A study on knowledge of animal bite management, rabies immunization, andprevention of rabies among interns in a tertiary care hospital, Bengaluru

Introduction

Rabies is an enzootic and epizootic disease of worldwide importance¹. It is an acute, highly fatal viral disease of the central nervous system. It is a zoonosis of warm-blooded animals, particularly carnivorous animals like dogs, cats, jackals, and wolves. The main mode of transmission to humans is by the bites or licks of rabid animals. It causes around 59,000 fatalities per annum worldwide.² In India, dogs are accountable for about 95% of human rabies. The disease is invariably highly fatal in which the patient is tormented with thirst and fear of water (Hydrophobia)³ . There is no treatment for the disease worldwide, hence prevention is the only intervention.⁴

Rabies is a major public health problem in India. It occurs in all parts of the country with exception of Lakshadweep, Andaman and Nicobar Island.³ Some countries have achieved “RABIES FREE” status through vigorous elimination campaigns.⁵ In India, Goa was the first state to be declared a rabies-controlled state. At the global level, more than 15 million people receive rabies prophylaxis annually. It is estimated that in absence of post-exposure prophylaxis (PEP), about 327,000 people would die from rabies in Africa and Asia each year. In India alone, 20,000 deaths (about 2 per lac population at risk) are estimated to occur annually³ .

According to the World Health Organization (WHO), proper PEP can prevent human rabies completely. Inadequate knowledge regarding the classification of animal bite wounds leading to improper vaccination is seen in India and other parts of the world.

The present study was undertaken to identify the knowledge regarding animal bite management and preexposure prophylaxis and PEP including vaccination and prevention of rabies.

Materials and method

The present hospital-based, cross-sectional study was carried out in Victoria Hospital (tertiary care hospital) attached to Bangalore Medical College and Research Institute, Bengaluru from October 2021 to December 2021. The study was approved by the institutional ethical committee.

Based on the study conducted by Ranadip Chowdary et al⁵ , a sample size of 90 was obtained. From 250 interns, 90 interns were selected based on the inclusion and exclusion criteria. All the study participants gave consent for their inclusion in this study. A pre-tested, semi-structured, self-administered questionnaire was sent as a Google form to all the participants via WhatsApp messaging app. All the participants responded to the questionnaire. Hence, the final analysis comprised of these 90 respondents.

Data analysis and management

Information was extracted related to Rabies transmission dynamics, wound management, immunization, and preventive measures to eliminate rabies by 2030 while reviewing the literature. The first author extracted the information from the guidelines, and all co-authors reviewed and validated it. The data collected was entered into an Excel sheet and analyzed using Jamovi version.2.3.12. Sociodemographic data were presented using descriptive statistics wherever applicable. Data was represented in the form of tables and figures wherever necessary.

Results

In this study, out of 90 subjects, 51(56.7%) were males and 39 (43.3%) were females. The age of all participants was between 23–25 years. The mean age was 24.14 years.

Discussion

The study highlights that the majority of the participants had adequate knowledge regarding wound management in animal bite and rabies immunization. Interestingly, most of them lack knowledge about preventive measures both at the individual and community level to eliminate rabies. The study report that the majority of the interns were familiar with animal bite wound categorization, management of dog bites, and rabies immunization which include pre-exposure prophylaxis, PEP, and indications for administration of rabies immunoglobulin.

In our study, 96.6% of the participants knew that wound wash is the first step to be done after an animal bite. 68.9% of the participants answered that antiseptics should be applied to the wound after an animal bite. Regarding suturing the wounds after an animal bite, 76.67% agreed not to suture the wound.

In our study the majority of participants had a fair knowledge of the site, route, and schedule of PEP., Around 68.89% of the participants responded deltoid region as the site of vaccination. Around 31.11% responded only IM as the route of vaccination and 46.67% and 20% responded, only ID and either IM/ID, respectively as the route of vaccination for an antirabies vaccine. Around 65.55% of the interns responded correctly about the schedule of the antirabies vaccine. Regarding knowledge about the prevention of rabies, only 33% agreed that vaccinating 50% of the susceptible dog population stops transmission. Around 48% believed that eliminating rabies in dogs is a 3-phased process. Around 80% responded that dog vaccination is the most cost-effective way to prevent rabies. A similar study was carried out by Ranadip Choudary et al. in Kolkata. The results suggested that among 80 interns, 56.3% and 72.6% of interns did not categorize bites into single transdermal bites and licks on broken skin as Cat-III wounds. 12.5% of interns were aware of the intradermal route of vaccination. The PEP management of Cat-I wounds was correctly described by 10% of the interns while 31.2% of interns thought it was necessary to add rabies immunoglobulin in Cat-II wounds. ⁶ So comparatively, our study participants (Interns) had a very good knowledge of animal bite management and the prevention of rabies. This might be attributed to the presence of an antirabies clinic in our study site whichwas not present at the above-mentioned study site.

Interns are the future clinicians, physicians, surgeons, etc. Therefore, they were envisioned to be the focus group for this study. Overall, the interns participating in the study were well aware of the animal bite management, treatment protocol, and rabies vaccination. This was due to the presence of an animal bite clinic in the medical college dealing with animal bite management and rabies vaccination. Since Bengaluru is a metropolitan city, most of the cases will be referred from peripheral hospitals to Victoria Hospital. It is an autonomous government hospital where most of the poor people come and the treatment cost is very low. Hence, interns are exposed to more patients. But they were not well aware of the facts concerning the prevention of rabies at the community level. Hence, they need proper education regarding prevention at the community level which mainly includes mass dog vaccination.

Conclusion

Most of the interns have sufficient knowledge regarding the use of immunization schedules and rabies immunoglobulin. But knowledge regarding “PREVENTION” is still lacking. Therefore, all healthcare workers need regular training regarding animal bite management and the prevention of rabies.

Conflict of Interest

None