J Korean Med Assoc.  2015 Mar;58(3):227-234. 10.5124/jkma.2015.58.3.227.

Animal bite injuries and vaccination

• Kang H

• KMID: 2194943
• DOI: http://doi.org/10.5124/jkma.2015.58.3.227

Abstract

Animal bites are a common problem managed by primary physicians and often involve wound infection, neurovascular injury, poor cosmetic outcome, and high medical costs. During clinical assessment, a thorough medical history is acquired, including details of the bite circumstances and the patient's immune status and vaccination history. A meticulous physical examination should be performed in order to identify any injuries to deep structures, in addition to exploring the wound by creating a narrow opening and using diagnostic tools such as radiograph and ultrasound where necessary. Infection is the most problematic complication after a bite injury. Cleaning, irrigation, and debridement are the most important steps in preventing infection. The use of prophylactic antibiotics is controversial, but probably indicated in immunocompromised individuals and in anatomical areas that are more likely to be infected, such as the hand and foot. The decision to close a bite wound must be based on consideration of the benefit of a good cosmetic outcome and the increased risk of infection. In Korea, human rabies has not occurred since 2005, but the transmission of rabies is still a concern with animal bites. The transmission of viral hepatitis, herpes virus and human immunodeficiency virus can occur following human bites. To prevent the transmission of various viruses, healthcare providers should know the guidelines for post-bite exposure prophylaxis.

Keyword

Bites and stings; Immunization; Rabies; Wounds and injuries

MeSH Terms

Animals
Anti-Bacterial Agents
Bites and Stings
Bites, Human
Debridement
Foot
Hand
Health Personnel
Hepatitis
HIV
Humans
Immunization
Korea
Physical Examination
Rabies
Ultrasonography
Vaccination*
Wound Infection
Wounds and Injuries
Anti-Bacterial Agents

Reference

1. Benson LS, Edwards SL, Schiff AP, Williams CS, Visotsky JL. Dog and cat bites to the hand: treatment and cost assessment. J Hand Surg Am. 2006; 31:468–473.

2. Statistics Korea. Surveys of occupational diseases and injuries in farmers [Internet]. Daejeon: Statistics Korea;2013. cited 2015 Feb 16. Available from: http://kosis.kr/statHtml/statHtml.do?orgId=143&tblId=DT_14303_E1429&vw_cd=&list_id=&scrId=&seqNo=&lang_mode=ko&obj_var_id=&itm_id=&conn_path=K1&path=.

3. Nonghyup Economic Research Institute. The trend and prospect of the pet industry: research report [Internet]. Seoul: Nonghyup Economic Research Institute;2013. cited 2013 May 13. Available from: http://www.nheri.re.kr/sub2/sub2_1.php?smenu=sub2&stitle=subtitle2_2&ssrc=sub2.php&sdetail=sub2_1.php&idx=588&code=&page=3&CATE=104000000&SUB_CATE=.

4. Noh JC, Park HM, Park JH, Won YK, Lee CH, Kim JY. Five year experience of preexposure and postexposure rabies prophylaxis in Korean children at the national medical center. Korean J Pediatr Infect Dis. 2013; 20:9–16.

5. Weiss HB, Friedman DI, Coben JH. Incidence of dog bite injuries treated in emergency departments. JAMA. 1998; 279:51–53.

6. Kim SH, You JY, Ryu JY. Comparison of characteristics in dog bite patients. J Trauma Inj. 2005; 18:135–140.

7. Sacks JJ, Lockwood R, Hornreich J, Sattin RW. Fatal dog attacks, 1989-1994. Pediatrics. 1996; 97(6 Pt 1):891–895.

8. Hutson HR, Anglin D, Pineda GV, Flynn CJ, Russell MA, McKeith JJ. Law enforcement K-9 dog bites: injuries, complications, and trends. Ann Emerg Med. 1997; 29:637–642.

9. Capellan O, Hollander JE. Management of lacerations in the emergency department. Emerg Med Clin North Am. 2003; 21:205–231.

10. Elenbaas RM, McNabney WK, Robinson WA. Evaluation of prophylactic oxacillin in cat bite wounds. Ann Emerg Med. 1984; 13:155–157.

11. Westling K, Farra A, Cars B, Ekblom AG, Sandstedt K, Settergren B, Wretlind B, Jorup C. Cat bite wound infections: a prospective clinical and microbiological study at three emergency wards in Stockholm, Sweden. J Infect. 2006; 53:403–407.

12. Dire DJ. Cat bite wounds: risk factors for infection. Ann Emerg Med. 1991; 20:973–979.

13. Griego RD, Rosen T, Orengo IF, Wolf JE. Dog, cat, and human bites: a review. J Am Acad Dermatol. 1995; 33:1019–1029.

14. Correira K. Managing dog, cat, and human bite wounds. JAAPA. 2003; 16:28–32.

15. Margileth AM. Cat scratch disease. Adv Pediatr Infect Dis. 1993; 8:1–21.

16. Vermeulen MJ, Rutten GJ, Verhagen I, Peeters MF, van Dijken PJ. Transient paresis associated with cat-scratch disease: case report and literature review of vertebral osteomyelitis caused by Bartonella henselae. Pediatr Infect Dis J. 2006; 25:1177–1181.

17. Wallace CG, Robertson CE. Prospective audit of 106 consecutive human bite injuries: the importance of history taking. Emerg Med J. 2005; 22:883–884.

18. Smith PF, Meadowcroft AM, May DB. Treating mammalian bite wounds. J Clin Pharm Ther. 2000; 25:85–99.

19. Lee HM, Jung KE, Koo DW, Lee JS. A case of recurrent type 1 herpes simplex viral infection on the areola after human bite. Korean J Dermatol. 2014; 52:357–358.

20. Chadaev AP, Jukhtin VI, Butkevich AT, Emkuzhev VM. Treatment of infected clench-fist human bite wounds in the area of metacarpophalangeal joints. J Hand Surg Am. 1996; 21:299–303.

21. Talan DA, Abrahamian FM, Moran GJ, Citron DM, Tan JO, Goldstein EJ. Emergency Medicine Human Bite Infection Study Group. Clinical presentation and bacteriologic analysis of infected human bites in patients presenting to emergency departments. Clin Infect Dis. 2003; 37:1481–1489.

22. Drobatz KJ, Smith G. Evaluation of risk factors for bite wounds inflicted on caregivers by dogs and cats in a veterinary teaching hospital. J Am Vet Med Assoc. 2003; 223:312–316.

23. Dire DJ, Welsh AP. A comparison of wound irrigation solutions used in the emergency department. Ann Emerg Med. 1990; 19:704–708.

24. Lineaweaver W, Howard R, Soucy D, McMorris S, Freeman J, Crain C, Robertson J, Rumley T. Topical antimicrobial toxicity. Arch Surg. 1985; 120:267–270.

25. Callaham M. Prophylactic antibiotics in common dog bite wounds: a controlled study. Ann Emerg Med. 1980; 9:410–414.

26. Chen E, Hornig S, Shepherd SM, Hollander JE. Primary closure of mammalian bites. Acad Emerg Med. 2000; 7:157–161.

27. Mehta PH, Dunn KA, Bradfield JF, Austin PE. Contaminated wounds: infection rates with subcutaneous sutures. Ann Emerg Med. 1996; 27:43–48.

28. Presutti RJ. Bite wounds: early treatment and prophylaxis against infectious complications. Postgrad Med. 1997; 101:243–244.

29. Stillman RM, Marino CA, Seligman SJ. Skin staples in potentially contaminated wounds. Arch Surg. 1984; 119:821–822.

30. Rodeheaver GT, McLane M, West L, Edlich RF. Evaluation of surgical tapes for wound closure. J Surg Res. 1985; 39:251–257.

31. Cummings P. Antibiotics to prevent infection in patients with dog bite wounds: a meta-analysis of randomized trials. Ann Emerg Med. 1994; 23:535–540.

32. Turner TW. Evidence-based emergency medicine/systematic review abstract. Do mammalian bites require antibiotic prophylaxis? Ann Emerg Med. 2004; 44:274–276.

33. Talan DA, Citron DM, Abrahamian FM, Moran GJ, Goldstein EJ. Emergency Medicine Animal Bite Infection Study Group. Bacteriologic analysis of infected dog and cat bites. N Engl J Med. 1999; 340:85–92.

34. Centers for Disease Control and Prevention. Manual for the surveillance of vaccine-preventable diseases [Internet]. Atlanta: Centers for Disease Control and Prevention;2012. cited 2015 Feb 16. Available from: http://www.cdc.gov/vaccines/pubs/surv-manual/.

35. Colombet I, Saguez C, Sanson-Le Pors MJ, Coudert B, Chatellier G, Espinoza P. Scientific Committee of the TetaQuick 1000 Study. Diagnosis of tetanus immunization status: multicenter assessment of a rapid biological test. Clin Diagn Lab Immunol. 2005; 12:1057–1062.

36. Smith DK, Grohskopf LA, Black RJ, Auerbach JD, Veronese F, Struble KA, Cheever L, Johnson M, Paxton LA, Onorato IM, Greenberg AE. U.S. Department of Health and Human Services. Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States: recommendations from the U.S. Department of Health and Human Services. MMWR Recomm Rep. 2005; 54:1–20.

37. Holmes GP, Chapman LE, Stewart JA, Straus SE, Hilliard JK, Davenport DS. The B virus Working Group. Guidelines for the prevention and treatment of B-virus infections in exposed persons. Clin Infect Dis. 1995; 20:421–439.

38. Park JS, Kim SY, Hwang KJ. Animal bite cases in high-risk region of rabies, 2013. Public Health Wkly Rep. 2014; 7:713–719.

39. Yang DK, Kim SY, Oh YI, Lee JA, Cho SD, Lee KW, Song JY. Epidemiological characteristics of rabies in South Korea from January 2004 to March 2011. J Bacteriol Virol. 2011; 41:165–171.

40. Rupprecht CE, Briggs D, Brown CM, Franka R, Katz SL, Kerr HD, Lett SM, Levis R, Meltzer MI, Schaffner W, Cieslak PR. Centers for Disease Control and Prevention (CDC). Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices. MMWR Recomm Rep. 2010; 59:1–9.