Animal bite is one of the major causes of mortality and also a major health problem worldwide . The aim of this study was to investigate the epidemiology of animal bite cases in Kermanshah province during 2013–2017. The results showed that in the studied period, 5618 people had been bitten and an increasing significant trend was found for prevalence of animal bites over a 5-year time period. The mean prevalence of animal bites was estimated 44.1 per 100,000 populations during this time. In 2017, the prevalence of animal bites was 1.21 times higher than in 2013. In Holzer et al. study (2019) in the United States, the prevalence of animal bite cases between 2010 and 2014 was 0.25 and 0.19%, respectively . Venkatesan et al. (2014) study in India indicated the prevalence of 81.8% per 1000 population for animal bite . The high incidence of animal bites indicates the need for serious consideration to this issue. In this regard, health authorities should take the necessary measures to limit stray dogs, vaccine dogs, and develop training programs to make people inform about the complications of animal bites and how to prevent them. The animal bite cases have been increasing in Kermanshah through 2013–2017, which is consistent with the results of Frey et al. in Chad . The results of a study by Cuc et al. (2018) in Haiti reported 690 animal bite cases within 6 months . The results of Zohrevandi et al. (2012) study in Gilan, Iran showed that 1014 cases of animal bite were recorded in 2012 . According to the Charkazi et al. (2013) study in Golestan, Iran, through 1998–2009 13,142 animal bites were reported . In Kermanshah province, livestock farming is common and there is a high number of stray animals such as dogs and cats, so the possibility of animal bites is high. On the other hand, the growing number of animal bites shows that despite significant advances in health carein Kermanshah province, it has not yet been effective.
In our study, the prevalence of animal bites in both genders increased significantly over the study time period, which was 3.15 times higher in males than females. This finding is consistent with the results of other studies [9, 11, 25, 26]. The high prevalence of animal bite in male subjects can be associated with the large number of tribes living in Kermanshah. Accordingly, men are more likely to be bitten by animals as they are more active in outdoor activities.
In the current study, the prevalence of animal bites in urban/rural residency increased significantly over the study time period, which was 1.07 higher in urban areas than rural areas. This finding is consistent with the results of the Patel et al. (2017) and Riahi et al. (2012) studies in India and Iran, respectively [27, 28]. However, in some studies, the higher prevalence of animal bite cases were observed in rural areas [11, 23, 29]. In our opinion, the higher prevalence of animal bites in urban areas compared to rural areas may be due to the fact that urban dwellers do not know how to treat animals.
In the present study, except for the age group of 1–19 year old, an increasing trend of animal bites prevalence was found for other age groups during the study period, which was significant for 30–39 and 40–49 age groups. The prevalence of animal bites in the age groups of 30–39 and 40–49 was 1.2 and 1.13 times higher than that in the age group of 1–19, respectively. In most studies, the age group of younger than 40 years is the most common group that gets bitten by animals [3, 6, 11, 27, 30,31,32]. Those who are in the age range of 30–49 years are more active and adventurous, so animals can be stimulated to attack. They are also more present in the community, which can make them more vulnerable to animal bites.
In our study, the upper extremities were more involved than the lower extremities, and this difference was significant by the post hoc test. This finding is in line with the results of Shuzhen et al. (2018) study in Shenzhen and Shantou cities in China and also Zohrevandi et al. (2012) in Guilan, Northern Iran [23, 33]. However, some studies reported lower extremities as the most common affected site [8, 26, 27, 30, 34]. During an animal attack, both upper and lower extremities may be affected, which may be related to the position of the victim during the animal attack.
Based on the results, dogs were the most common cause for animal bite, which is similar to other studies [3, 11, 23, 27, 31, 34, 35]. The high prevalence of animal bite by dogs can be associated with the large number of tribes living in Kermanshah as well as the presence of stray dogs through the city. A sudden animal attack was the most common type of exposure to animal bite. Its high incidence can indicate that most cases were occurred without any special reason or stimulation.
Most cases had vaccinated with rabies vaccine for three times. In other studies, vaccination and human Rabies Immunoglobulin (HRIG) vaccination were reported as post-exposure measures [3, 9, 22, 27, 36, 37]. Vaccination and administration of HRIG, along with basic measures, such as washing with water and soap, can prevent the risk of animal bites, including the possibility of rabies [21, 38]. To schedule a rabies vaccination, 0.5 cc of the vaccine is inoculated into the deltoid muscle for five times on the first, third, seventh, fourteenth, and twenty-eighth days post exposure .
In the current study, the most common animal bite season was spring, which is consistent with some other studies [23, 40, 41]. The high prevalence of animal bites in the spring can be due to the presence of more people in recreational areas and outdoors, which makes them more likely to face animals.
In terms of occupation, the most victims had non-governmental jobs, however in some studies, students and university students were shown as the most common victims [11, 27]. The high incidence of animal bites in people with non-governmental jobs may be due to their working conditions, since they actually spend more time outdoors and are more likely to be exposed by animals.
Incomplete information recorded in victims’ documents was one of the main limitations of this study. Accordingly, they were contacted to answer incomplete information as far as possible. Other possible limitation was related to the possibility of inaccurate transferring the records data into the checklist, herewith the researcher tried to recheck all the information at least twice. The differing health status of different countries as well as laws related to animals affect the generalizability of our results.