Arch Clin Infect Dis. 2014 October; 9(4): e18773. DOI: 10.5812/archcid.18773 Research Article Published online 2014 September 25. Epidemiology and Public Health Aspects of Animal Biting in Shush County, Khuzestan Province, Iran 1 2,* 2 2 Mohammad Hossein Feizhaddad ; Hamid Kassiri ; Masoud Lotfi ; Seyedeh Sahar Hoseini 1Department of Medical Parasitology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran 2Department of Medical Entomology and Vector Control, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran *Corresponding author : Hamid Kassiri, Department of Medical Entomology and Vector Control, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran. Tel: +98-6113738269, Fax: +98-6113738282, E-mail: [email protected] Received: ; Revised: ; Accepted: March 5, 2014 September 20, 2014 September 23, 2014 Background: Animal bites, especially dog bites, are common health problems which are rarely addressed. It is estimated that 15 million people are bitten by animals worldwide annually. Diseases caused by animal bites are problematic matters in the world as well as in Iran. The main disease caused by animal bites is rabies. Rabies is a fatal acute viral disease causing inclusive symptoms in the central nervous system in domestic and wild carnivores. Humans and other warm-blooded mammals are often randomly involved with an infected animal bite. Objectives: Due to the increasing number of cases of animal bites in the County of Shush (southwestern Iran) because of its geographical status as a farming-animal husbandry region as well as the residents that are more exposed to animal bites, this study was designed to investigate the epidemiology and prevalence rate of animal bites in this county during 2000-2004. Materials and Methods: In this descriptive cross-sectional research, a particular questionnaire was filled out for all the cases. The questionnaire included questions about demographic and epidemiologic characters such as, occupation, sex, age, biting animal type, treatment type, bite site, etc. Data analysis through SPSS and Excel software was performed and the percentages and mean of statistical figures were determined. Finally, descriptive statistics was used in the forms of tables and graphs to summarize the data. Results: Findings of this study indicated that the average prevalence of animal bites during the above five years was 1.3 per 1000 population and there was an increased trend in the prevalence rate of animal bite in this county. During these five years, a total number of 1300 cases of animal bites were recorded: males 971 (74.7%) and females 329 (25.3%). The numbers of animal bites in rural and urban areas were 1061 (81.6%) and 239 (18.4%), respectively. Therefore, a 4.4-time rate of animal bites was recorded for rural areas. Moreover, the majority of animal bites (31.9%) were determined in the age group of 10-20. In terms of employment, students with 390 cases (30%) comprised the highest work-related group. From the viewpoint of bite site, the most prevalent biting site was feet with 907 cases (69.7%), followed by hands with 236 (18.2%) cases, while only one bite was recorded on the neck area. Totally, 95.8% of bites were confirmed to be applied by dogs; however, cats were responsible for only 3.3% of bites. During the five years of the study, 155 stray dogs in rural areas and 84 in urban areas were hunted. Conclusions: Due to the demographic status of Shush County, its high rural population engaged in agriculture and livestock farming, keeping dogs at home for job demands and a great percentage of animal bites among students, educational programs for students in schools and for farmers should be prioritized regarding first aid for prevention of animal biting. Keywords: Epidemiology; Animals; Bites; Prevalence; Rabies; Iran 1. Background Animal bites are a significant threat to human health In terms of epidemiology, rabies is found in domestic because of the fatality of subsequent infections such as and sylvatic forms. The disease is common in most ar- rabies. Although animal bites are preventable, they are eas of Asia, Africa and small parts of North America and still a health problem in many countries, especially in South America. Rabies is common in both domestic and Asia and Africa. Every year, more than 15000000 people sylvatic forms in most provinces and counties of Iran (3). receive post-exposure prophylaxis, mostly in China and Rabies is endemic in Iran and occurs frequently in do- India. More than 55000 people die of rabies every year, mestic animals (4-6). The annual Increase of animal bites mostly in Asia and Africa. About 40% of people who are can enhance the costs due to importing anti-rabies vac- bitten by suspect rabid animals are children under 15 cines and serums. Furthermore, rabies has a high fatality years old (1, 2). rate; thus, after the appearance of clinical symptoms in Copyright © 2014, Infectious Diseases and Tropical Medicine Research Center; Published by Kowsar. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. Feizhaddad MH et al. humans or in animals it is not curable and death is al- demiologic features such as, occupation, sex, age, biting most inevitable (7, 8). animal, treatment regimen, bite site, etc. Data analysis The main infection reservoirs in different geographical through SPSS and Excel software was performed and areas vary in wildlife, which are important reservoirs for percentages and mean of statistical figures were deter- rabies transmission. In the United States, Skunk (in the mined. Finally, descriptive statistics was used in the form west), fox (in the east) and raccoon (in Florida) are the of tables and graphs to summarize the data. The ethical main reservoirs for rabies (9). Dogs have the most impor- principles of this research were investigated and dis- tant role in transmission of rabies to humans (2). Dog cussed in the Research Committee of Medical Entomol- bite, in addition to bacterial infections, can transfer ra- ogy Department and required modifications were made, bies, tetanus and tularemia and cat bite may cause trans- faced to be approved. mission of rabies and tetanus. Being bitten and scratched Bartonella henselae by cat can also transfer (causing cat 4. Results Francisella tularensis scratch disease) and (causing tulare- The results showed that 1300 cases with animal bites mia) (10). in rabies vaccination centers had been recorded during In the northern region of Iran, dogs and foxes and in 2000-2004. The average prevalence rate of animal bit- west and north-west of the country wolves are the most ing in Shush County during the above five years was ap- important disease vectors and reservoirs. Previous stud- proximately 1.3 per 1000 population. There was almost an ies showed that the cause of rabies has not been isolated increased prevalence rate for animal biting over the five from bats in Iran (11, 12). In many studies, animal bites years with 1.22, 1.17, 1.11, 1.53 and 1.47 per 1000 population, have been reported for different age groups. According to for each year, respectively. Figure 1 shows the trend of ani- the World Health Organization reports, most cases of hu- mal bite cases during the study period. Depending on the man rabies have been occurred in boys under 15 years old age group, the results showed that the frequency of cases as well as in 40% of patients aged 5-14 (13). With an excep- with animal bites in the 10-20-year age group (31.9%) was tional in Pandey's study on foreign residents and tourists more than other age groups and the lowest rate was ob- in Nepal which indicated that more females than males served in children under four years old (3.6%) (Figure 2). were bitten by a rabid animal, in other studies the animal Regarding the time of bites, December (10%) was re- bite cases have been higher for males (14). corded for most of the cases; however, the lowest rates In general, many factors must be considered for rabies were traced in January (4.8%) (Table 1). Seasonally, cases control campaign plans and the first act is surveillance with animal bites were documented in autumn (26.8%), and epidemiologic data gathering. One of the main con- winter (25.2%), summer (24.1%) and spring (23.9%), respec- cerns in relation to prevention and control of this disease tively (Table 1). The findings from this study indicated is the lack of consistent care and regular reporting by that cases with animal bites during 2000-2004 and for all health centers. In this context, this shortcoming has led the months were higher in males than in females. Dur- to unavailability of accurate, adequate and timely infor- ing these five years, a total of 1300 animal bites in both mation for the abovementioned issues. Therefore, com- genders were recorded with 971 (74.7%) in males and 329 munity participation and cooperation should be granted (25.3%) in females. According to the results extracted from for successfulness of the above responsibilities. Table 1, the animal bite rate in males was approximately 2.9 times more than females. 2. Objectives Throughout 2000-2004, around 81.6% of animal bites Given the high rate of rural population in the County occurred in rural areas in Shush County, which were of Shush, keeping dogs in homes and the increased inci- 4.4 times more than urban areas (18.4%). From the bite dence rate of animal bites in recent years, it persuaded site point of view (on the body), 907 cases (69.7%) were the authors to perform an epidemiological study on ani- documented for feet and the subsequent bite sites were: mal bites in this region.