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CME Table of Contents   
Year : 2006  |  Volume : 31  |  Issue : 1  |  Page : 24-25
 

Dog bites in children


Deptt. of PSM, Govt. Medical College & Hospital, Nagpur, India

Date of Web Publication8-Aug-2009

Correspondence Address:
K M Kale
Deptt. of PSM, Govt. Medical College & Hospital, Nagpur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-0218.54927

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How to cite this article:
Kale K M, Wadhva S K, Aswar N R, Vasudeo N D. Dog bites in children. Indian J Community Med 2006;31:24-5

How to cite this URL:
Kale K M, Wadhva S K, Aswar N R, Vasudeo N D. Dog bites in children. Indian J Community Med [serial online] 2006 [cited 2019 Jul 17];31:24-5. Available from: http://www.ijcm.org.in/text.asp?2006/31/1/24/54927



   Introduction Top


Rabies has plagued mankind since ancient times. Despite of tremendous progress in the fields of preventive medicine and vaccinology, rabies is widely prevalent in India, causing extensive morbidity and mortality. Estimated annual human mortality in India due to rabies is 25,000 to 50,000 [1] . Though it can strike virtually all mammals, dog is the principal reservoir of this disease in India. Over 95% of human deaths due to rabies are caused by dog bites. [1],[2],[3],[4]

The fear psychosis linked with the bite of a dog is understandable because of the trecherous nature of the disease, which once sets in invariably leads to the death of the victim. Anxious parents seeking medical aid with the history of dog bite in children is not an uncommon feature. Children love to play with dogs and usually get bitten by them as a result of undue provocation [5] . Though such bites are usually innocuous the risk of rabies can not be totally ruled out. On the other hand bites by stray dogs should always be considered as possibly infectious.

Present study was undertaken to find out the common types of dog bites encountered in children and to study the acceptability of nervous tissue vaccine and its possible common complications.


   Material and Methods Top


1630 cases of dog bite in children upto 14 years of age registered in the Anti Rabies Vaccination Centre of Govt. Medical College and Hospital, Nagpur over a period of 6 months from January, 97 to June, 97 constituted the study sample for the present study.

A detailed history was taken and all relevant data pertaining to age, sex, type of dog, site of bite, interval between the dog bite and arrival for vaccination etc. was noted for every study subject. According to the site and severity wounds were classified as class I, II and III. The status of the dog after bite whether alive, taken ill, dead, killed or untraceable were also noted.

Beta-propiolactone inactivated sheep brain nervous tissue vaccine manufactured at Haffkine - Biopharmaceutical corporation Ltd. Parel, Bombay, was administered as per the revised immunization schedule of manufacturer. A detailed record was kept about the doses of ARV recommended and number of doses actually received. Information regarding treatment taken before attending antirabies vaccination centre and their dietary beliefs during vaccination were also noted. All study subjects were judiciously followed for any complications or associated reactions during the treatment period. Recurrence of bite if any was noted and analysed.


   Results Top


In all, 1743 children upto 14 years of age were registered for antirabies vaccination during study period, of which 1630 (93.5%) were cases of dog bite and 113 (6.5%) had bite by other animals -62(3.5%) had pig bite, 36 (2.1%) had cat bite and 15 (0.9%) had monkey bite. Of the 1630 children with dog bite 981 (60.2%) were males and 649 (39.8%) were females. The youngest child to be bitten was one and half months old male child with class III bite. Age distribution is given in [Table 1].

Lower limbs (47.2%) were more prone for bite than upper limbs (32.8%). 10.2% children had bite on trunk, 9.3% on face, 6% on head and neck and 3% on genitalia.

In 60.5% cases the bites were by pet dogs and in 39.5% cases bites were by stray dogs. In 36.2% cases bites were by adult grown up dogs and in 13.8% cases bites were by pups. Only in 10.3% cases bites were by vaccinated dogs. In 57% cases the bite was provoked bite.

1266 (77.7%) of cases reported within 3 days of dog bite whereas 364 (22.3%) were late by more than 3 days of which 94 were late by more than 10 days and 8 were late by more than one month. Reasons for coming late were out of station (19.8%); long distance between home and ARV centre (17%); family problems (11.9%); ignorance (7.6%); negligence (6.8%) and performed tantra-mantra (36.9%).

87% of those who were advised the 10 dose + booster schedule completed the full course. 96% of 3 dose schedule children and 90% of 7 dose schedule children took the full course. Thus the acceptance and compliance was fairly good. This may be partly due to fear psychosis linked with the fatal nature of disease.

The commonest reaction following ARV injections were local reactions like redness in 90.9%, swelling in 80.2%, tenderness in 43.1%, pain in 27.4%, and itching in 19.8% cases. General reactions like fever, headache, insomnia etc. were relatively less common. No allergic or neurological complication was reported.

Fate of dogs after bite: 1008 (61.8%) of dogs were alive and healthy following bite whereas 192 (11.8%) were killed and 77 (4.7%) died. 353 (21.7%) dogs were untraceable after bite.

34 (2.1%) subjects had recurrence of dog bite. The bite being by same dog in 14 (41.2%) cases and by different dog in 20 (58.8%) cases. These recurrence cases were vaccinated as per the procedure recommended by the manufacturer of vaccine.

In 12% cases wounds were washed with plain water, in 9% cases with soap and water while in 7.4% cases antiseptic ointment was applied on wound before attending ARV centre. Application of oil and salt, turmeric powder, red chillies, lime, balm, some herbs on wound were carried out in 42.8% cases by their parents while in 14.1% cases their parents took recourse to supernatural methods like going to tantriks, wearing tawiz, beads etc. In 239 (14.7%) cases no prior treatment or first aid was carried out.


   Discussion Top


Dog bite is one of the most common childhood accidents causing significant morbidity and mortality in paediatric age group [6] . Rabies, an almost invariably fatal disease continues to be the most serious and most dreaded disease associated with dog bite [7] .

Very often, children do not realise that their playful behaviour may elicit an angry or defensive reaction from an otherwise friendly well known pet dog. Also, behaviour not generally regarded as provocative may be interpreted by a dog as an invasion of his territory and incite an attack. Therefore young children should never be left unsupervised around any dog.

39.5% of dog bites were by stray dogs. The stray dog menace is rampant due to poor dog elimination activities by municipal bodies. Compounding this, there is also community resistance to dog catching and stray dog elimination. Rabies awareness campaigns should be launched and pet enumeration, licensing and vaccination should be made compulsory.

The commonest reaction following ARV injections were local reactions like redness swelling and tenderness. In general the acceptance and compliance of antirabies vaccination was fairly good. Considering the risk of rabies per se, the risk of complications due to nervous tissue vaccines are not much serious and hence all suspected cases of dog bites should be given the benefit of a recommended full dose of BPL inactivated nervous tissue vaccine.

In the present study, it was observed that many parents applied turmeric powder, chillies, oil and salt etc. on the wound. There were some parents who took recourse to supernatural methods like going to tantriks, wearing tawiz, beads etc. Some parents also had wrong ideas about diet during antirabies vaccination. Hence there is a need for educating people ragarding the correct methods of wound treatment and correcting wrong ideas about diet during vaccination of the children.

This paper demonstrates the need for more lay and professional education and action on the growing problem of dog bite.

 
   References Top

1.Park K. Textbook of Preventive and Social Medicine 14th ed. Jabalpur: M/s Banarsidas Bhanot Publishers; 1994.  Back to cited text no. 1    
2.Sudharshan MK. Is rabies under control in India. Indian J of Prev and Soc Med 1994; 25: 3-4.  Back to cited text no. 2    
3.Rehman SA Country report on medical and veterinary aspects of rabies prevention and control - India from a veterinatary perspective. Ind J Comm Health 1996; 2: 20-30.  Back to cited text no. 3    
4.Sehgal S. Medical and Veterinary aspects of rabies prevention & control in India. Ind J Comm Health 1996; 2: 18-19.  Back to cited text no. 4    
5.Chun Y, Berkelhamer JE, Herold TE. Dog bites in children less than 4 years old. Paediatrics 1982:69:119-20.  Back to cited text no. 5    
6.Lauer EA. White WC, Lauer BA. Dog bites: a neglected problem in accident prevention. Am J Dis Child 1982; 136:202-4.  Back to cited text no. 6    
7.Berzon DR, Farber RE, Gordon J, Kelly EB. Animal bites in a large city : a report on Baltimore, Maryland. Am J Public Health 1972; 62 : 422-6.  Back to cited text no. 7    



 
 
    Tables

  [Table 1]


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    Introduction
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    Results
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