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Pattern of Animal Bites and Post Exposure Prophylaxis for Rabies: an One Year Study in Bangladesh Institute of Tropical Infectious Disease (bitid) Chattogram

Md Mamunur Rashid
Associate Professor & Corresponding author
Department of Clinical Tropical Medicine, Bangladesh Institute of Tropical Infectious Disease (BITID) Chattogram, Bangladesh

M A Hassan Chowdhury
Department of Clinical Tropical Medicine Bangladesh Institute of Tropical Infectious Disease (BITID) Chattogram, Bangladesh

Md Hossain Rashid Chowdhury
Department of Clinical Tropical Medicine Bangladesh Institute of Tropical Infectious Disease (BITID) Chattogram, Bangladesh

Abstract/ Executive Summary:

Background: Rabies is a global disease occurring in more then 150 countries including Bangladesh. It was neglected in Bangladesh before 2010 with more than 2000 annual rabies case. Number of rabies patients are declining in whole world due to more availability of resources needed for rabies prevention. In this background here our objective is to study the Post Exposure Prophylaxis (PEP) in rabies & to observe the pattern of animal bites in Bangladesh Institute of Tropical and Infectious Disease (BITID) which is a national institute dealing Tropical & Infectious diseases of Bangladesh. Materials and methods: It was a retrospective study carried out among bite patients coming to BITID (Both outdoor & indoor) from 01.01.2017 to 31.12.2017 where a registry of all post-exposure treatments was maintained. Total 1863 cases of animal bite patients came to BITID over the study period. The data were analyzed finally. Results: Among 1836 cases, 1185(63.66%) were male and 678 (34.44%) were female. 1155 cases (62%) belonged to >12 years of age and 708 (38%) cases belonged £12 years of age 815(43.74%) cases were category III bite. 1386 (74.4%) cases were bitten by dog & bites in 1110 (59.6%) cases occurred in lower limbs. Most patients 1138 cases (61.1%) came from rural areas & maximum bites occurred from March 2017 to September 2017. Conclusion: Animal bite is a great burden for Bangladesh. To prevent it we need public awareness, mass dog vaccination, street dog control and complete post-exposure prophylaxis as per schedule given by national rabies elimination program of Bangladesh government.

Keywords: PEP=Post Exposure Prophylaxis, ARV = Anti Rabies Vaccine, ERIG= Equine Rabies Immunoglobulin, PVRV= Purified Verocell Rabies Vaccine, PCEC= Purified Chick Embryo Cell Caccine, FAT= Fluorescent Antibody Test

Location: In Bangladesh

Start Date: 01-01-2017

End Date: 31-12-2017

Program Area: Pest Management

Commodity: Vertebrate, Vaccine

Objectives:

To study the Post Exposure Prophylaxis (PEP) in rabies & to observe the pattern of animal bites in Bangladesh Institute of Tropical and Infectious Disease (BITID) which is a national institute dealing Tropical & Infectious diseases of Bangladesh.

Methodology:

It was a retrospective study conducted from January to December 2017. The study was aimed to identify patterns of animal bites and post-exposure prophylaxis for rabies. The basic details of all animal exposure like name, age, sex residence, contact number, location of bite, category of bite, animals involved, care given to wound & details of PEP was recorded in a register supplied by CDC, DGHS. PEP was started without delay according to WHO criteria, eg category III bites were given wash plus ARV plus ERIG and category II were give wash & ARV. No treatment was given in category I patients. A card was supplied to every patient containing all details about PEP. Every patient was asked individually to report to the center for anything abnormal they notice following the prophylaxis. Patients who were severely injured got admission to BITID & got PEP & other treatment. The patients had been contacted individually 2 to 6 months following vaccinations to know their status. The wound area is cleaned with simple soap and running tap water for 20 minutes to wash the virus and also concomitant bacteria. Usually suturing of wound area is not done unless profuse bleeding where less number of suturing can be done after rabies immunoglobulin administration in and around the wound. For PEP we used two kinds of inactivated anti-rabies cell culture vaccines normally Purified Vero Cell Rabies Vaccine (PVRV) and Purified Chick Embryo Cell Vaccine (PCEC) and most of them were supplied by the government of Bangladesh. Cold chain was maintained & the intradermal route was followed on day 0,3,7& 28 days at dose 0.1 ml on both upper arm. Immunoglobulins used were Equine source of Rabies Immunoglobulin (ERIG) at a dose of 40 iu/kg body weight in and around the wound. All data’s of year 2017 from registries were extracted after obtaining permission from the hospital authority. After compiling all the data we had analyzed them and made the inference.

Source of Information: Chattogram Maa-O-Shishu Hospital Medical College Journal, Volume 20, Issue 1, January 2021

Article Link (Online Journal):

Funding Source:

Total Budget (Tk.) :

Achievement/Findings:

Nationwide CDC is the executive body governing rabies elimination in Bangladesh and BITID is a control and prevention center regarding this under the supervision of CDC. Among the prophylaxis provided at BITID maximum animals, bites were found dog bite & most of them were category III bite & most common sites were lower limb. Patients with more severe bites came earlier than the lesser bites in our center. Public awareness should be increased by mass media to come to the health center as soon as possible after bite Health care providers should be well trained in this regard & also health policy-makers should ensure rabies control within animal populations and appropriate supplies of post-exposure rabies treatment and antibiotic prophylaxis for bitten people. Complete course of PEP as per schedule of national rabies elimination program of Bangladesh government must be ensured. Continued surveillance and rabies control along with mass dog vaccination is still necessary.

Knowledge Management: Journal