Epidemiology of animal bites and rabies cases in India. A multicentric study.

Rabies, a disease of antiquity continues to be a major public health problem in India. Multiple factors contribute to high mortality and morbidity due to animal bites. An effective strategy for control of rabies takes into account the epidemiology of animal bites, rabies and factors influencing post exposure treatment. The study was carried out as a part of Agreement for Performance of Work (APW) from World Health Organization (WHO) during the period April 2001 to September 2002. Two sets of proformae were developed and used after field testing to interview cases of animal bites and get retrospective information about rabies cases. The study was carried out at six selected centres across the country viz. Delhi, Hyderabad, Raipur, Jamnagar, Coonoor and Rajahmundry and was co-ordinated by National Institute of Communicable Diseases (NICD), Delhi. The officials engaged in the study work were thoroughly trained in the study methodology before the start of the study itself. To maintain quality and uniformity supervisory checks were done during the survey. A total of 1357 fresh animal bite victims were interviewed (exit interview) from the anti-rabies centres (ARCs). Dog bites caused maximum morbidity (92%). Second most common biting animal was monkey (3.2%), followed by cat (1.8%), fox (0.4%) etc. Most bites (64.3%) were unprovoked bites by stray (64.7%) animals. In this study 72.4% animal bite victims were males and 47.5% were children in age group of 2-18 years. 63% had Category III exposure as per the WHO classification. Before coming to ARCs 58.5% people had washed the wound with water/soap or water alone. Some of the bite victims (10.8%) had also applied chillies, salt, turmeric powder, lime, snuff powder, paste of leaves, acid, ash given by Peer Baba (magician) etc. These practices varied from one region to another. The practice of wound washing at the ARC which is an important component of animal bite management was being practiced at only one of the six centres. Of the six centres, Rabies Immunoglobulin (RIG) was available and was being used at only two centres. The study was conducted in public sector ARCs where Nervous Tissue Vaccine (NTV) was available free of cost. All the centres were using NTV except Coonoor, which is using indigenously produced Tissue Culture Vaccine along with NTV. Analysis of 192 case records of rabies cases, from two centres, revealed that dog bites caused maximum mortality (96.9%). Nearly 40% were children below 15 years of age and 78.6% were males indicating that it is an exposure related disease. In all cases, failure to seek timely and appropriate treatment led to development of disease. This paper provides an overview of epidemiology of animal bites and retrospective information about rabies patients. There is a need to strengthen Information, Education and Communication (IEC) programme regarding merits of local wound management including "do's and don'ts". ARCs should be strengthened in terms of facilities and availability of safe and effective anti rabies immunobiologicals. There is a need to create awareness regarding epidemiology and at-home and hospital management of animal bites among the service providers and general community.