title: A prospective study on the incidence of dog bites and management in a rural Cambodian, rabies-endemic setting.
abstract: Rabies circulates intensely in Cambodia, mainly affecting rural populations. We conducted a prospective study to estimate the baseline incidence of potentially infective dog bites in rural villages of Siem Reap province, Cambodia. The study was conducted in a convenience sample of 844 families totaling 1779 persons in four villages. The study collected data in a total of 802.3 person-years. Trained village health workers (VHW) exhaustively documented consecutive dog bites at the end of each month. Between May 15th and November 15th, 2011, a total of 40 attacks (43 bites; 1.07 bites per attack) were notified by 39 persons (50% female; one suffered two distinct incidents) to VHW. The all-age attack rate for bites over this 6-month period was 2.3% (CI95%: 1.7-3.1%), with a global incidence rate estimated at 4.84 bites/100 person-years (CI95%: 3.5-6.6). The mean age in bite victims was 20.8±18.9years (median 12.5; interquartile range 6-36; range 1-63). The dog was identified in 39 (97.5%) of cases, being the household dog in 9 (22.5%) of cases. Bites were classified as severe (WHO Category III-broken skin with bleeding) in 33 (82.5%) of cases with a severe dog bites incidence estimated at 4/100 person-years (CI95%: 2.8-5.6). The bites involved the hand or face in 1 (2.5%) case each (both Category III). In 20 incidents (50%), only rice was applied to the wounds. There were no suspected or confirmed human rabies deaths during the study period but one dog died after biting (2 others were lost to follow-up and 14 were put down by their owner). Our study documented an extremely high incidence of dog bites in of rural Cambodian adults and children. Adapted control policies for canine vaccination are urgently needed.
authors.affiliation: Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; Agronomes et Vétérinaires Sans Frontières (AVSF), Phnom Penh, Cambodia.
authors.forename: Aurelia
authors.initials: A
authors.lastname: Ponsich
authors.affiliation: Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; Centre de coopération internationale en recherche agronomique pour le développement (CIRAD), Département ES, UR AGIRs, Montpellier, France.
authors.forename: Flavie
authors.initials: F
authors.lastname: Goutard
authors.affiliation: National Animal Veterinary Research Institute (NaVRI), Phnom Penh, Cambodia.
authors.forename: San
authors.initials: S
authors.lastname: Sorn
authors.affiliation: Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia. Electronic address: atarantola@pasteur-kh.org.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Tarantola
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001733:Bites and Stings / Q000517:prevention & control*; D002160:Cambodia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004285:Dogs; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011818:Rabies / Q000453:epidemiology* / Q000517:prevention & control; D012424:Rural Population; D014611:Vaccination; D055815:Young Adult
keywords: Asia; Cambodia; Dog bite; Incidence; Prospective; Rabies; Rural