Paolo Dela Rosa, MDLawrence Allen Tria, MD

Ariel Valones, MDDepartment of Medicine PGH

Animal Bite Surveillance Report in a Government Hospital –

The Philippine General Hospital Anti-Rabies Unit Experience:

A 10 year Retrospective Review

2.29 per million5th

FATAL

100% Preventable

US$ 40 in AfricaUS$ 49 in AsiaPhP 1705-4470

The study described the epidemiological characteristics of animal bite cases consulting at the Anti-Rabies Unit of Philippine General Hospital from 2001-2011.

Objectives

It described the clinical and demographic profile (age distribution, sex, area of residence, area of injury) of patients who sought consult at the Anti-Rabies Unit

of the Philippine General Hospital

It compared the compliance on ERIG/ Post-exposure Prophylaxis to the Category of Animal bite.

Retrospective Descriptive Cohort

Medical records/ registry at the Anti-Rabies Unit of the Philippine General Hospital from its inception in 2002 to 2011. Demographic Data were extracted such as age, sex, area of residence, place of injury, initial wound management done before consult, patient’s immunization history and status, bite to consult time interval, animal profile (biting animal, ownership status, animal status at the time of bite and consult, animal vaccination status), immunization status, compliance to PEP regimen).

Methodology

Primary Outcome Variable• Epidemiologic characteristics of animal bite patients who sought

consult at the Anti-Rabies Unit of the Philippine General Hospital from 2001-2011

Secondary Outcome Variables• Demographic profile of patients who sought consult at the Anti-

Rabies Unit of the Philippine General Hospital. • Proportion of animal bites at the Anti-Rabies Unit’s Ten-Year

existence at the Philippine General Hospital, and• Compliance on ERIG/ Post-exposure Prophylaxis to the Category

of Animal bite.

Outcome Variables

Category of Animal BiteCategory I: touching or feeding animals, licks on intact skin (i.e. no exposure)Category II – nibbling of uncovered skin, minor scratches or abrasions without bleedingCategory III – single or multiple transdermal bites or scratches, licks on broken skin; contamination of mucous membrane with saliva from licks, exposures to bats

Operational definition

Results

Table 1. Demographics and Baseline Characteristics of Patients at Philippine General Hospital - Anti Rabies Unit (PGH-ARU) from

2002 to 2011 (n=10,146)

Figure 1. Animal Bite Consult per year N=10, 146

Figure 2. Proportion Distribution of Animal Bite Patients According to Age Group at PGH-ARU

for 2002-2011 (n=10,146)

Figure 3. Top Ten Places of Animal Bite occurrence as to Place of Injury,

PGH ARU 2002 to 2011 (n= 9,889)

Map of Philippines showing the frequency of animal bite occurrence

Figure 4. Three Dimensional Relationship among the Time in years ( X axis), Proportion of Animal

Bites ( Y axis) and the Age Group

Table 2. Characteristic of Domestic Animal bites at the Philippine General Hospital Anti Rabies

Unit from 2002 to 2011

Table 2. Characteristic of Domestic Animal bites at the Philippine General Hospital Anti Rabies

Unit from 2002 to 2011

Table 2. Characteristic of Domestic Animal bites at the Philippine General Hospital Anti Rabies

Unit from 2002 to 2011

Table 2. Characteristic of Domestic Animal bites at the Philippine General Hospital Anti Rabies

Unit from 2002 to 2011

Table 2. Characteristic of Domestic Animal bites at the Philippine General Hospital Anti Rabies

Unit from 2002 to 2011

Table 2. Characteristic of Domestic Animal bites at the Philippine General Hospital Anti Rabies

Unit from 2002 to 2011

Table 2. Characteristic of Domestic Animal bites at the Philippine General Hospital Anti Rabies

Unit from 2002 to 2011

Figure 5. WHO Wound Category

Figure 6. Animal Bite to Consult time Interval

Figure 7. Frequency of Initial Wound Management

Figure 8. Percentage distribution of herbal and traditional animal bite wound management

Figure 9. Percent distribution of ancillary animal bite wound management

Figure 10. Proportion Distribution of Post Exposure Prophylaxis (PEP) vaccine

Administered as to Category ( n= 9,541)

Table 3. Association of Wound category with the compliance with PEP

Table 3. Association of Wound category with the compliance with PEP

Table 4. Cost of vaccination depending on WHO Wound Category

• Children and reproductive age-group are vulnerable to domestic animal bite.

• Most of the animals are owned/ unleashed• 13% are vaccinated which is below the national vaccination coverage. • Barangays and non-government organizations played a role in a

majority of canine vaccination, which can be further tapped to increase vaccination.

• Herbal and traditional remedies account for 13.9%, of these 88% used garlic.

• Completion of PEP is a function of the category of animal bite and the health awareness of the patient to comply with the recommended vaccination.

Conclusion

There is a need for a multi-sectoral approach to strengthen mass advocacy campaign, accessibility of rabies unit and affordability of rabies vaccine. These revelations and public’s ability to recognize a potential rabies exposure and the appropriate management of the case by healthcare professionals are critical in rabies advocacy.

Conclusion

The researchers recommend doing a biomedical research on the herbal and traditional practices, as well as surveillance on the clinical outcome of animal bite patients, and the various reasons for noncompletion of recommended post-exposure prophylaxis

Recommendation