A Retrospective Study on Dog Bite Associated Rabies in Human and the Use of Post-exposure Prophylaxis in Nepal during 2008 to 2017

Abstract

A 10-year (2008-2017) retrospective canine-mediated human rabies epidemiology was studied to assess the burden of rabies in Nepal. To this end, the number of dog bites, the use of post-exposure prophylaxis (PEP), and human death records from 2008 to 2017 were retrieved from Sukraraj Tropical Hospital, Kathmandu, Nepal. The findings revealed that the number of human rabies occurrences was consistent with minor fluctuations throughout the study period. There were 252,297 dog bite cases in humans recorded between 2008 and 2017. Every month, 2,102 people were bitten by mostly stray dogs. There was a gradual increase in PEP use throughout 10 years. On average, 36,995 PEP dosages were used per year for stray dog bites. The PEP consumption and the number of human deaths were negatively correlated. A total of 482 human rabies deaths were recorded in Nepal during the study period. On average, 49 people died of canine-mediated rabies each year. Although there was an increase in the use of PEP, the number of human deaths and street dog bites recorded were still high. The high mortality due to rabies could then be attributed to the flawed surveillance system and stray dog population management, and not merely the lack of PEP services. Hence, it is recommended that the government agencies and other concerned stakeholders should organize mass vaccination and population management program for stray dogs in order to reduce the country’s rabies burden.

Epidemiology of dog bites to people in Uruguay (2010–2020)

“…The biting prevalence in Uruguay is lower than that reported in other countries from North America (Daigle et al., 2022 ; Overall & Love, 2001 ; Quirk, 2012 ) and from Oceania (Mair et al., 2019 ). Studies from Asia have variably reported higher (Abedi et al., 2019 ; Amiri et al., 2020 ; Babazadeh et al., 2016 ; Gongal & Wright, 2011 ) and slightly lower prevalence (Masiira et al., 2018 ; Pal et al., 2021 ). Similarly, the frequencies reported in European countries have been both higher (Westgarth et al., 2018 ) and slightly lower (Rosado et al., 2009 ) than found in our study.…”

Clinico-epidemiological study on animal bite presenting to a tertiary care hospital in western part of Nepal

“…2 However, most of these bites were reported from urban areas, where the stray dog population is higher than the rural areas. 9 Regarding circumstances of animal bite, most were unprovoked. Unprovoked cases were as high as 81 to 87%.…”

“…2 Rabies has been endemic in Nepal with an underestimated annual death of 100 per year. 9,10 In Nepal, the transmission of rabies is from jackals to humans through stray dogs as the mediator. 10 The fenceless forests allowing contiguity of wild and pet animals and the free trade and movement of humans and animals across unbarred border with India has facilitated the transmission of infectious diseases.…”

“…Also, the increasing population of stray dogs has primarily escalated the transmission risk of rabies from wild animals to stray dogs, which subsequently imparts the virus to humans. 9,10 The majority of the human and animal rabies cases have been reported from terai region. 8 The objective of this study was to study the clinicoepidemiological aspects of animal-bite in cases reporting to our hospital.…”