Ouch! A cross‐sectional study investigating self‐reported human exposure to dog bites in rural and urban households in southern Ontario,Canada

This study investigated self‐reported dog bites in humans in rural and urban households in southern Ontario, Canada. Our objectives were to determine, and compare, the incidence of dog bites in rural and urban households, and to describe the profile of bite victims, biting dogs, and the proportion of biting dogs that respondents self‐reported as being not up to date on rabies vaccination. We conducted a cross‐sectional observational study using an online questionnaire. The 2,006 respondents, each representing one household, included 1,002 rural and 1,004 urban residences. The incidence risk of at least one person in the household being bitten over the previous year in rural households (6.09% per year) was less than in urban households (10.76% per year). In 53.20% of households from which at least one person had been bitten within the past year, only a single person had been bitten. Mostly, victims were 25 to 34 years old (21.67%), male (54.19%), and playing with or interacting with the biting dog at the time of the incident (59.11%). Most biting dogs were 3 to 5 years old (32.02%), males (53.69%), and unleashed (76.85%). Based on self‐reporting by respondents, 83.33% of respondent‐owned biting dogs were vaccinated against rabies at the time of the biting incident. Irrespective of dog ownership, the odds of an individual in a rural household being bitten by a dog were 0.53 (95% CI: 0.38–0.73) the odds for an individual in an urban household. Dog bites constitute a serious, yet preventable, public health concern that requires targeted, community‐specific efforts. Public health organizations could consider findings in developing messaging, particularly as we highlight biting dogs reported by their owners as not up to date on rabies vaccination.     

Cause,Setting and Ownership Analysis of Dog Bites in Bay County,Florida from 2009 to 2010

Emergency room and hospital discharge data have been used to describe the risk factors and public health impact of dog bites. These data sets are based on financial charges for severe bites and underestimates dog bite burdens within communities. This study expands both the source of information and risk factor data collected to provide demographic analysis of dog bite injury risk factors reported in Bay County, Florida in 2009–2010. Extended data for dog bites reported by various sources from January 1, 2009 to December 31, 2010 were collected by Florida Department of Health in Bay County. Data collected included bite victim's age and gender, primary reported cause of bite, setting, dog's restraint status and relationship between the victim and the dog. A total of 799 bites were reported. Most bites (55%) were reported first by healthcare practitioners, particularly bites involving children <6 years. Bites involving unfamiliar dogs and dogs off the owner's property were more likely to be reported by other sources. Boys aged 6–14 years accounted for 2.24 times more bites than same‐aged females (P < 0.001) and had the highest incidence with 424 bites per 100 000 persons per year. Persons 6 years or older were 3.6 times more likely to be bitten by an unfamiliar dog. Inappropriate behaviour management was the most common cause of bites (26%), followed by protective behaviour (24%). Bites of unknown cause were 2.5 times more likely in children <6 years. Separating dog fights was the most common cause of bites for persons 15 years or older (24%); females were significantly more likely to be bit than males (P = 0.01). Bites by unrestrained dogs off the owner's property (32% of all bites) most commonly involved males. Estimates based solely on healthcare discharge data significantly underestimate dog bite burden within a community. Characterizing these risks by age group or gender provides an opportunity to implement targeted interventions to prevent dog bites.     

Free‐Roaming Dogs in Nepal: Demographics,Health and Public Knowledge,Attitudes and Practices

In Nepal, most dogs are free to roam and may transmit diseases to humans and animals. These dogs often suffer from malnutrition and lack basic health care. Minimal information is available about their demographics and about public attitudes concerning dogs and diseases. We carried out a study in Chitwan District (central Nepal), to collect baseline data on free‐roaming owned dog demographics, assess knowledge, attitudes and practices of dog owners concerning dogs and rabies, evaluate rabies vaccination coverage and anthelmintic treatment of dogs, measure dogs' response to rabies vaccination and assess dog health through body condition scores and parasites. We conducted household interviews with owners of free‐roaming female dogs (n = 60) and administered dogs with rabies vaccination and anthelmintics. Dog owners regularly fed free‐roaming dogs but provided minimal health care; 42% of respondents did not claim ownership of the dog for which they provided care. We collected skin, faecal and blood samples for parasite identification and for measuring rabies virus‐specific antibodies. Ninety‐two per cent of dog owners were aware of the routes of rabies virus transmission, but only 35% described the correct post‐exposure prophylaxis (PEP) following a dog bite. Twenty‐seven per cent of the dogs had measurable rabies virus‐specific antibody titres and 14% had received anthelmintics in the previous year. Following rabies vaccination, 97% of dogs maintained an adequate antibody titre for ≥6 months. Most dogs appeared healthy, although haemoprotozoans, endoparasites and ectoparasites were identified in 12%, 73% and 40% of the dogs, respectively. Poor skin condition and parasite load were associated. Seventy‐four per cent of the females had litters in 1 year (mean litter size = 4.5). Births occurred between September and February; we estimated 60% mortality in puppies. We concluded that vaccination coverage, PEP awareness and anthelmintic treatment should be emphasized in educational programmes focussed on animal welfare, veterinary and public health.     

The human-canine environment: a risk factor for non-play bites?

Few dog bite risk factor studies have been conducted. This veterinary clinic-based retrospective cohort study was aimed at identifying human-canine environmental risk factors for non-play bites in Kingston, Jamaica (660) and San Francisco (SF), USA (452). Data were analysed using modified Poisson regression with confounders selected using directed acyclic graphs (DAGs) and the change-in-estimate procedure. Dogs acquired for companionship were more likely (RR=1.66; 95% CI 1.02-2.70) to bite than those acquired for protection. Routinely allowing a dog into the presence of visitors was also positively associated with it biting. A dog sleeping in a family member's bedroom was a risk factor for biting in Kingston (RR=2.54; 95% CI 1.43-4.54) but not in SF, while being able to leave the yard unaccompanied was a risk factor for biting in SF (RR=3.40; 95% CI 1.98-5.85) but not in Kingston. Overall, dogs which were less restricted in their interactions with humans were at elevated risk for biting. An observed association with dog bites in one cultural setting might not exist in another.     

Evaluating the contact rate between companion dogs during dog walking and the practices towards potential cases of rabies among dog owners in Japan

This study aimed to examine the habits of dog walking in Japan using an internet survey of insured dog owners. About 96.4% of the respondents (n = 1,151) reported that they would take their dogs for a walk and they most frequently walk their dogs once or twice a day (75.9%) for 30 min to 1 hr (83.1%). The probability of a companion dog having contact with other dogs during dog walking was estimated to be 0.83 (95% confidence interval [CI]: 0.81–0.85), and the associated daily contact rate was estimated using log‐normal distribution with a mean of 2.73 (95% CI: 2.42–3.11) and a standard deviation (SD) of 6.39 (95% CI: 5.18–7.84). Multiple linear regression revealed that the contact rate is mainly influenced by the social behaviour of the owner and to a lesser degree by his/her demographic characteristics including the area of residence, the breed size of dog and the age of the owner. In addition, ten Likert items measured on a 5‐point scale were designed to assess the practices towards potential cases of rabies among dog owners. The respondents (n = 972) achieved a mean score of 2.99 (out of a full score of 4) with a SD of 0.90 in responding to situations related to dog bite incidents and injury from stray cat scratches during dog walking. They achieved a higher score in responding to situations related to sighting a stray or wild animal during dog walking and situations related to non‐specific clinical signs of rabies and bite injuries from stray dogs or wild animals during dog walking with a mean of 3.70 (SD = 0.58) and 3.84 (SD = 0.34), respectively. The level of best practice was also proved to be significantly associated with the demographic characteristics of the dog owner.     

Fighting Rabies in Eastern Europe,the Middle East and Central Asia ‐ Experts Call for a Regional Initiative for Rabies Elimination

MEEREB is an informal network of rabies experts from the Middle East, Eastern Europe and Central Asia, seeking to eliminate rabies from the region. They met for the second time to review the current rabies situation, both globally and in their respective countries, highlighting current rabies control problems and potential solutions. Success stories in Latin America, in Western Europe, in some Asian countries, as well as in Croatia and Serbia prove that elimination of human rabies is achievable in the MEEREB region. It requires political willingness and cooperation of all stakeholders, including Ministries of Health and of Agriculture; adequate management of animal bites through post‐exposure prophylaxis; pre‐exposure prophylaxis for populations at high risk of rabies exposure, animal vaccination and humane control of stray dog populations. MEEREB members called for a regional initiative for rabies elimination in Eastern Europe and the Middle East. They are confident that the elimination of human rabies of canine origin can be achieved in the region through adopting a One Health approach, and that campaigns for rabies elimination will have significant benefit for public health, including strengthening the structure for control of other zoonoses.     

Canine and human factors related to dog bite injuries

OBJECTIVE: To identify physical traits of biting dogs and characteristics of injured persons and dog owners associated with bite situations for use in public health prevention activities. DESIGN: Retrospective cohort study. STUDY POPULATION: Licensed dog and dog bite report data from June 30, 2002, to July 1, 2003, that were obtained from Animal Control Services of Multnomah County, Oregon. PROCEDURES: To determine the canine and human factors associated with dog bite injuries, the number of bites, dog and injured person characteristics, and the overall canine population were evaluated. Dog owner characteristics at the block group level were defined by use of geographic information system software through 2000 census information based on place of residence. RESULTS: During the study period, 636 dog bites were reported to Animal Control Services, and 47,526 dogs were licensed in Multnomah County. Risk factors associated with biting dogs included breed (terrier, working, herding, and nonsporting breeds), being a sexually intact male, and purebred status. Male children aged 5 to 9 years had the highest rate of injury (178 bites/100,000 children). Biting dogs were more likely than nonbiting dogs to live in neighborhoods where the residents' median incomes were less than the county median income value ($41,278). CONCLUSIONS AND CLINICAL RELEVANCE: Dog bites continue to be a source of preventable injury. Prevention programs should target owners of sexually intact male and purebred dogs and owners who live in lower income neighborhoods.     

Increased detection of rabies virus in bats in Ceará State (Northeast Brazil) after implementation of a passive surveillance programme

The intensification of dog, cat and livestock vaccination campaigns significantly reduced rabies cases in humans and domestic animals in Ceará State, Brazil. However, sylvatic animals—bats (order Chiroptera), wild canids, raccoons and non‐human primates— remain as reservoirs for the virus. Our hypothesis is that surveillance and monitoring of rabies virus in bats, especially passive surveillance, is of fundamental importance, besides the implementation of health education and strengthening of surveillance actions in humans exposed to aggressions. Thus, we assessed the occurrence of rabies virus in animals focusing on bats, before and after launching of the Sylvatic Rabies Surveillance Program in 2010. Surveillance data from the 184 municipalities of Ceará State were analysed, collected during the periods 2003–2010 (active surveillance) and 2011–2016 (passive surveillance), respectively. A total of 13,543 mammalian samples were received for rabies diagnosis from 2003 to 2016. Of these, 10,960 were from dogs or cats (80.9%), 1,180 from bats (8.7%), 806 from other sylvatic animals (foxes, marmosets, raccoons; 6.0%) and 597 from herbivores (cattle, goats, sheep, equines, pigs; 4.4%). A total of 588 (4.3%) samples were positive for rabies. About 8.4% (99/1,180) of the bat samples were infected with rabies virus, 92 (92.9%) of these were from non‐haematophagous bat species and 7 (7.1%) from haematophagous species. The number of bat samples received and infection rates increased considerably, after a shift from active surveillance (9/355 [2.5%] samples positive), to passive surveillance (90/825 [10.9%] samples positive). Surveillance of rabies virus in bats is fundamental for human and domestic animal health in Ceará State. Bats have to be considered as targets in surveillance and control programmes. Virus lineages should be characterized to increase knowledge on transmission dynamics of sylvatic rabies virus to domestic animals and the human population, and to provide additional evidence for planning and implementation of improved control measures.     

Dog ecology and its implications for rabies control in Gwagwalada,Federal Capital Territory,Abuja, Nigeria

The objectives of this study were to determine the characteristics of a dog population, including their accessibility to vaccination and health care, in urban and semiurban areas of Gwagwalada, Abuja, Nigeria. Direct street counts and a house‐to‐house survey of city streets were performed. A total of 451 households were surveyed comprising 43.7% urban and 53.3% semiurban areas. A total of 848 owned dogs were identified, along with 3,115 corresponding humans. With a dog‐to‐human ratio of 1:3.7, the dog population in the study area was estimated as 103,758. A total of 396 dogs were counted on the streets with the greater proportion (74%) in semiurban areas. Most dogs in semiurban areas (77.3%) had no certificate confirming vaccination against rabies, compared to 47.2% in urban areas (p = .004). The majority of dogs in the urban (60.9%) and semiurban (82.0%) were free roaming. In the multivariable model, age, presence of a collar, region, sex, use and having ever visited a veterinarian were significantly associated with rabies vaccination. The majority (125/197, 63.5%) of respondents with higher education were willing to pay more for the healthcare needs of their dogs as opposed to those with a lower level of education (93/251, 37.1%, p = .001). The study revealed a high dog population density, vaccination coverage below WHO recommendation of 70% and generally reduced healthcare‐seeking behaviour among dog owners in Gwagwalada, Abuja, Nigeria.     

Animal bite epidemiology and surveillance for rabies postexposure prophylaxis

OBJECTIVES: To understand the epidemiology of animal bites and exposure, evaluate the animal exposure reporting system for surveillance of rabies postexposure prophylaxis (PEP), and identify opportunities to reduce PEP. DESIGN: Period prevalence survey. STUDY POPULATION: Pennsylvania residents in 1995. PROCEDURE: Data from animal bite reports from Pennsylvania county health offices were summarized for 1995. Animal bite incidences for the state, counties, various age groups, and various population densities were calculated. Animal species, treatment, location of wounds, and PEP recommendations were evaluated for exposures. RESULTS: More than 16,000 animal-related potential rabies exposures were reported from 65 of 67 counties in Pennsylvania. The highest incidence was in children less than 5 years old (324/100,000). Of the 75% of victims requiring wound treatment, 50% received antimicrobials, 29% received a tetanus toxoid, and 19% had wounds sutured, were admitted to hospitals, or were referred for plastic surgery. Although 75% of exposures were to dogs, victims exposed to cats were 6 times as likely to receive PEP (relative risk, 6.1; 95% confidence interval, 5.1 to 7.4). Thirty percent of 556 PEP were given for exposures to dogs, 44% for cats, 7% for raccoons, 4% for bats, 2.5% for squirrels, 2.1% for groundhogs, 2% for foxes, and 8% for exposures to other species. Fifty-nine percent of owned dogs were up-to-date on rabies vaccinations compared with 41% of owned cats. CONCLUSION: Interventions, such as dog bite prevention education, vaccination of pets against rabies, appropriate use of PEP, and reduction of feral cat populations, should be instituted, enhanced, or better enforced in communities.     

Dogs Entering the United States from Rabies‐Endemic Countries, 2011–2012

International dog imports pose a risk because of the potential movement of disease agents, including the canine rabies virus variant which has been eliminated from the United States since 2007. US regulations require a rabies vaccination certificate for dogs arriving from rabies‐endemic countries, but permit the importation of dogs that have not been adequately immunized against rabies, provided that the dogs are confined under conditions that restrict their contact with humans and other animals until they have been immunized. CDC Form 75.37, ‘Notice to Owners and Importers of Dogs’, explains the confinement requirements and serves as a binding confinement agreement with the importer. In this evaluation, we describe the characteristics of unimmunized dogs imported into the United States over a 1‐year period based upon dog confinement agreements recorded at the Centers for Disease Control and Prevention (CDC) quarantine stations. Confinement agreements were issued for nearly 2800 unimmunized dogs that entered the United States during 1 June 2011–31 May 2012, the majority of which travelled to the United States by air and without any seasonal pattern in import volume. Over 60% of these animals were puppies <3 months of age and included a wide variety of breeds. The dogs arrived from 81 countries, with the majority arriving from North America or Europe. Dogs placed on confinement agreements had final destinations in 49 states. California, New York, Texas, Washington and Florida received the largest number of dogs on confinement agreements. These results (which do not reflect human travel or US dog ownership data) suggest that a large portion of unimmunized dogs arrive from rabies‐endemic countries for commercial, shelter and rescue purposes. Further evaluation and key stakeholder involvement are needed to assess whether the current dog importation regulations are an adequate compromise between the benefits and risks of dog importation.     

The experience of dog bites: A survey of veterinary science and veterinary nursing students

AIM: To investigate the circumstances of dogs biting people in New Zealand.

METHODS: Veterinary science and veterinary nursing students enrolled at Massey University in 2003 completed a questionnaire detailing their lifetime experience of dog bites and their opinions of dog control legislation.

RESULTS: The response rate was 100%. There were 228 completed responses to the survey, and 87 (38%) respondents had been bitten by a dog. Most bites caused minor injury, but 17 (20%) required medical attention. Male respondents were more likely to have been bitten. The highest proportion of respondents (27; 31%) had been bitten while between 6 and 10 years of age, and the hand was the part of the body most often injured. Eighteen (21%) bites involved a stranger's dog, but most bites were by a dog known to the victim. Respondents from rural areas were three times more likely to have been bitten than city dwellers. The victim's home was the place where most (31; 36%) bites occurred. Male dogs were responsible for a larger proportion of bites (38; 44%) than females (24; 28%); respondents were unsure about the sex of the remainder of the dogs (25; 29%) that bit them. Protecting the home, play, accidents, rough handling and pain were identified as the common reasons for dogs to bite. Most (46; 52%) respondents did not believe legislation could have prevented their bite. Only four (5%) bites were reported to authorities.

CONCLUSION: Rural dwellers, people with more experience of dogs, children <11 years of age, and male respondents were bitten by dogs most often. Only legislation relating to the fencing of dog owners′ properties may have prevented a reasonable proportion (25; 29%) of the bites reported here.     

Will breed-specific legislation reduce dog bites?

So how do we deal with biting dogs? To start with, we must remind ourselves that biting is a natural activity of all dogs, and that there is potential for injury. All dog owners must understand this and must be made aware that they are fully responsible for the actions of their dogs. I am not convinced that this is universally understood by dog owners, nor am I satisfied that every dog owner takes the necessary steps to train and socialize their dog. Owners need to be encouraged to actively work at inhibiting biting behaviour when dogs are young. As well, all dogs should be socialized to accept children, regardless of whether or not there are children living with the dog. Adults without dogs need to learn that dogs don''t understand "people''s rights," and that dogs should not be expected to act differently with different people. Adults also need to understand that young children should never be left alone with a dog (or a cat) without supervision, and that all children should be taught how to behave around dogs, particulary around dogs they don''t know. So long as we have dogs living with us there will be people who get bitten. The most effective way to prevent bites is to encourage dog owners to become knowledgeable about their animals and to train and socialize them so that they can become good dog neighbours. Many municipalities already have by-laws that deal with animal bites, and in Ontario the Dog Owners Liability Act has proven to be effective in confining, restraining or disposing of biting or attacking dogs judged to be a definite threat to public health and safety, and when evidence warrants, there is always Section #221 of the Criminal Code of Canada. Most legislation deals with bites after the fact. If we want to prevent all bites, there is only one sure way and that is to ban all dogs. That is of course as unrealistic as trying to prevent bites by enacting breed specific legislation.     

The experience of dog bites: a survey of veterinary science and veterinary nursing students

AIM: To investigate the circumstances of dogs biting people in New Zealand. METHODS: Veterinary science and veterinary nursing students enrolled at Massey University in 2003 completed a questionnaire detailing their lifetime experience of dog bites and their opinions of dog control legislation. RESULTS: The response rate was 100%. There were 228 completed responses to the survey, and 87 (38%) respondents had been bitten by a dog. Most bites caused minor injury, but 17 (20%) required medical attention. Male respondents were more likely to have been bitten. The highest proportion of respondents (27; 31%) had been bitten while between 6 and 10 years of age, and the hand was the part of the body most often injured. Eighteen (21%) bites involved a stranger's dog, but most bites were by a dog known to the victim. Respondents from rural areas were three times more likely to have been bitten than city dwellers. The victim's home was the place where most (31; 36%) bites occurred. Male dogs were responsible for a larger proportion of bites (38; 44%) than females (24; 28%); respondents were unsure about the sex of the remainder of the dogs (25; 29%) that bit them. Protecting the home, play, accidents, rough handling and pain were identified as the common reasons for dogs to bite. Most (46; 52%) respondents did not believe legislation could have prevented their bite. Only four (5%) bites were reported to authorities. CONCLUSION: Rural dwellers, people with more experience of dogs, children <11 years of age, and male respondents were bitten by dogs most often. Only legislation relating to the fencing of dog owners' properties may have prevented a reasonable proportion (25; 29%) of the bites reported here.     

Stabilizing Dog Populations and Improving Animal and Public Health Through a Participatory Approach in Indigenous Communities

Free‐roaming dog populations are a global concern for animal and human health including transmission of infectious disease (e.g. rabies, distemper and parasites), dog bite injuries/mortalities, animal welfare and adverse effects on wildlife. In Saskatchewan (SK), Canada, veterinary care is difficult to access in the remote and sparsely inhabited northern half of the province, where the population is predominately Indigenous. Even where veterinary clinics are readily available, there are important barriers such as cost, lack of transportation, unique cultural perspectives on dog husbandry and perceived need for veterinary care. We report the effects of introducing a community action plan designed to improve animal and human health, increase animal health literacy and benefit community well‐being in two Indigenous communities where a dog‐related child fatality recently occurred. Initial door‐to‐door dog demographic surveys indicated that most dogs were sexually intact (92% of 382 dogs), and few had ever been vaccinated (6%) or dewormed (6%). Approximately three animal‐related injuries requiring medical care were reported in the communities per 1000 persons per year (95% CL: 1.6–6.6), and approximately 86% of 145 environmentally collected dog faecal samples contained parasites, far above levels reported in other urban or rural settings in SK. Following two subsidized spay/neuter clinics and active rehoming of dogs, parasite levels in dog faeces decreased significantly (P < 0.001), and important changes were observed in the dog demographic profile. This project demonstrates the importance of engaging people using familiar, local resources and taking a community specific approach. As well, it highlights the value of integrated, cross‐jurisdictional cooperation, utilizing the resources of university researchers, veterinary personnel, public health, environmental health and community‐based advocates to work together to solve complex issues in One Health. On‐going surveillance on dog bites, parasite levels and dog demographics are needed to measure the long‐term sustainability of benefits to dog, human and wildlife health.     

An epidemic of canine rabies in Central Java, Indonesia

An epidemic of rabies in the province of Central Java, Indonesia, in 1985–1986 was investigated. Eighty-nine percent of confirmed cases occurred in dogs, 70% of which were domestically owned. While the number of cases clearly exceeded that normally expected and thus constituted an epidemic, the actual risk of human exposure to a rabid animal bite during the peak epidemic period was only 1.5 per million for females and 3.4 per million for males. Males between the ages of 5 and 14 years were the group at greatest risk of being exposed to the bite of a rabid dog. In the most seriously affected district, the risk of a dog contracting rabies was estimated to be 105 per 100 000 during the epidemic period. No cases were reported in wildlife. The results of the investigation suggest methods by which rabies could be eradicated from Java.     

Rabies-vaccination coverage and profiles of the owned-dog population in Santa Cruz de la Sierra, Bolivia

The Bolivian government issued a regulation for rabies control in November 2005, owing to increasing the prevalence of dog and human rabies cases in recent years. An assessment of rabies-vaccination coverage and other factors that might influence the success of the on-going vaccination campaign was needed. The objective of this study was to investigate dog rabies vaccination coverage and risk factors associated with dogs being unvaccinated against rabies, and profiles of the owned-dog population in Santa Cruz de la Sierra, Bolivia, where dog rabies was endemic. Mainly due to logistical reasons, the WHO's expanded programme on immunization cluster-survey method was used. The 390 households were included in the study. Information about dog population and management characteristics was obtained for 542 dogs from 301 households. On average, households had 1.4 dogs and 1.8 dogs per dog-owning household (median = 1). The human-to-dog ratio was 4.6 : 1. During the last 1 year prior to the study, of the 539 dogs aged >or=1 month, 463 (85%; 95% CI 79-91; design effect 3.6) were classified as vaccinated. Amongst the study dogs, dogs aged 1-11 months were the higher risk of dogs not being vaccinated (OR = 8.2; 95% CI 4.3-15.6; P < 0.01). Almost two-thirds of the study dogs were allowed to roam freely throughout the day or in part. Community education efforts should address the importance of dog ownership and movement restriction, and the need to vaccinate young dogs.