An increase in animal-related occupational injuries at a veterinary medical center (2008-2022)

OBJECTIVE

To characterize animal-related injuries in veterinary medical center staff at a veterinary medical center.

SAMPLE

706 hospital staff injuries.

METHODS

Deidentified injury reports were submitted to Human Resources from 2008 through 2022. Injury data collected included the injury description, date of injury, occupation, and worker's compensation claim information. Data were summarized by year, cause of injury, total cost associated with injury, and occupation.

RESULTS

There was an increase in injuries reported in recent years when compared to past years, with the plurality of injuries being bite injuries, specifically occurring on the hand, finger, and wrist area. Bite injuries had a higher average total worker's compensation cost paid to staff than striking injuries. There were more injuries reported by staff who had less experience working with animals. More injuries occurred during the summer months (June through September). There was not an unusual trend in the reporting of injuries due to COVID-19. Other injuries (eg, needlesticks and falls) were reported from only 2019 to 2022, but constituted a substantial burden for staff.

CLINICAL RELEVANCE

These findings can help stakeholders at teaching hospitals and veterinary clinics to take steps toward creating a safer workplace environment for employees. It is important to identify work hazards and provide proper training and prevention methods to reduce the risk of injuries, especially among less experienced employees. Proper prevention methods will help reduce worker's compensation costs for the teaching hospital and reduce the number of workdays missed by staff.

To Lick One's Wounds: A Case of Pasteurella canis oralis Osteomyelitis and Neisseria animaloris Infection from Canine Saliva

The complications of wound infections caused by animal related trauma are well known and explored. Of the numerous polymicrobial etiologies, Neisseria animaloris and Pasteurella canis oralis have been reported only in a limited number of cases. This manuscript explores the rare finding of these species in the case of an 83-year-old male with a diabetic foot wound complicated by infection from the saliva of his pet dog. The case highlights the first instance of P. canis oralis without the setting of a penetrating animal bite, emphasizing the vulnerability of open lesions in patients whose comorbidities impair proper wound healing. These bacteria are susceptible to beta-lactams with beta-lactamase inhibitors and can be treated once identified. It is crucial to recognize rare pathogens and initiate appropriate treatment early, and to emphasize proper wound care, especially in the context of pet interactions.

An unusual etiology of a scrotal dog bite injury and review of the literature

Soft tissue injuries from animal bites are encountered occasionally in rural areas, resulting from attacks by, for example, dogs, wolves, horses, donkeys, and cats. The commonly affected body parts include the face, head and neck, nose, ears, hands, arms, and legs. The traumatic exposure of the external genital organs following an animal bite is a highly rare condition. Dog bite injuries in this area are a clinical condition that requires careful management due to the bacterial density of the oral flora of dogs, and also the potential bac-terial flora in the genital area, resulting in a high risk of infection. Tissue defects following dog bites to the genital area are at high risk of morbidity, and may even result in life-threatening conditions in the event of a major infection. The classical treatment approaches to soft tissue defects resulting from animal bites include wound irrigation, debridement, rabies and tetanus immunoprophylaxis, antibiotic therapy, and reconstruction after the elimination of the infection. Recently, however, the early acute approach seems to have replaced the conventional late period treatment, with studies recommending surgical repair in the early stage where possible. In this article, an unusual etiology of scrotal defect was determined under the light of detailed literature data. The present study reports on a case in which an early repair was made after wound cleaning and care, debridement, and then prophylactic antibiotic therapy, soon after the referring of the case to the hospital. No signs of local or systemic infection were noticed at the wound site during follow-up. Post-op-erative recovery was uneventful and the repair performed on the case had a satisfactory outcome. Based on our clinical experience, we believe that reconstruction accompanied by an early prophylactic antibiotherapy can produce satisfactory outcomes in genital defects caused by animal bites.

Microbiological Characteristics and Surgical Management of Animal-Bite-Related Oral & Maxillofacial Injuries: A Single Center's Experience

The objective of the current study is to retrospectively evaluate animal-bite injuries and to gain insight into the epidemiology, accident consequences and treatment concept of these accidents in oral and maxillofacial surgery. Data of patients, who were admitted January 2015 and April 2021, were retrospectively evaluated regarding the patients’ characteristics (age, gender), facial distribution of substance defects/partial amputations, duration of hospitalization, operation treatments and antibiotic treatments. Data of 75 patients were included. Patients were bitten by dogs (n = 69.92%), cats (n = 4) and horses (n = 2). Lower eyelid/cheek complex was the most affected region (n = 37, 32.74%). Most of the patients between 0 and 3 years had to be operated on under general anesthesia (p = 0.011), while most of the adults could be operated on under local anesthesia (p = 0.007). In the age group 0–12 years, 30 patients (68%) were operated on under general anesthesia. Ampicillin/Sulbactam (48%) was the antibiotic most used. Antibiotics were adjusted after wound swabs in case of wound infections or critical wound conditions. This means that resistant antibiotics were stopped, and sensitive antibiotics were used. Structured surgical and antibiotic management of animal-bite wounds in the maxillofacial region is the most important factor for medical care to avoid long-term aesthetic consequences. Public health actions and policies under the leadership of an interdisciplinary committee could improve primary wound management, healing outcome and information status in the general population.

Wound infection caused by Neisseria zoodegmatis, a zoonotic pathogen: a case report

The isolation of Neisseria zoodegmatis from a 63-year-old female presenting to the emergency department following a cat bite injury to her right hand is described in this report. N. zoodegmatis , also known as Centers for Disease Control (CDC) group EF-4b, is considered to be a zoonotic pathogen, and is usually associated with dog or cat bites. Despite the potential of this organism to cause serious soft tissue infections, it can be overlooked in routine clinical laboratories due to its slow growth characteristics and when the history of animal bite is not provided to the laboratory. This case highlights the importance of appropriate clinical history provision to the microbiology laboratory to help provide important information about potential pathogens and allow microbiologists to optimize culture and identification methods. The introduction of tools such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) into clinical laboratories allows identification and the interpretation of results to be performed within a few minutes of isolation on proper culture media, as opposed to traditional methods, whose slowness may be problematic, as shown in this case report.

Epidemiology of Rabies and Current US Vaccine Guidelines

Rabies is an acute encephalitis that is caused by rabies virus (RABV) infection, which belongs to the Rhabdoviridae family of viruses. It causes about 59,000 human deaths per year (although this number may be under-reported) and is generally fatal, once signs and symptoms begin to appear. Rabies is still very prevalent and under- reported, particularly in low to middle-income countries such as Asia and Africa, where there is lack of access to healthcare and domestic dogs are not widely vaccinated. Although not commonplace in the USA, rabies is mostly transmitted by wild animals such as bats, raccoons, skunks and foxes. Domesticated cats and dogs are also at risk of acquiring rabies, if they have not been vaccinated. Larger carnivores, such as coyotes, bobcats, mountain lions, wolves, bears, woodchucks, and beavers, should also be considered rabid (unless proven otherwise) if they are involved in an unprovoked attack on a person. The rabies vaccine can prevent 99% of deaths if administered promptly after exposure. There are two main vaccination strategies for rabies prevention: pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). This article reviews background and epidemiology of rabies and current guidelines for rabies PrEP and PEP regimens for the United States.

Severe Sea Lion Bites in Urban Cold-Water Swimmers

BACKGROUND

A series of sea lion bites in open-water swimmers recently gained the attention of the national and international media. Pinniped (the clade including seals and sea lions) bites historically have been in people who hunt or handle marine mammals. As populations of humans and pinnipeds continue to grow, interactions with animals by those participating in recreational activities are likely to become more frequent.

CASE REPORTS

In December of 2017 and January of 2018, four sea lion (Zalophus californianus) bites in humans occurred at a popular open-water recreational swimming area in San Francisco, California. Three swimmers required treatment at a local trauma center and two required surgery. Two of the wounds were potentially life threatening; one swimmer required a field tourniquet to stop bleeding from the antecubital fossa, and the bite in another narrowly missed the femoral artery. The purpose of this report is to offer an in-depth discussion of antimicrobial use and rabies postexposure prophylaxis in patients with severe pinniped bites. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Information from this report can be used in conjunction with input from local experts to develop a thoughtful therapeutic plan for patients with severe pinniped bites. Doxycycline is the first-line antibiotic therapy, but broader coverage may be needed for severe wounds with the potential for contamination. The likelihood of rabies is low, and rabies postexposure prophylaxis should be reserved for cases that involve unusually aggressive animal behavior or other factors suggestive of rabies.

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

Human exposure to animal bites is the most important public health concern in relation to rabies transmission. This study aims to determine the factors associated with human exposure to animal bites in China. A cross-sectional study of visitors to rabies prevention clinics who were seeking treatment because of exposure to animal bites or scratches was conducted in Wuhan, China. Humans exposed to animal bites (n = 1015) were interviewed, and 87% of the bites were attributed to domestic animals. The risk types for animal bites included unprovoked aggression (31.7%), excessive play (27.5%), insufficient preparedness (26.7%), and improper care of animals (14.1%). Children aged 1-15 years (OR = 9.069, 95% CI: 4.572-17.987, P < 0.001) were more likely to be injured because of excessive play. Nonvaccinated people (OR = 2.168, 95% CI: 1.034-4.545, P = 0.040) and people who discontinued the rabies vaccine regimen (OR = 2.600, 95% CI: 1.561-4.331, P < 0.001) were at risk of rabies exposure and were more likely to be injured because of improper care of animals. This study showed that domestic animals were responsible for most animal bites. The associated factors were age, educational attainment, and animal ownership. Community health education with a special attention to schoolchildren and animal owners should be provided.

Dog bite injuries in the USA: prevalence, correlates and recent trends

Dog bite-related injuries are associated with high medical costs. The aim of this study was to estimate the prevalence, correlates and recent trends in dog bite injuries among male and female individuals presenting to US emergency departments. The prevalence of dog bites was calculated for years 2010–2014 using the Nationwide Emergency Department Sample. Sex-stratified multivariate logistic regression analyses were conducted with ‘dog bite’ as the dependent variable and patient and hospital characteristics as independent variables. Overall, the prevalence of dog bite injuries decreased from 2010 to 2014. The prevalence is highest in this sample among male youth. Male individuals diagnosed with an externalising behaviour disorder were more likely to present with a dog bite (OR=1.21, 95% CI 1.27 to 1.30). While the prevalence of dog bites has decreased in recent years, this costly and largely preventable injury remains a concern, especially among youth.

Pediatric dog bites: a population-based profile

BACKGROUND

Previous studies have identified risk factors for dog bites in children, but use data from individual trauma centers, with limited generalizability. This study identifies a population risk profile for pediatric dog bites using the National Trauma Data Bank. We hypothesized that the population at risk was younger boys, that such bites occur at home, are moderately severe, and are on the face or neck.

METHODS

For this retrospective cross-sectional study, a sample of 7912 children 17 years old and younger with International Classification of Diseases (ICD)-9 event code E906.0, for dog bites, were identified. Datasets from 2007 to 2014 were used. Data included patient's gender, age, ICD-9 primary and location E-codes, AIS body region and AIS severity.

RESULTS

Most children were 6-12 years old and female, but a similar number fell into the narrower range of 0-2 years old. Injuries in the younger group frequently occurred at home, on the face and head, and with minor severity. Age of the child predicts the location of incident (P<0.001), the severity of injury (P<0.001) and the body region of the injury (P<0.001). Body region of the injury predicted its severity (P<0.001).

DISCUSSION

Younger children are more likely to receive dog bites, and bites incurred are likely of greater severity. Children this young cannot yet be taught how to properly interact with a dog.

CONCLUSIONS

Dog bites are a significant source of morbidity for children. Based on the population risk factors profile generated, this study recommends targeting live dog education towards the parents of young children.

In Vitro Activity of Pexiganan and 10 Comparator Antimicrobials against 234 Isolates, Including 93 Pasteurella Species and 50 Anaerobic Bacterial Isolates Recovered from Animal Bite Wounds

Animal bite wounds affect more than 5 million Americans annually, resulting in 300,000 emergency department visits, 10,000 hospitalizations, and an untold number of physician office visits. Various forms of topical therapy are empirically self-employed by many patients prior to seeking medical attention. Pexiganan, a 22-amino-acid synthetic cationic analogue of the peptide magainin II, acts by selectively damaging bacterial cell membranes. We determined the MICs for pexiganan and other antimicrobial agents often used for treatment of bite wounds. Most isolates were from U.S. patients, and ∼10% were from European and Canadian patients. The comparator antimicrobials studied were penicillin, amoxicillin-clavulanate, piperacillin-tazobactam, meropenem, clindamycin, doxycycline, moxifloxacin, ceftriaxone, linezolid, and metronidazole. The MIC₉₀s of pexiganan were 32 μg/ml (against Pasteurella multocida subsp. multocida), 16 μg/ml (P. multocida subsp. septica, Pasteurella canis, and Pasteurella dagmatis), 8 μg/ml (Pasteurella stomatis), 8 μg/ml (Eikenella corrodens), 2 μg/ml (Neisseria weaveri, Neisseria zoodegmatis, and Moraxella canis-Moraxella lacunata group), 16 μg/ml (Bergeyella zoohelcum), 64 μg/ml (Bacteroides pyogenes), 4 μg/ml (Fusobacterium russii), 32 μg/ml (Fusobacterium canifelinum), and 64 μg/ml (Prevotella heparinolytica). The concentration of pexiganan in the cream used was 8,000 μg/ml, more than 60 to 100 times the highest MIC obtained. Pexiganan exhibited a broad range of antimicrobial activity, showing potential for treating animal bite infections. A clinical trial seems warranted.

Injecting rabies immunoglobulin (RIG) into wounds only: A significant saving of lives and costly RIG

An increasing number of dog bite victims were being presented to public hospitals in Himachal Pradesh in 2014 amidst virtual non availability of any rabies immunoglobulin (RIG). Only a small quantity of equine rabies immunoglobulin (eRIG) was available from the government owned Central Research Institute (CRI) Kasauli. This available eRIG was used in 269 patients as an emergency response and only for local infiltration of severe bite wounds by suspected rabid dogs. This was followed by rabies vaccination, using the WHO approved intra-dermal Thai Red Cross Society vaccination schedule. A subgroup of 26 patients were later identified who had been severely bitten by laboratory confirmed rabid dogs. They were followed for more than one year and all were found to be alive.

Burden of Bites by Dogs and Other Animals in Los Angeles County, California, 2009-2011

OBJECTIVES

The objective of this study was to analyze all animal-to-human bite reports during a 3-year period from a regional surveillance database. Results helped to inform local efforts to reduce and prevent animal-to-human bites.

METHODS

We reviewed all cases of animal-to-human bites occurring from 2009 through 2011 that were reported to the Los Angeles County Department of Public Health's Animal Bites Database. We collected data on the bite victim's date of birth, age, and address; bite circumstances (ie, date, time, location, how bite occurred); anatomic site and treatment of bite; type of reporting facility; and breed and management of biting animal.

RESULTS

From 2009 through 2011, 26   169 animal-to-human bites were reported, of which 23   103 (88%) were dog bites. Most animal-to-human bites (n = 7673, 29%) occurred between 4 pm and 8 pm and peaked during the month of July (n = 2663, 10%). Most animal-to-human bites occurred outdoors (n = 8772, 34%) and while victims engaged in recreational activities (n = 4353, 17%). The hands were the most common injury site (n = 9130, 35%), and only 1% of animal bites (n = 267) resulted in hospitalization. A total of 4115 bite victims (16%) received tetanus vaccinations. Of all animal-to-human bite cases, medical organizations reported 13   451 (51%), and animal control agencies reported 10   682 (41%).

CONCLUSIONS

Animal-to-human bites can often lead to medical complications. Surveillance is essential in helping to identify, manage, and reduce these highly preventable injuries and direct public health actions and policies on animal bite risk and prevention.

Traumatic Amputation of Finger From an Alligator Snapping Turtle Bite

Legend states that the alligator snapping turtle (Macrochelys temminckii) should be handled with extreme caution as it has jaw strength powerful enough to bite a wooden broomstick in half. Tales of bite injuries from what is the largest freshwater turtle in North America exist anecdotally, yet there are few descriptions of medical encounters for such. The risk of infection from reptilian bites to the hand in an aquatic environment warrants thorough antibiotic treatment in conjunction with hand surgery consultation. We present the first case report of a near total amputation of an index finger in an adolescent boy who had been bitten by a wild "gator snapper."

Local infiltration of rabies immunoglobulins without systemic intramuscular administration: An alternative cost effective approach for passive immunization against rabies

Presently the dose of rabies immunoglobulin (RIG) which is an integral part of rabies post exposure prophylaxis (PEP) is calculated based on body weight though the recommendation is to infiltrate the wound(s). This practice demands large quantities of RIG which may be unaffordable to many patients. In this background, we conducted this study to know if the quantity and cost of RIG can be reduced by restricting passive immunization to local infiltration alone and avoiding systemic intramuscular administration based on the available scientific evidence. Two hundred and sixty nine category III patients bitten by suspect or confirmed rabid dogs/animals were infiltrated with equine rabies immunoglobulin (ERIGs) in and around the wound. The quantity of ERIG used was proportionate to the size and number of wounds irrespective of their body weight. They were followed with a regular course of rabies vaccination by intra-dermal route. As against 363 vials of RIGs required for all these cases as per current recommendation based on body weight, they required only 42 vials of 5ml RIG. Minimum dose of RIGs given was 0.25 ml and maximum dose given was 8 ml. On an average 1.26 ml of RIGs was required per patient that costs Rs. 150 ($3). All the patients were followed for 9 months and they were healthy and normal at the end of observation period. With local infiltration, that required small quantities of RIG, the RIGs could be made available to all patients in times of short supply in the market. A total of 30 (11%) serum samples of patients were tested for rabies virus neutralizing antibodies by the rapid fluorescent focus inhibition test (RFFIT) and all showed antibody titers >0.5 IU/mL by day 14. In no case the dose was higher than that required based on body weight and no immunosuppression resulted. To conclude, this pilot study shows that local infiltration of RIG need to be considered in times of non-availability in the market or unaffordability by poor patients. This preliminary study needs to be done on larger scale in other centers with long term follow up to substantiate the results of our study.

A qualitative investigation of the perceptions of female dog-bite victims and implications for the prevention of dog bites

Preventing dog bites is an increasingly important public health and political issue with implications for both human and animal health and welfare. Expert opinion is that most bites are preventable. Intervention materials have been designed to educate people on how to assess the body language of dogs, evaluate risk, and take appropriate action. The effectiveness of this approach is rarely evaluated and the incidence of dog bites is thought to be increasing. Is the traditional approach to dog bite prevention working as well as it should? In this novel, small scale qualitative study, the perceptions of victims regarding their dog bite experience were explored in-depth. The study recruited 8 female participants who had been bitten by a dog in the past 5 years. In-depth, one-to-one interviews were conducted, transcribed, and analyzed using thematic analysis. The findings indicate that dog bites may not be as easily preventable as previously presumed, and that education about dog body language may not prevent some types of dog bites. The reasons participants were bitten were multifaceted and complex. In some cases, there was no interaction with the dog before the bite so there was no opportunity to assess the situation and modify behavior around the dog accordingly. Identifying who was to blame, and had responsibility for preventing the bite, was straightforward for the participants in hindsight. Those bitten blamed themselves and/or the dog owner, but not the dog. Most participants already felt they had a theoretical knowledge that would allow them to recognize dog aggression before the dog bite, yet participants, especially those who worked regularly with dogs, routinely believed, "it would not happen to me." We also identified an attitude that bites were "just one of those things," which could also be a barrier prevention initiatives. Rather than being special to the human-canine relationship, the attitudes discovered mirror those found in other areas of injury prevention. A new approach to dog-bite prevention may now be required, drawing on other injury prevention strategies including awareness-raising and minimizing the damage caused by a bite when it happens.

[Epidemiology, microbiology and diagnostics of dog and cat bites related infections]

Animal bites represent a significant global health problem and account for approximately 1-2% of all visits to the emergency department. The vast majority of animal bite injuries are inflicted by dogs (80-90%,) and cats (5-15%). The most common complication following an animal bite is a wound infection, which tends to be polymicrobial and include both aerobic and anaerobic bacteria mainly of oropharyngeal origin. The likelihood of a cat bite becoming infected is double of that of a dog bite. Pasteurella spp. predominates in infected dog and cat bites. Dog bite injuries can be also associated with Capnocytophaga canimorsus, an aggressive organism which can cause disseminated infections (sepsis) and death, particularly in immunocompromised individuals. Early aggressive local wound cleansing is the most important therapy to prevent infection after animal bites. Due to the polymicrobial etiology of infected bite wounds, broad-spectrum antibiotics, covering both aerobic and anerobic bacteria, are often recommended as empiric treatment of animal bites.

Exposure to Macaque Monkey Bite

BACKGROUND

The herpes B virus is a zoonotic agent that is endemic among macaque monkeys only, but can cause fatal encephalomyelitis in humans.

CASE REPORT

A 26-year-old female presented to a U.S. emergency department after being bitten by a wild macaque monkey. The emergency medicine team administered rabies immunoglobulin and rabies vaccine. The team also prescribed acyclovir for prophylactic coverage against herpes B, a deadly zoonotic agent that is endemic among macaque monkeys. A discussion of background, exposure, transmission, symptoms, treatment for herpes B, including latest data available, literature, and Centers for Disease Control and Prevention guidelines are included. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Zoonotic exposures can cause infectious diseases, which are unfamiliar and deadly. The emergency physician's knowledge of the association between the deadly herpes B infection and wild macaque monkey may expedite treatment and be instrumental in patient morbidity and survival.

Demographics of animal bite victims & management practices in a tertiary care institute in Mumbai, Maharashtra, India

BACKGROUND & OBJECTIVES

Rabies is an important public health problem worldwide and more than 55,000 people die annually of the disease. The King Edward Memorial Hospital, Mumbai, is a tertiary referral centre where a rabies clinic runs 24 hours. In view of lack of information about the demographics of the disease in an urban environment the present study was carried out.

METHODS

Data on 1000 consecutive animal bite victims presenting to the institute in 2010 were collected over a 15 wk period. An electronic database was specially created for capturing information and was modelled on the information available from the WHO expert consultation on rabies, 2005. Economic burden from the patients' perspective was calculated using both direct and indirect costs.

RESULTS

The victims were largely males (771 subjects). The dog was the major biting animal (891, 89.1%).Bites were mainly of Category III (783, 78.3%). One twenty three subjects used indigenous treatments only for local wound care. Of the Category III bites, only 21 of 783 (2.7%) patients were prescribed human rabies immunoglobulin (HRIG) which was primarily for severe bites or bites close to or on the face. A total of 318 patients did not complete the full Essen regime of the vaccine. The median cost to the patient per bite was Rs. 220 (3.5 USD).

INTERPRETATION & CONCLUSIONS

Our findings showed that the use of HRIG was low with less than 2 per cent of the Category III patients being prescribed it. As vaccine and HRIG continue to remain expensive, the intradermal vaccine, shorter regimes like the Zagreb regime and monoclonal antibodies may offer safer and cost-effective options in the future. Further studies need to be done in different parts of the country.

Survey of animal bite injuries and their management for an estimate of human rabies deaths in N'Djaména, Chad

OBJECTIVE

To estimate the annual human rabies incidence as a baseline prior to mass dog vaccination campaigns in N'Djaména, Chad.

METHODS

Survey of animal bites, involving 50% of all healthcare providers in N'Djaména, from September 2008 to April 2009. Of 86 people exposed to a suspected rabid animal, 50% received post-exposure vaccination and a further 8% had their wound cleaned. We estimated annual incidence of bites from suspected rabid animals of 12.9/100,000 and an incidence of 0.7 human rabies deaths/100,000, resulting in 7 estimated deaths (95% confidence interval 4-10 deaths) per year in N'Djaména. 14% of bite victims sought help from veterinarians.

CONCLUSIONS

Closer cooperation between physicians and veterinarians warrants more effective rabies control. The high proportion (42%) of potentially exposed people without post-exposure vaccination or wound treatment necessitates urgent attention.