us$ 40 in africa us$ 49 in asia php 1705-4470 the study described the epidemiological...
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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
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2.29 per million5th
FATAL
100% Preventable
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US$ 40 in AfricaUS$ 49 in AsiaPhP 1705-4470
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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.
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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
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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
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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
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Results
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Table 1. Demographics and Baseline Characteristics of Patients at Philippine General Hospital - Anti Rabies Unit (PGH-ARU) from
2002 to 2011 (n=10,146)
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Figure 1. Animal Bite Consult per year N=10, 146
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Figure 2. Proportion Distribution of Animal Bite Patients According to Age Group at PGH-ARU
for 2002-2011 (n=10,146)
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Figure 3. Top Ten Places of Animal Bite occurrence as to Place of Injury,
PGH ARU 2002 to 2011 (n= 9,889)
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Map of Philippines showing the frequency of animal bite occurrence
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Figure 4. Three Dimensional Relationship among the Time in years ( X axis), Proportion of Animal
Bites ( Y axis) and the Age Group
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Table 2. Characteristic of Domestic Animal bites at the Philippine General Hospital Anti Rabies
Unit from 2002 to 2011
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Table 2. Characteristic of Domestic Animal bites at the Philippine General Hospital Anti Rabies
Unit from 2002 to 2011
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Table 2. Characteristic of Domestic Animal bites at the Philippine General Hospital Anti Rabies
Unit from 2002 to 2011
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Table 2. Characteristic of Domestic Animal bites at the Philippine General Hospital Anti Rabies
Unit from 2002 to 2011
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Table 2. Characteristic of Domestic Animal bites at the Philippine General Hospital Anti Rabies
Unit from 2002 to 2011
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Table 2. Characteristic of Domestic Animal bites at the Philippine General Hospital Anti Rabies
Unit from 2002 to 2011
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Table 2. Characteristic of Domestic Animal bites at the Philippine General Hospital Anti Rabies
Unit from 2002 to 2011
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Figure 5. WHO Wound Category
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Figure 6. Animal Bite to Consult time Interval
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Figure 7. Frequency of Initial Wound Management
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Figure 8. Percentage distribution of herbal and traditional animal bite wound management
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Figure 9. Percent distribution of ancillary animal bite wound management
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Figure 10. Proportion Distribution of Post Exposure Prophylaxis (PEP) vaccine
Administered as to Category ( n= 9,541)
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Table 3. Association of Wound category with the compliance with PEP
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Table 3. Association of Wound category with the compliance with PEP
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Table 4. Cost of vaccination depending on WHO Wound Category
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• 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
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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
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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