Circumstances preceding animal-bite exposures in a tertiary anti-rabies clinic in North India: a retrospective descriptive record review

Abstract

Background Animal-bite-mediated rabies remains an important public health concern in India, where most human rabies cases are associated with dog bites. Prevention strategies commonly emphasize avoiding risky human–animal interactions; however, little is known about the circumstances and activities immediately preceding animal bite exposures among individuals presenting for postexposure care. Understanding these documented exposure contexts may help refine prevention strategies. Objective To characterize the behavioral and environmental circumstances preceding animal bite exposures in a rabies-endemic North Indian tertiary care setting and explore an activity-based classification of documented exposure contexts. Methods We conducted a retrospective descriptive review of 235 animal-bite records from a tertiary anti-rabies clinic in North India. Clinical records were reviewed to identify documented circumstances preceding the bite, activity at the time of exposure, human–animal interaction context, first-aid practices, and postexposure care-related information. Exposure contexts were derived inductively from record descriptions and descriptively grouped into categories reflecting passive environmental exposure, intentional human–animal interaction, and accidental disturbance. The classification was adapted conceptually from exposure-context approaches used in other zoonotic disease epidemiology, with modifications to account for defensive animal biting. Results Among 235 bite-event records screened, 233 animal-bite records were included in the exposure-context analysis. Most patients presented with WHO Category III exposures (165/235, 70.2%), followed by Category II exposures (70/235, 29.8%). Incidental exposure during routine activity was the most frequently documented circumstance, accounting for 149/233 cases (63.9%), including transient exposure during movement (116/233, 49.8%) and stationary exposure during sitting or standing (33/233, 14.2%). Intentional human–animal interaction accounted for 77/233 cases (33.0%), comprising caregiving-related interactions (40/233, 17.2%) and play-related interactions (37/233, 15.9%). Exposure following accidental disturbance was documented in 7/233 cases (3.0%). Conclusion In this clinic-based sample, most documented animal-bite exposures occurred during routine activities without recorded intentional interaction with animals, followed by intentional human–animal contact and accidental disturbance. These findings describe exposure circumstances among patients seeking post-exposure care but should not be interpreted as estimates of activity-specific bite risk or community incidence because population exposure denominators were unavailable.