Epidemiological study of patients attending anti-rabies vaccination clinic of tertiary care hospital

Background: Epidemiology of animal bite is imperative for policy making, planning and effective implementation of prevention and control programme at local, state and National level. Objectives: To study the epidemiology of patients attending anti-rabies vaccination clinic. Methods: A Hospital based cross-sectional study was conducted in 100 adult patients attending anti-rabies vaccination clinic of Indira Gandhi Government Medical College, Nagpur during January to May 2013. Detail history regarding sociodemographic profile, type of bites including site, duration, category of exposure, wound toilet, treatment, etc was inquired. Results: Out of total 100 patients screened, 76 % were males and 24 % were females. 16 % were illiterate and 23 % were professional. Majority of the patients i.e. 90% were from urban areas. 77 % animal bites were of category III with81 % bites being unprovoked. 76 % injuries were of superficial type and 24 % were deep wounds. Maximum number i.e. 68 % bites were on lower limb, 24 % were on upper limb and only 5 % on head, neck, face and 3 % on trunk. History of local wound toileting was present in 82 % cases and 45 % gave history of local application of salt, oil and or turmeric. Anti-rabies vaccine was administered to 70 % of cases and rabies immunoglobulin (equirab) to 50 % cases. Conclusion: Our study findings suggests that the majority of the patients were from urban set up inflicted upon by animal bites with poor knowledge regarding wound care and seeking early treatment. Introduction Rabies is an acute infectious highly fatal viral disease of the central nervous system leading to encephalomyelitis. It is primarily a zoonotic disease of warm blooded animals, particularly carnivorous such as dogs, cats, jackels and wolves. It is mainly transmitted by animal bites, mostly dogs in the Indian context. Although Rabies is 100% fatal disease, it is also 100% preventable. In spite of being a vaccine preventable disease, rabies still poses a significant public health problem in many countries in Asia and Africa. Surprisingly, 95% of 60,000 human deaths occur in developing countries.1-3 Worldwide, rabies occurs in more than 150 countries and territories. Although a number of carnivorous and bat species serves as natural reservoir, rabies in dogs is the source of 99 percent of human infection, and posses a potential threat to more than 3.3 billion people. In India alone, 20000 deaths (i.e. about 2 per lakh population at risk) estimated to occur annually; in Africa, the corresponding figure is 24000 (i.e. about 4 lack population at risk). 4-6 There is significant variation in epidemiology of animal bite cases at different health care settings. The present study was undertaken to understand the local epidemiology of animal bites for the development of an efficient precaution programme at local level. Methods: Study design: A hospital based cross-sectional study. Study area: The study was carried out in anti-rabies vaccination OPD of Indira Gandhi Government Medical College, Nagpur. Study period: The study was conducted from January to May 2013. Study subjects: 100 participants for this study were animal bite patients attending anti-rabies vaccination clinic. After obtaining written informed consent from the patients, all 100 adult patients were interviewed with the aid of preformed structured questionnaire. All the patients were subjected to sociodemographic profile and detailed history type of bites including site, duration, category of exposure, wound toilet, treatment including both active and passive immunization. Also history regarding health seeking behaviour of animal bite patients like application of oils, salt, lime, herbs, red chilies and turmeric paste on the wound was inquired. Statistical analysis was done by simple proportions and percentages. Results: Table 1 shows the characteristics of patients attending antirabies vaccination (ARV) Out of total 100 adult patients studied who had been bitten by animals, 76 % were male and 24 % were female. As far as the education of patients is concerned, majority i.e. 40 % were educated up to high school, 23 % patients were graduate or post graduate, 11% completed only primary education, 10 % were educated up to middle school whereas 16 % were illiterate. It was observed that majority of patients i.e. 90 % were from urban areas and only 10% were from rural areas. Distribution of patients according to wound characteristics has been depicted in Table 2. Patients were categorized as per WHO classification of animal bite, it was seen that 77 % animal bites were of category III exposure; 20 % belonged to category II animal exposure and only 3 % belonged to category I exposure. As far as types of injuries are concerned 76 % injuries were of superficial in nature (i.e. licks, abrasion) and 22% were deep wounds (lacerated, contusion) with 81 % being unprovoked and 19% were provoked. In our study, the commonest site of animal bite was found to be lower limb in 68 %, upper limb in 27%, head, neck face (HNF) in 5 % and trunk in only 3 % of cases of animal bites. Distribution of patients according to wound management is