <18 years of age were eligible for inclusion. Among 2,270 abstracts screened, 123 full texts were retrieved. Twelve studies were included in the qualitative synthesis; nine were included in the meta-analysis. Risk of bias and quality of evidence were evaluated.

Results

Cognitive/behavioral interventions had a moderate effect in improving children's knowledge and a larger effect in improving children's behavior with dogs. The most effective intervention strategies were video for knowledge and instruction with live dogs for behaviors. Quality of evidence was poor.

Conclusions

Cognitive/behavioral interventions have potential to improve both children's knowledge and behaviors around dogs. Future interventions should include multiple follow-ups on dog-bite rates from an international perspective using rigorous randomized controlled trials.

Injuries caused by pets in Asian urban households: a cross-sectional telephone survey

OBJECTIVES

Little is known about pet-related injuries in Asian populations. This study primarily aimed to investigate the incidence rate of pet-related household injuries in Hong Kong, an urban Chinese setting.

SETTING

Cantonese-speaking non-institutionalised population of all ages in Hong Kong accessible by telephone land-line.

PARTICIPANTS

A total of 43 542 telephone numbers were dialled and 6570 residents successfully completed the interviews.

PRIMARY AND SECONDARY OUTCOME MEASURES

Data of pet-related household injuries in the previous 12 months, pet ownership and socio-demographic characteristics were collected with a questionnaire. Direct standardisation of the incidence rates of pet-related household injuries by gender and age to the 2009 Hong Kong Population Census was estimated. Univariate and multivariate analyses were performed to estimate risks of socio-demographic factors and pet ownership for the injury.

RESULTS

A total of 84 participants experienced pet-related household injuries in the past 12 months, with an overall person-based incidence rate of 1.28%. The majority of the victims were injured once (69.6%). Cats (51.6%) were the most common pets involved. Pet owners were at an extremely higher risk after controlling for other factors (adjusted OR: 52.0, 95% CI 22.1 to 98.7). Females, the unmarried, those with higher monthly household income and those living in lower-density housing were more likely to be injured by pets.

CONCLUSIONS

We project a pet-related household injury incidence rate of 1.24% in the general Hong Kong population, with 86 334 residents sustaining pet-related injuries every year. Pet ownership puts people at extremely high risk, especially the unmarried. Further studies should focus on educating pet owners to reduce pet-related injuries in urban Greater China.

A prospective study on the incidence of dog bites and management in a rural Cambodian, rabies-endemic setting

Rabies circulates intensely in Cambodia, mainly affecting rural populations. We conducted a prospective study to estimate the baseline incidence of potentially infective dog bites in rural villages of Siem Reap province, Cambodia. The study was conducted in a convenience sample of 844 families totaling 1779 persons in four villages. The study collected data in a total of 802.3 person-years. Trained village health workers (VHW) exhaustively documented consecutive dog bites at the end of each month. Between May 15th and November 15th, 2011, a total of 40 attacks (43 bites; 1.07 bites per attack) were notified by 39 persons (50% female; one suffered two distinct incidents) to VHW. The all-age attack rate for bites over this 6-month period was 2.3% (CI95%: 1.7-3.1%), with a global incidence rate estimated at 4.84 bites/100 person-years (CI95%: 3.5-6.6). The mean age in bite victims was 20.8±18.9years (median 12.5; interquartile range 6-36; range 1-63). The dog was identified in 39 (97.5%) of cases, being the household dog in 9 (22.5%) of cases. Bites were classified as severe (WHO Category III-broken skin with bleeding) in 33 (82.5%) of cases with a severe dog bites incidence estimated at 4/100 person-years (CI95%: 2.8-5.6). The bites involved the hand or face in 1 (2.5%) case each (both Category III). In 20 incidents (50%), only rice was applied to the wounds. There were no suspected or confirmed human rabies deaths during the study period but one dog died after biting (2 others were lost to follow-up and 14 were put down by their owner). Our study documented an extremely high incidence of dog bites in of rural Cambodian adults and children. Adapted control policies for canine vaccination are urgently needed.

Seroepidemiology of human Toxocara and Ascaris infections in the Netherlands

Toxocara canis, Toxocara cati and Ascaris suum are worldwide-distributed zoonotic roundworms of dogs, cats and pigs, respectively. The epidemiology of these parasites in developed countries is largely unclear. Two countrywide cross-sectional serosurveys were therefore conducted in the Netherlands in 1995/1996 and 2006/2007 to investigate the prevalence, trends and risk factors for human Toxocara and Ascaris infections in the general population. The Netherlands is characterized by high pig production, freedom from stray dogs and virtual absence of autochthonous infections with the human-adapted roundworm Ascaris lumbricoides. Over the 10 years between the two serosurveys, Toxocara seroprevalence decreased significantly from 10.7 % (n = 1159) to 8.0 % (n = 3683), whereas Ascaris seroprevalence increased significantly from 30.4 % (n = 1159) to 41.6 % (n = 3675), possibly reflecting concomitant improvements in pet hygiene management and increased exposure to pig manure-contaminated soil. Increased anti-Toxocara IgGs were associated with increasing age, male gender, contact with soil, ownership of cats, cattle or pigs, hay fever, low education, high income and non-Western ethnic origin. Increased anti-Ascaris IgGs were associated with increasing age, owning pigs, low education, childhood geophagia and non-Dutch ethnic origin. Besides identifying specific groups at highest risk of Toxocara and Ascaris infections, our results suggest that these infections mainly occur through environmental, rather than foodborne, routes, with direct contact with soil or cat and pig ownership being potentially modifiable exposures.

Investigation to determine staff exposure and describe animal bite surveillance after detection of a rabid zebra in a safari lodge in Kenya, 2011

INTRODUCTION

Rabies is a fatal viral infection, resulting in >55,000 deaths globally each year. In August 2011, a young orphaned zebra at a Kenyan safari lodge acquired rabies and potentially exposed >150 tourists and local staff. An investigation was initiated to determine exposures among the local staff, and to describe animal bite surveillance in the affected district.

METHODS

We interviewed lodge staff on circumstances surrounding the zebra's illness and assessed their exposure status. We reviewed animal bite report forms from the outpatient department at the district hospital.

RESULTS

The zebra was reported bitten by a dog on 31(st) July 2011, became ill on 23(rd)August, and died three days later. There were 22 employees working at the lodge during that time. Six (27%) had high exposure due to contact with saliva (bottle feeding, veterinary care) and received four doses of rabies vaccine and one of immune-globulin, and 16 (73%) had low exposure due to casual contact and received only four doses of rabies vaccine. From January 2010 to September 2011, 118 cases of animal bites were reported in the district; 67 (57%) occurred among males, 65 (57%) in children <15 years old, and 61 (52%) were inflicted in a lower extremity. Domestic and stray dogs accounted for 98% of reported bites.

CONCLUSION

Dog bites remains the main source of rabies exposure in the district, but exposure can result from wildlife. This highlights the importance of a one health approach with strong communication between wildlife, veterinary, and human health sectors to improve rabies prevention and control.

Age-related changes in the propensity of dogs to bite

This retrospective cohort study was aimed at describing the effects of age at acquisition, age, and duration of ownership of dogs on the risk of (1) bites during play and (2) non-play bites to humans. Data were collected on 110 dogs that had bitten during play with a person, 161 dogs that had bitten outside of play and 951 non-biting dogs from veterinary clients in Kingston (KGN), Jamaica and San Francisco (SF), USA. Modified Poisson regression was employed to model the relationships of both types of bites to each variable separately. Effects of the variables on dog bite risk (1) during and (2) outside of play with the dog, differed from each other and by type of bite. Effects varied with the dog's age and age-related associations were strongest in dogs younger than 1 year old. Ages at acquisition of dogs at highest risk for bites during play were substantially lower than those at risk for non-play bites. Ages and durations of ownership of dogs at highest risk for bites during play were also lower than those of dogs at highest risk for non-play bites. The propensity of a dog to bite changes as it ages and relationships between dog bites occurring during and outside of play and the dog's age at acquisition, current age, and duration of ownership, differ from each other.

A multi-site study on knowledge, attitudes, beliefs and practice of child-dog interactions in rural China

This study examines demographic, cognitive and behavioral factors that predict pediatric dog-bite injury risk in rural China. A total of 1,537 children (grades 4–6) in rural regions of Anhui, Hebei and Zhejiang Provinces, China completed self-report questionnaires assessing beliefs about and behaviors with dogs. The results showed that almost 30% of children reported a history of dog bites. Children answered 56% of dog-safety knowledge items correctly. Regressions revealed both demographic and cognitive/behavioral factors predicted children’s risky interactions with dogs and dog-bite history. Boys behaved more riskily with dogs and were more frequently bitten. Older children reported greater risks with dogs and more bites. With demographics controlled, attitudes/beliefs of invulnerability, exposure frequency, and dog ownership predicted children’s self-reported risky practice with dogs. Attitudes/beliefs of invulnerability, dog exposure, and dog ownership predicted dog bites. In conclusion, both demographic and cognitive/behavioral factors influenced rural Chinese children’s dog-bite injury risk. Theory-based, empirically-supported intervention programs might reduce dog-bite injuries in rural China.

Mental disorder as a risk factor for dog bites and post-bite cellulitis

OBJECTIVES

Patients with mental disorders are at an increased risk for sustaining traumatic injury. No study has evaluated the association between mental disorders and the injury of dog bite. We conducted case-control studies to investigate whether people with mental disorders are at elevated risks of dog bite and post-bite cellulitis.

METHODS

Using insurance data of 2000-2007, we compared 4660 patients with dog bites and 18,640 controls without the events for the association with mental disorders and other covariates. Amongst those with dog bites, a nested case-control study was performed to compare 286 patients with post-bite cellulites and rest of 4374 patients for factors associated with the infection.

RESULTS

Young children, the older adults, and people with low socioeconomic status were at an elevated risk of sustaining the dog bite. In separate logistic regression models adjusting for socio-demographic variables, the results showed that patients with concomitant psychotic and non-psychotic mental disorders were associated with increased risks of dog bites (adjusted odds ratio [OR]=1.51, 95% confidence interval [CI]: 1.32-1.74) and of post-bite cellulitis (OR=2.13, 95% CI 1.46-3.10).

CONCLUSIONS

Individuals with mental disorders are likely at an elevated risk for serious dog bites and post-bite cellulitis.

Risk factors for dog bites occurring during and outside of play: are they different?

The aim of this study was to determine whether the effects of selected human-canine interaction/environmental factors on bites occurring when the victim was and was not playing with the dog differed from each other. A veterinary clinic-based retrospective cohort study was conducted in Kingston, Jamaica (709), and San Francisco, USA (513) to compare the effects of selected exposures on non-play bites (161) relative to bites preceded by play with the dog (110) as reported by veterinary clients. Additionally, 951 non-biting dogs were used for a risk factor analysis of bites occurring during play. Using directed acyclic graphs and the change-in-estimate procedure to select and adjust for confounders, modified Poisson regression was used to estimate (a) the ratios of proportions of non-play bites out of all bites comparing exposed to unexposed dogs (proportionate bite ratios) and (b) risk ratios for bites occurring during play for each factor of interest. Proportionate bite ratios ranged from 0.84 to 1.29, with most 95% confidence intervals including one, thus implying a lack of specificity of effects of the examined factors on non-play bites relative to bites occurring during play with the dog. Consistent with this lack of specificity, risk ratios for bites occurring during play were similar in magnitude and direction to risk ratios previously published for non-play bites using the same non-biting dogs as a reference group. No country-specific differences in proportionate bite ratios were detected. Each human-canine environmental factor showed similar levels of association with both types of bites. One possible explanation is that both types of bites have a common causal pathway leading from each factor up to the point of human-canine contact. If the human-canine contact then leads to either play or non-play interactions with dogs and subsequently to both types of bites, the presence of such a common pathway would make the factor non-specific to either type of bite. As some of the examined factors are associated with increased frequencies of both types of bites, this could explain high percentages of bites occurring during play with the dog as reported in various case series of dog bites. If so, dog bite prevention strategies targeting these factors will simultaneously reduce the incidence of both types of bites.

The Blue Dog: evaluation of an interactive software program to teach young children how to interact safely with dogs

OBJECTIVE

Pre-post-randomized design evaluated The Blue Dog, a dog safety software program.

METHODS

76 children aged 3.5-6 years completed 3 tasks to evaluate dog safety pre- and postintervention: (a) pictures (recognition of safe/risky behavior), (b) dollhouse (recall of safe behavior via simulated dollhouse scenarios), and (c) live dog (actual behavior with unfamiliar live dog). Following preintervention evaluation, children were randomly assigned to dog or fire safety conditions, each involving 3 weeks of home computer software use.

RESULTS

Children using Blue Dog had greater change in recognition of risky dog situations than children learning fire safety. No between-group differences emerged in recall (dollhouse) or engagement (live-dog) in risky behavior. Families enjoyed using the software.

CONCLUSIONS

Blue Dog taught children knowledge about safe engagement with dogs, but did not influence recall or implementation of safe behaviors. Dog bites represent a significant pediatric injury concern and continued development of effective interventions is needed.

Characteristics of dog bites among nursing students and knowledge about their emergency management

BACKGROUND

Dog bites represent a significant health concern leading to a variety of consequences. Nursing students should be appropriately educated in order to manage and help prevent such injuries.

AIM

This paper is the first to report the lifetime experience and characteristics of dog bites among Greek nursing students and their knowledge in managing the above injuries.

METHODS

A cross-sectional quantitative study was performed using an anonymous questionnaire distributed to first and fourth year nursing students from April though June 2009. A knowledge score based on key questions was set on a scale from 0 to 7, to assess their competence on bite injuries management.

RESULTS

Of 237 nursing students recruited, 56 (23.6%) had experienced a dog bite. Men outnumbered women as dog bite victims [n = 15 (39.5%) vs. n = 41 (20.6%), P = 0.012]. Mean age at the attack was 11.1 (standard deviation = 5.6) years and legs sustained the majority of injuries (n = 31; 55.4%). Most bites (n = 39; 69.9%) involved a dog known to the victim, were provoked (n = 30; 53.6%) and occurred in a public place (n = 35; 62.5%). Ten (17.9%) of the victims sustained a moderate or severe injury. The majority (67.9%) of students answered correctly to less than or equal to three out of seven key knowledge questions. After multiple linear regression analysis, previous educational course attendance was the only factor associated with increased score (b = 0.48, standard deviation = 0.17, 95% confidence interval = 0.12-0.84, P = 0.009).

CONCLUSIONS

Dog bites were common and presented characteristic patterns among nursing students, but knowledge in their management was suboptimal. Improved education should be provided during undergraduate studies.

Dog bites in humans and estimating human rabies mortality in rabies endemic areas of Bhutan

BACKGROUND

Dog bites in humans are a public health problem worldwide. The issues of increasing stray dog populations, rabies outbreaks, and the risk of dogs biting humans have been frequently reported by the media in Bhutan. This study aimed to estimate the bite incidence and identify the risk factors for dog bites in humans, and to estimate human deaths from rabies in rabies endemic south Bhutan.

METHODS

A hospital-based questionnaire survey was conducted during 2009-2010 among dog bites victims who visited three hospitals in Bhutan for anti-rabies vaccine injection. Decision tree modeling was used to estimate human deaths from rabies following dog bite injuries in two rabies endemic areas of south Bhutan.

RESULTS

Three hundred and twenty four dog bite victims were interviewed. The annual incidence of dog bites differed between the hospital catchment areas: 869.8 (95% CI: 722.8-1022.5), 293.8 (240-358.2) and 284.8 (251.2-323) per 100,000 people in Gelephu, Phuentsholing and Thimphu, respectively. Males (62%) were more at risk than females (P<0.001). Children aged 5-9 years were bitten more than other age groups. The majority of victims (71%) were bitten by stray dogs. No direct fatal injury was reported. In two hospital areas (Gelephu and Phuentsholing) in south Bhutan the annual incidence of death from rabies was 3.14 (95% CI: 1.57-6.29) per 100,000 population. The decision tree model predicted an equivalent annual incidence of 4.67 (95% CI: 2.53-7.53) deaths/100,000 population at risk. In the absence of post exposure prophylaxis, the model predicted 19.24 (95% CI: 13.69-25.14) deaths/year in these two areas.

CONCLUSIONS

Increased educational awareness of people about the risk of dog bites and rabies is necessary, particularly for children in rabies endemic areas of Bhutan.

Assessing human-dog conflicts in Todos Santos, Guatemala: bite incidences and public perception

The issues surrounding dog bites are a major public health concern, particularly in areas of low income where accessibility to adequate health care, veterinary medicine and sufficient management of canine population control is low. An understanding of the risk factors associated with human-dog conflicts may be important when establishing dog bite and disease prevention strategies. In May 2008, a census of 12 consociated neighbourhoods in Todos Santos, Guatemala was conducted to investigate dog bite incidences and the public perception of free-roaming dog populations. Approximately 16.5% (78/472) of households reported at least one dog bite between May 2006 and May 2008. In total, 85 incidents occurred: 49.4% (42/85) with adults (≥18 years) and 50.6% (43/85) children (<18 years). However, there was no significant difference in cumulative incidence of dog bites by victim gender or among age categories, there was a non-significant trend of higher cumulative incidence of dog bites in children aged six to 17 years compared to other age categories. The anatomical location of the bite varied, but bites to the legs were the most common (73/85; 85.9%). Of the 85 reported dog bites, 5.9% (5/85) were from dogs from the victims' own households, 48.2% (41/85) were from a neighbour's dog, 9.4% (8/85) were from dogs regularly seen in the community, and 15.3% (13/85) were from dogs not regularly seen in the community; the ownership status of the latter two categories of dogs could not be determined. Approximately 21% (18/85) of respondents did not know the type of dog that bit. Residents were asked for their opinions on potential problems associated with dogs in the community. The majority of respondents strongly agreed that dogs posed physical risks (78.8%; 372/472), could transmit infections to people (88.6%; 418/472), scared the family (82.4%; 389/472) and were too high in number (82.6%; 390/472). There were significant but weak correlations between owning a dog and expressing negative perceptions of community dogs (Spearman rho<0.13). Reporting of a dog bite was not significantly correlated to expressing fear or negative perceptions towards community dogs. A further understanding of current programs directed at the prevention of dog bites and means of dog population control may help determine appropriate future steps for canine management. Conflicts between free roaming dogs and people are a pressing issue worldwide, and a focus on prevention strategies through education, rather than rapid extermination, would be of benefit.

Free-roaming dog control among OIE-member countries

A questionnaire was distributed to the state veterinary services of all 172 OIE countries to collect data on the different national approaches to dog population control. We used all 81 completed questionnaires with ≥80% of the question answered to identify the different national approaches to the issue. The intensity of the free-roaming dog (FRD) problem was negatively correlated with the value of the UN's human development index recognized for each country. Dog bites/attacks and rabies were the main problems associated with FRDs, and these problems were reported disproportionately by less-developed countries. Dog-control programs (DCP) were more widely used among the more-developed countries. In less-developed countries, DCPs (when they existed at all) tended to employ killing methods (including poisoned baits), that are not recommended on animal-welfare grounds.

Human fatalities resulting from dog attacks in the United States, 1979-2005

INTRODUCTION

Dog attacks are a major public health concern worldwide. Dogs bite over 4 million people resulting in the hospitalization of 6000 to 13,000 people each year in the United States. Rarely deaths may occur after an attack.

METHODS

This study utilized the compressed mortality files from CDC WONDER to evaluate deaths from dog attacks over the 27-year period 1979-2005.

RESULTS

An average of approximately 19 deaths was reported annually from dog attacks during this time period. Males and children less than 10 years of age had the highest rate of death from dog attacks. Deaths have been reported in 49 states with Alaska reporting the highest death rate from dog attacks. The number of deaths and death rate from dog attacks appear to be increasing.

CONCLUSIONS

Deaths from dog attacks appear to be increasing as the population of both humans and dogs has increased during this time period. Children have the greatest risk of death. There is a need for a national reporting system on dog bites to fully capture the extent of fatalities and look at risk factors surrounding the attack. The development of effective prevention practices is dependent upon examination of these risk factors.