The Ministry of Health decided to start including dog bite injuries in the National Epidemiological Bulletin. The intention is to have a record of these injuries. Specialists explain what is known so far on the subject and what to do before a wound of these characteristics.
The announcement was made in the Bulletin of epidemiological week 19 (from May 7 to 13) to specify in week 20 (from May 14 to 20). The incorporation is part of the section "Tools for surveillance, prevention and response".
"Continuing with the implementation of the manual of rules and procedures for surveillance and control of mandatory notification events, since epidemiological week 20 of 2023, the events included in the unintentional injuries subgroup agreed in the last update are enabled in the National Health Surveillance System (SNVS)," they detail in the Bulletin.
And they point out: "The dog bite injury is the most frequent aggression of animals to humans. This event arises from a close coexistence that has been modified by development and urbanization, resulting in various forms of bond between people and canines."
Attack by a pit bull on a woman in Jujuy. Photo capture video / We are Jujuy.
According to the same text, it has "relevance for public health due to the multiple consequences it can bring, not only those related to serious zoonotic diseases such as rabies but, especially, for injuries of different severity with possible sequelae including death, psychological damage, social impact and various economic costs," they contribute in this regard.
They also refer to the numbers associated with these injuries. "In the United States, for example, about 4.5 million people suffer dog bites every year. Of these, almost 885,000 seek medical assistance; 30,000 undergo reconstructive procedures; Between 3% and 18% contract infections, and there are between 10 and 20 deaths," they warn.
"In other high-income countries, such as Australia, Canada and France, incidence and case fatality rates are comparable. In Spain, children under 14 years of age have a 4 times higher risk than other age groups," they add.
Less information is available in Argentina. In the Bulletin of week 20 they specify that, "according to the data arising from the Injury Surveillance System through its sentinel units, 6,245 people were treated for dog bites between 2004 and 2014".
The Rottweiler, one of the breeds considered dangerous for their attacks. Photo Shutterstock
And that "the main age group affected is children between 5 and 9 years old. The injuries described vary in severity from simple excoriations to severe polytrauma."
In turn, they cite local figures from the Directorate of Statistics and Health Information (DEIS), for the period 2005 and 2011, in which they registered 7,481 discharges for dog bites, representing five discharges for this cause per 10,000 of the total.
"In 60% of the cases those affected were males, with the highest concentration of cases occurring under 5 years of age. 50% of those affected were hospitalized for at least two days. Regarding the severity of the event, between 23% and 37% required surgical intervention. Also, according to the mortality records of the DEIS, in that same period 38 deaths were reported, "they add.
The Pitbull breed is another of those that usually star in attacks.
The objectives of this surveillance, according to the same source, are "to estimate the magnitude of the event and identify affected populations, epidemiologically characterize the serious cases and deaths as a result of these injuries and the aggressor agent and the circumstances in which the attack occurs." Also manage the information to "carry out follow-up actions".
The expert eye
Angela Nakab, a pediatrician at Pedro de Elizalde Hospital, says that "it is important that it be considered a public health issue because it is a relatively frequent injury."
He argues that the chances of infection by this type of bite are low, between 5% and 15%: "In older children and adolescents, wounds are usually recorded in the arms and legs while in the smallest and infants, in the face or neck."
"We must also analyze if it was an accident in the framework of a game or if the dog bit the child without any previous interaction to evaluate a possible case of rabies," says Nakab.
Stray dogs are dangerous due to the lack of sanitary controls.
The procedure, before the bite, is to wash the wound well with soap and water as soon as possible and visit a guard. "If the injury is to the arms or legs, you have to elevate the damaged limb and immobilize it," he adds.
It is key to know if the bitten person received his tetanus vaccination or if he has to repeat it and, in cases where the dog is unknown or does not have his vaccination card to confirm that he has the corresponding rabies applications, the affected person should start a rabies vaccination plan, according to the pediatrician.
Liliana Papalia, who is a clinical physician, points out that beyond vaccination and prophylaxis measures against the risk of infection, in many cases treatment with antibiotics is required.
He agrees that it is essential to clean the wound well and that suturing may be necessary. In addition, it is possible that the person has to be hospitalized, it depends on whether the wound is superficial or if it caused damage to muscles, tendons, for example, hurt the patient's face.
Ramiro Heredia, a clinician at the Hospital de Clínicas José de San Martín, agrees that "it is an event of relevance to public health."
"Health professionals always have to report the situation to the health authorities, detailing under what conditions it occurred and referring to the health of the animal, the injuries caused, as well as the treatments established and the follow-up of the case," he says.
Bites are related "to traumatic injuries, bacterial infections and serious zoonotic diseases, such as rabies," he says.
Risk of rabies
"Rabies is a vaccine-preventable viral disease that affects more than 150 countries and causes tens of thousands of deaths a year, mainly in Asia and Africa," Heredia said.
"In 99% of cases of transmission to humans, the disease is spread by dogs. Therefore, it can be prevented by vaccinating them. If it is believed that a bite has been received from a rabid animal, prophylactic measures should be applied. You have to wash the wound immediately and thoroughly with soap and water for 15 minutes, apply a series of rabies vaccines, and administer rabies immunoglobulins, "he explains.
Dogs and vaccination
Meanwhile, veterinarian Walter Pérez points out that dogs should receive their first rabies vaccine at three months of age and that the application must be repeated annually.
"The owner will receive a rabies vaccination certificate that he will have to show in case his pet bites another animal or a person," says Pérez.
And he adds: "Regardless of this, during the 10 days following the bite, the veterinarian must do an anti-rabies control to the animal to confirm that it is not sick."