Dog bite, complications and management
M. Dankyau
June 2023
Outline
Bites
Dog bites
Early management
Dog bite prevention
Rabies risk and prevention
Summary
Conclusion
Bites
Introduction
Health impact depends on:
type & health of animal species
size & health of bitten person
access to appropriate health care.
Animal bites pose a major public health problem in children and adults worldwide
Introduction
Numerous animal species have the potential to bite humans
Most important are those arising from snakes, dogs, cats and monkeys.
Introduction
No global estimates of dog bite incidence, but studies suggest dog bites account for tens of millions of injuries annually.
In the US, approximately 4.5 million people are bitten by dogs every year.
Of these, nearly 885,000 seek medical care
Introduction
Data more fragmented for LMICs but studies show dogs account for 76–94% of animal bite injuries.
Fatality rates higher in LMICs
About 59,000 people die annually from rabies, and bites from rabid dogs account for the vast majority of these deaths.
Dog bites in Nigeria
True incidence is unknown due to poor reporting
Reported cases give prevalence of 11 dog bite cases per million
6.6 rabies positive cases per million people
Mean reported annual dog bite cases of 184
Who is most at risk?
Children, with highest incidence in mid-to-late childhood.
Risk of injury to head and neck is greater in children, adding to increased severity, necessity for medical treatment and death rates.
Males have a higher frequency of bites than females.
Fatal Dog Bites
Injuries concentrated about head and neck
Injuries only on limbs in most non-fatal bites
Fatal attacks cannot be predicted from the dog's prior behaviour
Most offending dogs revert to normal friendly behaviour after the attack
Most common bacteria isolated
Staph. aureus (30 %)
Staph. epidermidis (10 to 20%)
Strep. various species (50 %)
Corynebacterium (10 to 30 %)
Gram neg. such as E. coli
Other bacteria Isolated
Other Uncommon Infections
Treatment
Early medical management
Irrigation & cleansing of the wound
Primary closure if the wound is low-risk for developing infection
Prophylactic antibiotics for high-risk wounds or people with immune deficiency
Rabies post-exposure treatment depending on the dog vaccination status
Administration of tetanus vaccine if the person has not been adequately vaccinated.
Criteria for Hospital Admission
Dog bite prevention
Global Strategic Plan
Dog Behaviour and Dog Bite Prevention
Rabies risk and PEP
Categories of contact with suspect rabid animal | Post-exposure prophylaxis measures |
Category I - touching or feeding animals, animal licks on intact skin (no exposure) | Washing of exposed skin surfaces, no PEP |
Category II - nibbling of uncovered skin, minor scratches or abrasions without bleeding (exposure) | Wound washing and immediate vaccination |
Category III - single or multiple transdermal bites or scratches, contamination of mucous membrane or broken skin with saliva from animal licks, exposures due to direct contact with bats (severe exposure) | Wound washing, immediate vaccination and administration of rabies immunoglobulin |
Summary
Rabies Pre-exposure Prophylaxis
Summary (8,6,9,5,1,7,2,4,3)
| Human | Agent (Dog) | Environment |
Pre event (Before attack) | 1 | 2 | 3 |
Event (During Attack) | 4 | 5 | 6 |
Post Event (After Attack) | 7 | 8 | 9 |
Conclusion
Bibliography