|Year : 2016 | Volume
| Issue : 1 | Page : 104
Epidemiological study of animal bites and rabies in Lorestan Province in West of Iran during 2004-2014 for preventive purposes
Ali Chegeni Sharafi1, Mohammad Javad Tarrahi2, Mohammad Saki1, Mohammad Mirza Sharafi1, Elham Nasiri3, Hamid Mokhayeri1
1 Department of Prevention and Control of Communicable Diseases, Vice-Chancellery for Health, Lorestan University of Medical Sciences, Khorramabad, Iran
2 Department of Epidemiology and Biostatistics, School of Public Health, Lorestan University of Medical Sciences, Khorramabad, Iran
3 Infectious Diseases Ward, Shahid Madani Hospital, Lorestan University of Medical Sciences, Khorramabad, Iran
|Date of Submission||15-Aug-2015|
|Date of Acceptance||26-Jun-2016|
|Date of Web Publication||08-Sep-2016|
Mohammad Javad Tarrahi
Department of Epidemiology and Biostatistics, School of Public Health, Lorestan University of Medical Sciences, Khorramabad
Source of Support: None, Conflict of Interest: None
Background: Despite the progress made, animal bites and rabies are one of the important health problems in the country. The purpose of this study was to investigate the epidemiology of animal bites and rabies during 2004-2014 in Lorestan Province to prevent them in population of the province for the future prospective aspects.
Materials and Methods: In a descriptive cross-sectional study, all those cases bitten in the province, during 2004 and 2014, were studied. The required information about the age, sex, the bitten organ, type of the invasive animal time, and location of the event were collected in questionnaires and then analyzed.
Results: The total number of cases of animal rabies during the period of study was 43,892, shown at the rate of 223.23 in 100,000 people. Seventy-eight percent of animal bites in rural areas, 41.42% in the ages 10-29-year-old, 26.8% of cases were students, 56.77% leg bites, and 82.5% of dog bites. Four cases of human rabies were observed during this period.
Conclusions: Rate of animal bites and rabies is high in Lorestan Province. Controlling animals such as dogs and cats in the province through training people at risk, especially among the students, rural areas and inter-sectorial coordination to eliminate stray animals should be considered over and over. Preventive actions to avoid bites are a priority.
Keywords: Animal bites, epidemiology, Iran, Lorestan, rabies
|How to cite this article:|
Sharafi AC, Tarrahi MJ, Saki M, Sharafi MM, Nasiri E, Mokhayeri H. Epidemiological study of animal bites and rabies in Lorestan Province in West of Iran during 2004-2014 for preventive purposes. Int J Prev Med 2016;7:104
|How to cite this URL:|
Sharafi AC, Tarrahi MJ, Saki M, Sharafi MM, Nasiri E, Mokhayeri H. Epidemiological study of animal bites and rabies in Lorestan Province in West of Iran during 2004-2014 for preventive purposes. Int J Prev Med [serial online] 2016 [cited 2020 Nov 26];7:104. Available from: https://www.ijpvmjournal.net/text.asp?2016/7/1/104/190090
| Introduction|| |
Rabies is a dangerous zoonosis that caused by a lyssavirus.  More than 3.3 billion people are exposed to the disease.  The incidence of animal bites in the world is estimated at 250 out of 1000 people. In Iran, 180 people in 100,000, and the incidence of rabies <1 in a million is calculated.  According to statistics published by the WHO, this disease causes between 1.3 and 2.6 million Dally in a year.  Although rabies is preventable with safe and effective vaccines, it is still a health problem so that approximately 60,000 deaths occur annually in the world, and most cases occur in Asia and Africa. ,
Forty percent of those bitten by animals were children under 15.  Annually, in different parts of the world, more than 15 million people due to animal bites refer to special centers to treat.  The real number of cases is probably higher than the figures reported due to the lack of advanced care system.  In addition to the public human health, the incidence of the disease in animals causes significant economic losses. 
Rabies has always existed in Iran  and also exists among Iran's endemic wildlife. Domestic animal contamination frequently occurs and its incidence has been increasing. , The occurrence of this disease is reported every year from various provinces of Iran.  The growing cases of stray dogs and also the increasing number of animal bites and rabies distribution in many provinces has caused massive annual costs to prepare vaccines, serum, and preventive actions. , And that more attention needs to be paid to control the disease and research about its different aspects.
Furthermore, wide geographical distribution, ecological diversity, and dependency of the risk factors of rabies to wildlife species, and also different levels of health knowledge, indicate that separate investigations should be conducted in different regions of the country.
Being aware of the epidemiology, prevalence, and at risk age groups, we can provide the officials with good ways to prevent this health problem in the health systems.
This study aimed to evaluate the incidence of animal bites in the Lorestan Province in the West of Iran, its distribution, and human rabies deaths from the disease over a period of eleven years from 2004 to 2014 to prevent its growing in future planning.
| Materials and methods|| |
This was a descriptive cross-sectional study performed in Lorestan Province, West of Iran. The population of this study were comprised those bitten by animals from the beginning of 2004 to the end of 2014. They had referred to all Medical Science units in province belonging to Lorestan University, to get rabies prevention treatment. The census method was used for all the qualified individuals. In our definition, a "bitten person" is called one bitten by an animal and refers to the rabies prevention centers due to animal bites and fear of rabies. A person is said "rabies case" whose infection is confirmed by the Pasteur Institute. During the study, the required information in all cases of animal bites and human rabies were collected by questionnaire. Questions included age, sex, the bitten organ, place of occurrence, the bite time, and the kind of aggressive animal. The collected data were entered into the SPSS statistical software version 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.) and were analyzed by descriptive statistics such as frequency distribution and percentage. To calculate the incidence rate, the population of Lorestan Province was obtained from Management and Planning Organization of the province, and the calculations were conducted based on them.
| Results|| |
During 2004 till 2014, the number of animal bite cases in the province which has received preventive treatment care was 43,892. The incidence of animal bites during this period was an average 223.23 in 100,000 inhabitants [Table 1]. Seventy-eight percent of all cases of animal bites in rural areas and 22% in urban areas, respectively. Totally, 33,230 (76%) were men, and 10,662 (24%) occurred in women, respectively; the incidence of most animal bites 21.1% occurred between the ages of 29 and 20 and 19 and 10 years with a 20.3% of cases. Students were the most cases (26.8%).
|Table 1: Frequency distribution and incidence rate of animal bite cases in Lorestan Province, West of Iran (2004-2014) |
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Most cases of lower limb for limb bites (feet), with 24,861 (57%) followed by the upper extremities (hands) with 14,716 (33%), trunk with 3079 (7%), and head and neck with 1236 (3%), respectively. The report included dogs with the most bites, 36,222 cases (82.5%), followed by cats with 5894 cases (13.4%), and other animals in 1776 (1.4%) [Table 2]. Distribution of animal bite cases based on month and gender indicated that most cases of animal bites occurred in spring and summer [Table 3].
|Table 2: Distribution of animal bite cases in Lorestan Province, West of Iran (2004-2014) based on gender, residency, age, bite site, type of biting animal and job |
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|Table 3: Frequency distribution of animal bite cases in Lorestan Province, West of Iran (2004-2014) based on month and gender |
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Human rabies infections which were observed in four of all cases were confirmed by the Pasteur Institute of Iran. All these people were rural. Two of them were females (3 and 18-year-old) who had been affected by a fox, and two were males (16 and 50-year-old). Dog was the source of their illness. None of them referred to the centers to receive treatment to prevent rabies. Four cases, respectively, happened in the years 2009, 2010, 2012, and 2013.
| Discussion|| |
Findings of this study showed that 43,892 people in the years 2004-2014 in Lorestan Province had been bitten by the animals. During this time, the animal bite was 223.23 out of 100,000 that in comparison to the same period all over Iran was (an average of 180/10,000) higher. Increasing the incidence can lead to permanent educational programs in urban and rural health centers and health homes to prevent the occurrence of rabies in humans and raising awareness of the risk caused by the biting animals in the province. On the other hand, inaction and inadequacy of the measures taken by the Animal (stray dogs) Rabies Control Committee, especially in the rural areas in most cities and the lack of widespread implementation of the vaccination of domestic dogs and cattle can increase the incidence of rabies.
The incidence of the disease is higher than the study conducted by Riahi et al. in Tabas  Sabouri Ghannad et al. in Ilam,  Saghafipour et al. in Qom,  and Sadeghi et al. in the West of Azarbayejan.  However, it is nearer to the reports by Kassiri et al. in Kermanshah and Khuzestan, , Amiri and Khosravi in Shahrood  and Sheikholeslami et al. in Rafsanjan.  In studies conducted by Khazaei et al. in Hamedan,  Dadypour et al. in Kalaleh,  and Charkazi et al. in Aq Qala in the North of Iran,  the amount of reported cases, respectively, is 423, 7773 and 1222 in 100,000 people.
Higher incidence of animal rabies in the mentioned areas is due to the climatic conditions where the presence of the main reservoirs of the disease including wolf-likes, and other wild animals are higher than Lorestan Province.
In this study, the result of the observed cases of animal rabies is the same as the results taken in different provinces of Iran. ,,,,,,,,,,,,,,,,,,,,,,,,,, It is higher in men in comparison to women, because men have more exposure to animals, and also spend most of their time outside the home environment and also sense of adventure in men is more exposure than women. However, the situation is not the same everywhere for both sexes. Maybe, due to the social and climate conditions, both of them are equally at risk of animal bites. For example, in Ethiopia Ramos' study shows that animal bite is almost equal in both sexes. 
According to the results of this study, high percentage of people bitten by animals was under 20 years in 17,125 (39%), and most of the observed cases were students in 11,765 (26.8%).
The reason of high percentage of bite among the students is that the students and those who are in the same range are more willing to play with animals, or hurt them.
The results show that on this age and work group, training at schools about rabies, and its transmission should be done more. It can especially be effective in reducing the incidence of animal bites.
In all other reported studies, higher occupational distribution of animal bites is in children. ,,,,,,,,, The most cases have occurred in the 10-19 age group, ,,,,,,,,, at least 23% in Dehghani's study  and up to 49.3% in Bahonar et al.'s study. 
Anatomically, most of the bites were related to feet (56.7%). In a study conducted by Charkazi et al. in AQ qala 69.4%,  Bahonar et al. in Ilam 69.7%,  Kassiri et al. in Kermanshah 75.8% in Shush 81.4%, , Dehghani et al. in Semirom in Isfahan Province 67%,  Haratynejad and Khanjani in Rashtkhar in Khorasan Province 63.9%,  Dadypour et al. in Kalaleh 67%,  Khazaei et al. in Hamadan 49.4%,  Sabouri Ghannad et al. in Ilam 71.8%,  Amiri and Khosravi in Shahrood 60%,  and Alavi and Alavi in Khuzestan 58%  were cases related to the feet.
Kassiri's study in Khuzestan 61.4%,  Yalcin et al. in Turkey 53%,  and Erfanian et al. in Mashhad 43.4%  showed that the most bites happened in upper limbs. In Naghibi et al.'s study 46.3%,  Sheikholeslami et al. in Rafsanjan 48%,  Zohrevandi et al. in Rasht,  and Saghafipour et al. in Qom 52.4%  the bites are on the hands.
The differences between the results of studies may be related to the ways of facing the animal.
In taller adults and in cases where an animal attacks a person fleeing, feet are more exposed to bites. However, in cases where a person is playing with or harassing an animal or has shorter stature (like children), it is more likely to bite upper limbs, head, and face.
In this study, most people injured were rural (79%), which is consistent with most of the studies. ,,,,,,,,,,,,,,,
Animal bites occur more in rural areas, because in most villages, livestock or agriculture is the main occupation of the people, especially in forests and mountainous areas, it is more likely for the people to face stray dogs and wild animals.
However, studies conducted in the centers of province or city, for instance Saghafipour et al. in Qom,  Kassiri et al. in Khuzestan,  Riahi et al. in Tabas,  Erfanian et al. in Mashhad,  and Fayaz in Tehran,  Most people cases were in urban areas.
Most cases of animal bites in the study occurred in spring and summer. Apart from the study conducted by Kassiri et al. in which the animal bite has happened more slightly in fall and winter, in other studies, most cases have occurred in spring. ,,,,,,, Higher exposure to animals, especially in rural areas, is due to agricultural activity and contact with the animals and the increase in leisure travels to areas of good weather in spring by travelers.
In terms of spices, respectively, 83% was related to dogs and 13% to cats, which shows the same results conducted in Iran or abroad. Most cases have involved dogs.
Dogs face wild animals more, especially wolves and canines, which statistically are the main source of disease. Most observed cases of animal bites and human rabies result from dog and canine bites. Therefore, vaccination, containment of domestic dogs and cattle (at least during the day) and enable the special committee to lose the stray dogs, seem necessary.
During the study, four cases of rabies have occurred in the province. None of these people had referred for preventive services. In Bahonar's study in Ilam Province, where conditions are similar to Lorestan province, four fatal cases were reported. This shows that despite the efforts made, and providing prevention services, lack of awareness of disease risks, and also poor information do not let all the people who are attacked by animals refer to the centers to get services.
| Conclusions|| |
Due to the rather high rate of human rabies and animal rabies in the province, we can conclude that wildlife of the province is infected with the virus that causes disease in domestic animals, owner dogs or some cases, with human bites carry rabies to people. According to the results of this study and other studies, students and residents of villages are more at risk. Hence, training the people at risk about hurting and mistreatment of dangerous animals, ways of transmitting the disease, convincing the owners of sheep dogs and domestic dogs to go to the veterinary, and vaccination offices to vaccinate and collar their dogs and their dogs can play an important role in reducing the incidence of animal bites and rabies cause death.
It is necessary to appreciate all who worked with us in this study, especially personnel worked in specialized units to fight against infectious diseases all over the province and subsidiary cities.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Azizi F, Hatami H, Janghorbani M. Epidemiology and Control of Common Diseases in Iran. 3 rd
ed. Tehran: Eshtiagh; 2012. p. 602-16.
Knobel DL, Cleaveland S, Coleman PG, Fèvre EM, Meltzer MI, Miranda ME, et al.
Re-evaluating the burden of rabies in Africa and Asia. Bull World Health Organ 2005;83:360-8.
Farahtaj F, Fayaz A, Howaizi N, Biglari P, Gholami A. Human rabies in Iran. Trop Doct 2014;44:226-9.
World Health Organization. Rabies Fact Sheet No. 99. Geneva: WHO; 2013.
Gholami A, Fayaz A, Farahtaj F. Rabies in Iran: Past, present and future. J Med Microbiol Infect Dis 2014;2:1-10.
World Health Organization. WHO Expert Consultation on Rabies. Second Report. World Health Organization Technical Report Series. Geneva: World Health Organization; 2013.
Bahonar AR, Rashidi H, Simani S, Fayaz A, Haghdoost AA, Rezaei-Nassab M, et al
. Relative frequency of animal rabies and factors affecting it in Kerman Province, 1993-2003. J Sch Public Health Inst Public Health Res 2007;5:69-75.
Janani AR, Fayaz A, Simani S, Farahtaj F, Eslami N, Howaizi N, et al.
Epidemiology and control of rabies in Iran. Dev Biol (Basel) 2008;131:207-11.
Nadin-Davis SA, Simani S, Armstrong J, Fayaz A, Wandeler AI. Molecular and antigenic characterization of rabies viruses from Iran identifies variants with distinct epidemiological origins. Epidemiol Infect 2003;131:777-90.
Eslamifar A, Ramezani A, Razzaghi-Abyaneh M, Fallahian V, Mashayekhi P, Hazrati M, et al.
Animal bites in Tehran, Iran. Arch Iran Med 2008;11:200-2.
Hatami H, Razavi S, Eftekhar A, Majlesi F, Sayed Nozadi M, Parizadeh S. Textbook of Public Health. 3 rd
ed. Tehran: Arjmand; 2012. p. 1030-40.
Sharifian J, Simani S, Shirzadi M, Fayaz A, Hoshmand B. National directory to rabies control. Tehran: Seda Publications; 2004. p. 56.
Riahi S, Latifi A, Bakhtiyari M, Yavari P, Khezeli M, Hatami H, et al
. Epidemiologic survey of animal bites and causes of delay in getting preventive treatment in tabbas during 2005-2010. Tolooe Behdasht 2012;11:20-31.
Sabouri Ghannad M, Roshanaei G, Rostampour F, Fallahi A. An epidemiologic study of animal bites in Ilam Province, Iran. Arch Iran Med 2012;15:356-60.
Saghafipour A, Noroozei M, Pahlevani S, Akbari Z. Epidemiology of animal bites in Qom Province during 2007-2012, Iran. Qom Univ Med Sci J 2014;8:42-7.
Sadeghi A, Shariatzadeh MR, Nezhadrahim R. The incidence of animal bites in the province of West Azerbaijan in 1999. Urmia Med J 2003;14:9-15.
Kassiri H, Kassiri A, Mosavi R, Jashireh A, Lotfi M. Prevalence rate and epidemiological determinants of animal bite in Ahvaz County, Khuzestan Province, Southwestern Iran. J Acute Dis 2014;3:51-5.
Kassiri H, Kassiri A, Pourpolad-Fard M, Lotfi M. The prevalence of animal bite during 2004-2008 in Islamabad-Gharb County, Kermanshah Province, Western Iran. Asian Pac J Trop Dis 2014;4 Suppl 1:342-6.
Amiri M, Khosravi A. Animal bites epidemiology in Shahroud City. Knowl Health 2009;4:41-3.
Sheikholeslami NZ, Rezaeian M, Salem Z. Epidemiology of animal bites in Rafsanjan, Southeast of Islamic Republic of Iran, 2003-2005. East Mediterr Health J 2009;15:455-7.
Khazaei S, Rezaeian S, Soheylizad M, Gholamaliee B. Factors associated with delay in post-exposure prophylaxis in bitten people. Med J Islam Repub Iran 2014;28:158.
Dadypour M, Salahi R, Ghezelsofla F. Epidemiological survey of animal bites in Kalaleh district, North of Iran (2003-5). J Gorgan Univ Med Sci 2009;11:76-9.
Charkazi A, Behnampour N, Fathi M, Esmaeili A, Shahnazi H, Heshmati H. Epidemiology of animal bite in Aq Qala city, Northen of Iran. J Educ Health Promot 2013;2:13.
Zohrevandi B, Asadi P, Kasmaie VM, Tajik H, Fatemi MS. Epidemiologic study of animal bite in Rasht County, Guilan Province, Iran's North, 2012. Iran J Emerg Med 2014;1:11-5.
Bahonar A, Bokaie S, Khodaveirdi K, Nikbakht Boroujeni G, Rad M. A study of rabies and the frequency of animal bites in the Province of Ilam, 1994-2004. Iran J Epidemiol 2008;4:47-51.
Dehghani R, Sharif MR, Sharif AR, Moghimi A, Ashaari A, Hosseini MA. Epidemiology of animal bite in Samirom in 2008 to 2012. Iran J Infect Dis Trop Med 2013;18:45-8.
Erfanian Taghvaei MR, Habibi F, Esmaeili HA, Erfanian Taghvaei M. Individual Animal biting in the city of Mashhad (2006-2009). Q J Med Sci Islam Azad Univ Mashhad 2010;5:253-8.
Fayaz, A, Simani, S, Janani, AR, Farahtaj F, Esfandyari, B, Eslami, N, et al
. Epidemiological survey of rabies in Mazandaran Province during 1996-2006. J Babol Univ Med Sci 2009;11:70-5.
Fayaz A, Fallahian V, Simani S, Eslamifar A, Mohammadian A, Hazrati M, et al
. Epidemiological characteristics of persons exposed to rabies in Tehran referred to Pasteur Institute of Iran during the years of 1993-1994 and 2008-2009. Research in Medicine 2011;35:168-73.
Haratynejad AR, Khanjani N. The Epidemiology of animal bites in the town of Rashtkhar from 1383 to 1389 (solar hejri). First National Conference on Environmental Protection and Planning, 21 February. Hamadan, Iran: Islamic Azad University; 2013.
Kassiri H, Kassiri A, Lotfi M, Shahkarami B, Hosseini SS. Animal bite incidence in the county of Shush, Iran. J Acute Dis 2014;3:26-30.
Naghibi SA, Yazdanicharati J, Shojaie J. Epidemiological characteristic of animal-bite cases in Mazandaran, 2004-2011. J Mazandaran Univ Med Sci 2014;24:218-24.
Pourmarzi D, Razi M. Activities leading to dog bite incidence in Guilan Province, North of Iran. Razi J Med Sci 2014;20:9-17.
Rezaeinasab M, Rad I, Bahonar A, Rashidi H, Fayaz A, Simani S, et al
. The prevalence of rabies and animal bites during 1994 to 2003 in Kerman Province, Southeast of Iran. Iran J Vet Res 2007;8:343-50.
Babaeeian-Moghaddam M, Hashemi-Nazari SS, Khodakarim S. Epidemiological study on animal bite cases and its related injury in Quchan district in 2013. J Saf Promot Inj Prev 2015;3:9-14.
Bharadva N, Mehta SR, Yerpude P, Jogdand K, Trivedi KN. Epidemiology of Animal bite cases attending tertiary health care centre of Bhuj City of India: A cross-sectional study. Int J Interdiscip Multidiscip Stud 2015;99:98-102.
Jafari-Khounigh A, Nayerpour A, Mahboub-Ahari A, Mahmoodi J, Rezadokht-Mamaghani P, Kalan MH, et al
. Epidemiology of animal bites in Azarshahr town: A cross-sectional study of key determinants. Depiction Health 2014;5:4-7.
Jain M, Prakash R, Garg K, Jain R, Choudhary M. Epidemiology of animal bite cases attending anti-rabies clinic of a Tertiary Care Centre in Southern Rajasthan. J Res Med Dent Sci 2015;3:79-82.
Pourmarzi D, Razi M. Incidence rate of rabies vaccination delay after dog bite in Guilan Province. Holistic Nurs Midwifery J 2015;25:17-26.
Riabi HR, Ghorbannia R, Mazlum SB, Atarodi A. A Three-year (2011-2013) surveillance on animal bites and victims vaccination in the South of Khorasan-e-Razavi Province, Iran. J Clin Diagn Res 2015;9:LC01-5.
Ramos JM, Melendez N, Reyes F, Gudiso G, Biru D, Fano G, et al.
Epidemiology of animal bites and other potential rabies exposures and anti-rabies vaccine utilization in a rural area in Southern Ethiopia. Ann Agric Environ Med 2015;22:76-9.
Alavi SM, Alavi L. Epidemiology of animal bites and stings in Khuzestan, Iran, 1997-2006. J Infect Public Health 2008;1:51-5.
Yalcin E, Kentsu H, Batmaz H. A survey of animal bites on humans in Bursa, Turkey. J Vet Behav 2012;7:233-7.
[Table 1], [Table 2], [Table 3]