JOAD156_proof ■ 25 September 2016 ■ 1/5 Journal of Acute Disease 2016; ▪(▪): 1–5 1 56 HOSTED BY Contents lists available at ScienceDirect 57 58 Journal of Acute Disease 59 60 journal homepage: www.jadweb.org 61 62 1 63 2 Original article http://dx.doi.org/10.1016/j.joad.2016.08.019 64 3 65 4 Epidemiology of acute animal bite and the direct cost of rabies vaccination 66 5 67 1 2 3 4 5* 6 Q2 Towhid Babazadeh , Hossein Ali Nikbakhat , Amin Daemi , Mohsen Yegane-kasgari , Saber Ghaffari-fam , 68 6 7 Morteza Banaye-Jeddi 69 8 1Health Education and Health Promotion, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran 70 9 2 71 10 Social Determinants of Health Research Center, Health Research Institute and Department of Biostatistics and Epidemiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran 72 11 73 3Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran 12 74 13 4Iranian Social Security Organization, Shahryar Hospital, Tehran, Iran 75 14 5School of Nursing of Miyandoab, Urmia University of Medical Sciences, Urmia, Iran 76 15 77 6Chalderan Health Center, Urmia University of Medical Sciences, Urmia, Iran 16 78 17 79 ARTICLE INFO ABSTRACT 18 80 19 81 Article history: Objective: To describe the epidemiological aspects of animal bites and to calculate the 20 82 Received 17 Jun 2016 financial burden resulting from rabies vaccination in Chalderan City. 21 83 Received in revised form 6 Jul 2016 Methods: In this cross-sectional study, records of all victims of animal bites was done in 22 84 23 Accepted 9 Aug 2016 a seven-year period reviewed. Studied variables included demographic information of fi 85 24 Available online xxx victims, biters' pro le, time and place patterns, clinical aspects of the victims and the cost of vaccination. 86 25 Results: Most of bites were observed in men in the age group (10–19 years old), at rural 87 26 Keywords: areas and occupational group of farmers. The vast majority of animal bites happened by 88 27 Animal bites dogs and domestic animals. The average age of victims with head and neck injuries was 89 28 Chalderan lower than the lower extremities, shoulders and hands (P = 0.001). The cost of vacci- 90 Epidemiology 29 nation was 11665 dollars with three doses of rabies vaccine and 849 dollars for five 91 Injuries 30 doses, and the 12514 dollars cumulative frequency in the studied period. Based on the 92 Vaccination costs 31 results of trend test, the incidence of animal bites was increased significantly during the 93 32 study period (P = 0.02). 94 33 Conclusions: The results of this study showed that due to the increasing incidence of 95 34 animal bites and the financial burden resulting from animal bite vaccination, it is 96 35 necessary to design and implement preventive measures in order to reduce the animal 97 36 bites. 98 37 99 38 100 39 101 40 102 41 1. Introduction economic costs annually in various countries[1,2]. Rabies is one of 103 42 the consequences of a bite that has high virulence and case fatality 104 43 Rabies is recognized as the most important viral zoonoses rate[3,4]. It is an acute viral illness that causes encephalomyelitis in 105 44 nowadays, due to the global distribution, high incidence, human humans, all mammals and warm-blooded animals. The disease is 106 45 and veterinary costs, and its mortality, which imposes high common in domestic and wild animals in most provinces of 107 46 Iran[5,6]. Dogs play the most important role in the transmission of 108 47 rabies to humans[6]. By proper vaccination coverage for at least 109 48 *Corresponding author: Saber Ghaffari-fam, School of Nursing of Miyandoab, 70% of dogs and cats population, an effective barrier will be 110 49 Urmia University of Medical Sciences, Urmia, Iran. Tel: +98 4445227929 created for the transmission of the disease to humans[7]. 111 50 E-mail: [email protected] The main sources of rabies in the northern regions of Iran are 112 51 The study was performed according to the Helsinky Declaration. The study dogs and foxes, and in the western and northwestern regions of 113 52 protocol was reviewed and approved by the Ethics Committee of Tabriz University of Medical Sciences. Identity of all bitten persons kept confidential. Iran are wolves[8,9]. In areas where rabies is endemic, children aged 114 53 Peer review under responsibility of Hainan Medical College. The journal im- 5–15 years old are about 40% of people exposed to dog bites[10,11]. 115 54 plements double-blind peer review practiced by specially invited international edito- 116 rial board members. In the world, the death rate due to rabies in children under 15 years 55 117 2221-6189/Copyright © 2016 Hainan Medical College. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Babazadeh T, et al., Epidemiology of acute animal bite and the direct cost of rabies vaccination, Journal of Acute Disease (2016), http://dx.doi.org/10.1016/j.joad.2016.08.019 JOAD156_proof ■ 25 September 2016 ■ 2/5 2 Towhid Babazadeh et al./Journal of Acute Disease 2016; ▪(▪): 1–5 1 old result in the loss of about 1.74 million disability adjusted life 2.4. Studied variables 63 2 years[12]. Asia carries 96.5% of the disease burden in developing 64 3 countries, with annual expenditures of about 560 million dollar Age, gender, occupation, residential information in urban or 65 4 mainly for the treatment-prevention[13]. rural and location of the injury in urban or rural, type of biting 66 5 Increased annual incidence of animal bites results in animal, biter's situation after 10 days of bite by domestic, wild or 67 6 increased costs for taking care of victims, such as the rabies escaped ones, injury site, the extent of the wound (large or 68 7 vaccine and serum[14]. In Iran, billions of rials are annually spent small), time patterns of injury (hour, month, season, year), pat- 69 8 to prevent human rabies, and there is no other contagious disease terns of health services provided for the victims: the number of 70 9 in the country that costs as much as rabies[15]. However, its vaccination, and vaccination costs in terms of the number of 71 10 global cost is estimated more than a billion dollars a year[15,16]. rabies vaccine were assessed. 72 11 In addition to the financial costs of prevention and treatment 73 12 74 of animal bites, the mental and social consequences caused by 2.5. Code of ethics 13 animal bites and scars can greatly affect the life of victims and 75 14 their family[17]. Wide geographical distribution, ecological 76 The study protocol was reviewed and approved by the Ethics 15 diversity and interdependence of the major risk factors of 77 Committee of Tabriz University of Medical Sciences. Identity 16 rabies with wildlife species, as well as differences in health- 78 information of all bitten persons kept confidential. 17 related behaviors and knowledge of the population, necessitate 79 18 the need to conduct researches separately in different regions of 80 19 the country[18]. 2.6. Data analysis 81 20 There were some quotes about high incidence of animal bite 82 21 in Chalderan County. So this study conducted with the aim of Data were analyzed by SPSS software version 20. Descrip- 83 22 describing the epidemiology of animal bites, identifying people tive characteristics of the participants were presented with sta- 84 23 at risk, seasonal and temporal patterns of animal bites, and tistics such as mean ± SD. And in case of lack of normality, the 85 24 calculating the financial burden of vaccination of victims. Re- median and inter-quartile range and qualitative variables were 86 25 sults of the study will help us to design the intervention pro- presented with the relative frequency. 87 26 grams in order to prevent and reduce cases of animal bites and 88 27 reduce its burden on health care system. 2.7. Statistical analysis 89 28 90 29 2. Materials and methods To investigate the possible correlations between the qualita- 91 30 tive variables, the Chi-square test was used. In case of low 92 31 This cross-sectional study examined the patterns of animal sample size, Fisher's exact test was used. To examine the 93 32 bite in a seven-year period from March 21st, 2008 to March equality of the means of quantitative variables, the independent 94 33 20th, 2014 longitudinally in Chalderan City, West Azerbaijan samples t-test was applied with equal variances assumed. To 95 34 province, Iran. The seven-year period of the study was selected examine the equality of means of categories of qualitative var- 96 35 due to the availability of data. The health center in this city had iables the One-way ANOVA test was used. The Cochran– 97 36 two units for the prevention of rabies, which provided health Armitage test for trend was also used to examine the incidence 98 37 care and treatment services for all victims of animal bites. Data trend of bites during the seven-year study period. In all statistical 99 38 on the bitten subjects were extracted from rabies records. tests, the P-value less than 0.05 was considered as significant.