Original Article An epidemiologic study of animal bites in North Khorasan Province, Iran, from 2005 to 2011 Alavinia SM, MD-PhD 1, Yaghubi M, BSc 2, Rajabzadeh R, MSc 3, Seyed Sharifi SH, MD 4* 1- PhD of Clinical Epidemiology, Vector-Borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran. 2- BSc in Nursing, Intensive Cardiac Care Unit, 9Day Hospital, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran. 3- MSc Student of Epidemiology, Vector-Borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran. 4- MD Student, Research Committee, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran. Abstract Received: May 2015, Accepted: June 2015 Background: Animal bite is an important and preventable health hazard. This study aimed to determine the epidemiology of animal bites in North Khorasan Province in Iran. Materials and Methods: Data gathered from health centers from March 2005 until December 2011 were used for this cross-sectional descriptive study of animal bites. Results: A total of 18,517 animal bite cases were reported during the study period. The victims were predominantly male (66%). The most affected persons were residents in rural areas (80.7%). Most victims had been bitten by dogs (90.5%). The number of patients with incomplete vaccinations was 16,232 (88.1%) compared to 2,185 (11.9%) completely vaccinated patients. The highest rate of animal bite cases was reported from Bojnurd County, Iran. The incidence of animal bites in North Khorasan increased from 255.05 per 100,000 in 2005 to 365.18 per 100,000 in 2011. Conclusions: Since the incidence of animal bites has increased in recent years, the dog population should be controlled and domesticated animals should be vaccinated. Education about animal bite prevention is an important strategy for preventing this problem and, consequently, rabies. Keywords: Bites, Epidemiology, Incidence, Vaccination, Rabies. Introduction spring. In different human groups, children (aged 5–9 years) are the most frequent victims of Rabies is an acute, progressive, and fatal animal bites, and men are 1.15 times more likely zoonotic disease. Human rabies is associated to report dog bites compared to women* (4). A with the rise of civilization, the growth of cities, survey conducted during 2001–2003 in the USA and domestication of animals, especially dogs estimated 4.5 million dog bites each year (an (1). Rabies is a major public health concern in incidence rate of 1,660/100,000 in adults and some countries including Iran. The highest 1,310/100,000 in children) (5). The annual incidence of human rabies cases in Iran was incidence of animal bite in Iran is estimated as reported during 1995-1999 in Chaharmahal and 140 cases per 100,000 population (6), and has Downloaded from johe.rums.ac.ir at 11:13 +0330 on Sunday September 26th 2021 [ DOI: 10.18869/acadpub.johe.3.1.1 ] Bakhtiari and Fars Provinces (2). The collection been increasing in recent years (7). Almost 94% and analysis of data about animal bites, can help of animal bite cases are inflicted by domestic to control and prevent this disease. Animal bite is defined as a bite or claw wound from a pet, or farm or wild animal (3). Animal * Corresponding author: Seyed Hassan Seyed Sharifi, bites were reported throughout the year with the MD Student, Research Committee, Medical School. North highest bite incidence occurring during the Khorasan University of Medical Sciences, Bojnurd, Iran. Email: [email protected] 1 JOHE, Winter 2014; 3 (1) Alavinia et al animals such as dogs and cats, and wild and (characteristics of the bitten persons and biting stray animals, such as wolves, jackals, and animals, and month of biting) were obtained foxes, constitute 16% of cases (8). from the data bank of all health centers in the Moreover, death rate due to dog bites in city and rural areas covered by the North Australia, United States, and Canada are 0.004, Khorasan Universities of Medical Sciences, Iran. 0.05-0.07, and 0.007 per 100,000, respectively The obtained data were recorded in a checklist. (9). The results were entered into Microsoft Excel Rabies is a fatal disease that is considered a 2010 with pull down notes and analyzed using reemerging zoonosis throughout much of the SPSS statistical software package (version 18, world. Rabies satisfies all the World Health SPSS Inc., Chicago, IL, USA). Organization (WHO) criteria for diseases that are a priority for control. In addition, safe and Results effective animal and human vaccines are widely During the study period (2005-2011), 18, 517 available for its prevention and control. Pre- (66% males and 34% females) individuals had exposure treatment (PET) in animals and been treated for animal bites (Figure 1). The humans is an effective way of decreasing the incidence of animal bite in North Khorasan costs of rabies. PET for humans is an effective, Province was estimated as 255, 258, 302, 321, but costly way to prevent clinical problems with 330, 359, and 365 per 100,000 in 2005, 2006, rabies, but does not provide a permanent 2007, 2008, 2009, 2010, and 2011, respectively. solution to rabies in the future. The cost of PET The animals were dogs in 16,670 (90.5%), goats in Asia was US $ 49.41 per patient and in Africa in 799 (4.34%), cats in 697 (3.78%), wild goats was US $ 39.5721 per patient, in 2011 (10). in 146 (0.8%), wolves in 48 (0.26%), jackals in Epidemiological studies have confirmed that the 29 (0.16%), and foxes in 28 (0.15%) cases majority of injured patients resided in rural (Figure 2). The animals were domestic in 84.8% areas. The first step in preventing diseases of cases, wild in 1.4%, and stray animals in related to animal bites, such as rabies, is to 13.8% of cases. Of the injured patients, 14,950 identify the associated risk factor. (80.7%) were living in rural and 3,567 (19.3%) The aims of this study were to determine the in urban areas. incidence of animal bites as well as the The highest rate of human bite cases were characteristics of the bitten persons and biting reported in Bojnurd, Iran (Figure 3). The number animals, and wound in North Khorasan Province of individuals who were bitten by animals of Iran. during the study period in different districts of North Khorasan Province is presented in Figure Materials and Methods 3. Up to 16,232 patients were treated by non- In this cross-sectional descriptive study, data completed vaccination (88.1%), and 2,185 were obtained from patients who suffered from (11.9%) with completed vaccination. The peak animal bites and referred to health centers incidence of animal bite cases was reported in Downloaded from johe.rums.ac.ir at 11:13 +0330 on Sunday September 26th 2021 [ DOI: 10.18869/acadpub.johe.3.1.1 ] located in North Khorasan Province from March June. The monthly distribution of animal bite 2005 to December 2011. cases (average animal bites per month per year) By law, all bite victims should be referred to is shown in figure 4. The incidence of animal health centers for treatment, and all animal bite bite increased during the study period from 255 cases are emergency cases. Thus, data per 100,000 in 2005 to 365 per 100,000 in 2011. 2 JOHE, Winter 2014; 3 (1) An epidemiologic study of animal bites Figure 1: Distribution of the rate of animal bites detected in North Khorasan Province, Iran, from March 2005 to December 2011 according to sex and total rate per 100,000 population Downloaded from johe.rums.ac.ir at 11:13 +0330 on Sunday September 26th 2021 [ DOI: 10.18869/acadpub.johe.3.1.1 ] Figure 2: Distribution of animal bites detected in North Khorasan Province, Iran, from March 2005 to December 2011 according to animal species 3 JOHE, Winter 2014; 3 (1) Alavinia et al Figure 3: Distribution of animal bites detected in North Khorasan Province, Iran, from March 2005 to December 2011 according to different districts of North Khorasan Province Downloaded from johe.rums.ac.ir at 11:13 +0330 on Sunday September 26th 2021 [ DOI: 10.18869/acadpub.johe.3.1.1 ] Figure 4: Distribution of animal bites detected in North Khorasan Province, Iran, from March 2005 to December 2011 according to average monthly number of animal bite cases per year 4 JOHE, Winter 2014; 3 (1) An epidemiologic study of animal bites Discussion cause of higher rates of bites in men than women is that men are more exposed to animals in their The incidence of animal bite in North Khorasan daily life, especially in rural areas. However, in Province increased during the study period from a survey performed in USA, most animal bite 255 per 100,000 in 2005 to 365 per 100,000 in cases were female (18). This issue may be 2011. The incidence of animal bite in different resulted from the different cultural behaviors in parts of Iran has also increased from 35.1 per that country. In Iran, people do not keep animals 100,000 in 1987 to 151 per 100,000 in 2001 in their houses, but this is common in other (11). countries such as USA. A study in Ilam Province also showed that the In the present study, dog bite was the most incidence of animal bites in Ilam increased from common cause of injuries in victims. A survey 34 per 100,000 in 1999 to 98 per 100,000 in performed in Rafsanjan showed that the most 2008 (8).