“A SINGLE DOG BITE CAN COST

A LIFE, ONE VACCINE CAN SAVE

IT”

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 “TIME GAP BETWEEN ANIMAL BITE AND FIRST DOSE
OF ANTI-RABIES VACCINE AMONGST PEOPLE WITH
ANIMAL BITE VISITING ARV CLINIC OF SIR-T HOSPITAL,
BHAVNAGAR”

By students of Batch D-2022 (3rd MBBS part 1)

NAME ROLL NO.
Sahil Siddiq 151
Sahil Mitaliya 152
Sanjay Gohil 153
Santosh Katara 154
Satyam Gangani 155

GUIDE
Dr. Dhiren Amin (Associate Professor)
Department Of Community Medicine
GMC, Bhavnagar
Co-Guide (Resident Doctor)
Dr. Sanjay Chaudhari
Department of Community Medicine
GMC, Bhavnagar

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 ACKNOWLEDGMENT

 We take this opportunity to express our heartily

gratefulness to the people visiting ARV clinic of Sir T
hospital Bhavnagar who participated and helped us to
make our project up to the level anticipated.

 We are very thankful to Dr. Bharat Patel Sir, Head of

Department of Community Medicine and Dr. Dhiren
Amin sir, Associate Professor of Community Medicine
for giving their sensitization regarding importance of
research project for medical students.

 We are very thankful to faculty and residents of

Department of community medicine who taught us
about PSBH.

 We are also thankful to Dr. Sanjay sir for guiding us for

this research project.

 We would like to thank the department of Community

Medicine and library of Government Medical College,
Bhavnagar for providing us opportunity of working on
this research project.

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 Department of Community Medicine

Government medical College Bhavnagar

CERTIFICATE

This is to certify that Mr./Miss.

…………………………………………………………………
Roll no………. of admission batch 2022, Third
First M.B.B.S.- part – I has completed
his/her public health innovation research project
titled TIME GAP BETWEEN ANIMAL BITE AND FIRST
DOSE OF ANTI-RABIES VACCINE AMONGST PEOPLE
WITH ANIMAL BITE VISITING ARV CLINIC OF SIR T.
HOSPITAL BHAVNAGAR.

He / She has obtained marks out of

100. Project guide:
Dr. DHIREN AMIN,
ASSOCIATE PROFESSOR
Department of Community Medicine,
Government Medical College,
Bhavnagar

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 INDEX
SR NO. TOPIC PAGE NO.

1 INTRODUCTION AND 06

RATIONALE

2 REVIEW OF LITERATURE 07

3 OBJECTIVE 14

4 METHODOLOGY 15

5 RESULTS 17

6 CONCLUSIONS 24

7 RECOMMANDATIONS 25

8 BIBLIOGRAPHY 26

9 ANNEXURE 27

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 INTRODUCTION & RATIONALE

Research question:

 What is the time gap between animal bite and first

dose of Anti-Rabies vaccine amongst people with
animal bite visiting ARV clinic of Sir T hospital
Bhavnagar?

Rationale:
 Rabies is a fatal viral disease that continues to pose a
significant public health challenge, particularly in low-
and middle-income countries. It is almost invariably
fatal once clinical symptoms appear, but entirely
preventable through timely and appropriate post-
exposure prophylaxis (PEP), which includes immediate
wound care and administration of anti-rabies vaccine
(ARV). One of the most critical factors in the
effectiveness of PEP is the time interval between the
animal bite and the administration of the first dose of
the vaccine.

 Delayed initiation of ARV may allow the rabies virus to

proliferate and reach the central nervous system,
reducing the effectiveness of the vaccine and

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 increasing the risk of disease progression.
Despite established guidelines recommending prompt
vaccination, delays are common due to a range of factors
including lack of awareness, accessibility issues, and
socioeconomic barriers.
Understanding this time-dependent risk is essential for:
Optimizing public health guidelines for PEP.

REVIEW OF LITERATURE
 Definition:

 Rabies, also known as hydrophobia is an acute, highly fatal

viral disease of the central nervous system, caused by
Lyssavirus type 1. It is primarily a zoonotic disease such as
dogs, cats, jackals and wolves. It is transmitted to man
usually by bites or licks of rabid animals. It is the only
communicable disease of man that is always fatal.[1]

 It is a 100% fetal in untreated cases and 100%

preventable by timely Anti rabies vaccination.
 This anti rabies vaccine available since 1885, Rabies
related mortality in human significant health concern,
particularly in low resource country.
 People become infected with rabies because of not /or
incorrectly administration of post exposure prophylaxis
(PEP).
 According to WHO, 59000 human death per year recorded
globally.[2]

National Studies on Time Gap between Animal Bite

and First Dose

a. Sudarshan et al. (2006) – Karnataka, India

A multi-centric study showed that only 47% of bite
victims received the first ARV dose within 24 hours. Key
reasons for delay included lack of awareness and non-
availability of ARV at nearby centers. [3]

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 b. Kole et al. (2017) – Kolkata, West Bengal
This study found that the average delay between bite
and vaccine administration was 29 hours, and 31% of
victims delayed more than 48 hours. The delay was
higher among rural populations due to transportation
issues and low awareness.[4]

c. Mehta et al. (2019) – Gujarat

In a cross-sectional study in Gujarat, 61% of the patients
received ARV within 24 hours. Common causes of delay
included financial constraints, low education levels, and
late recognition of risk. [5]
WHAT IS EPIDEMIOLOGICAL DETERMINANTS OF RABIES?

MODE OF INFECTION

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1. Bites: in India most of the cases results from dog bite.
Saliva of dog must contain the virus at the time of bite.
2. Licks: licks on abraded skin and mucosa can transmit the
disease.
3. Aerosols: aerosol transmission has been observed in
nature only in certain caves harboring rabies infected bats
and in laboratory where aerosols are created.
4. Person to person: it is rare but is possible. There are
reports of transmission of rabies by corneal and organ
transplants. [1]

INCUBATION PERIOD
 It is highly variable.
 Commonly 3-8 weeks following exposure but may vary
from 4 days to many years.
 It general, IP tends to be shorter in severe exposures and
bites.
 In no other specific communicable disease is the
incubation period so variable and dependent on so many
factors as in rabies. [1]

STRUCTURE OF RABIES VIRUS

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 FACTOR AFFECTING INTERVAL BETWEEN BITE AND
CLINICAL SYMPTOMS

 Site of Bite: Bites nearer to head and neck areas have

shorter incubation period.
 Severity of bite: Open bites have shorter incubation
period as compared to licks/scratches.
 Multiple wounds: The more the number of wounds the
shorter is the incubation period.
 Virus inoculum: Higher viral loads leads to early disease
manifestations.
 Biting animals: Dog bites have shorter incubation period
as compared to cat/vampire bites.
 Treatment of wound: Proper local treatment of the
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 wound may delay the clinical onset of disease.

CATEGORIES OF RABIES WOUND

STAGES OF RABIES

1. Stage of pathogenesis
2. Prodromal stage
3. Stage of encephalitis
4. Stage of brainstem dysfunction
5. Stage of paralysis
6. Death

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 MANAGEMENT OF RABIES

1. Pre exposure prophylaxis

2. Post exposure prophylaxis
3. Post exposure treatment of person who have been
vaccinated previously

1. Pre exposure prophylaxis

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 A dose of cell culture vaccine, given either 1ml IM or 0.1ml
ID on days 0, 7, 28.

Booster dose can also be administered if the antibody

level falls down.

Further booster in injection should be administered at

interval of 2 year as long as expose person remain at risk.

2. Post exposure treatment of person who have

been vaccinated previously

Three 1ml IM dose of HDC (Human Diploid cell) vaccine are

recommended on day 0, 3, 7. (if bite is severe)

If bite is not severe only 2 doses are needed on day 0, 3.

NOTE: Immunization of dog is most important weapon in

rabies control
All dogs should receive primary immunization at the age of 3
to 4 month and booster dose at regular interval.

3. POST EXPOSURE PROPHYLAXIS

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[1]

ABBREVIATED MULTISITE INTRAMUSCULAR REGIEMEN

(2-1-1)

DOSE: 1 IM dose (1 or 0.5ml)

SITE: Deltoid or thigh
DAY: 0 (two site), 7(one site), 21(one site) +RIG (if
necessary)

OR

TWO SITE INDRADERMAL REGEIMEN (2-2-2-0-2)

DOSE: 1 ID dose = 1/5th of IM dose (0.1ml ID per site)

DAY: 0 (two site), 3 (two site), 7(two site), 28 (two site), +
RIG (if necessary)

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 OBJECTIVES
 To estimate average time gap between animal bite and
first dose of Anti-Rabies vaccine amongst people with
animal bite visiting ARV Clinic of Sir-T Hospital, Bhavnagar.

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 METHODOLOGY
Study design- Cross sectional study.
Study area – ARV Clinic in Sir-T Hospital, Bhavnagar.
Study participants –Person with animal bite visiting
ARV clinic of Sir-T Hospital, Bhavnagar

Inclusion criteria – People who have taken 1st or 2nd

dose of anti-rabies vaccine

Exclusion criteria – People who have taken 3rd or 4th

dose of anti-rabies vaccine
Ethical considerations -Verbal consent was taken
and data will be keep confidential.
Sampling techniques -Convenient non random sampling.

Sample size – 205

Data management -

 Data was collected with the help of self - administered

questionnaires via goggle form which consist
information on socio demographics characteristics
(age, gender, occupation, education) and questions
related to wound washing and domiciliary practices.

 Data entry was done in MS excel.

Data Variables –
Independent Variable: - Age, Gender, occupation,
education
Outcome Variable: - date and time of animal bite,
date and time of first dose of ARV
Data analysis -
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 Done in MS excel by frequency and percentage

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 DATA COLLECTION METHOD

PILOT STUDY OF RESEARCH

TOPIC WAS CONDUCTED.

PERMISSION FROM COMMUNITY

MEDICINE DEPARTMENT

VERBAL CONSENT FROM STUDY

PARTICIPANTS OBTAINED AFTER
EXPLAINING OBJECTIVES AND
SCOPE OF STUDY

DATA COLLECTED BY GOOGLE

FORM

DATA COMPILATION AND

ANALYSIS WAS DONE BY MsExcel

Results
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Table no.1: Socio-demographic distribution of the
study participants (n=205)

Study Group N (%)

variable
Gender Male 152 (74%)
Female 53 (26%)
Age group 10 and below 10 (4.87%)
(Years) 11-20 30
(14.63%)
21-30 59
(28.78%)
31-40 45
(21.55%)
41-50 38
(18.53%)
50 and above 23
(11.21%)
Education Graduate and above 31
(n=201) (15.42%)
Post high school 17 (8.45%)
diploma
High school 49
(24.37%)
Middle school 37
(18.40%)
Primary school/ literate 41
(20.39%)
Illiterate** 25
(12.43%)
Occupatio Professional 5 (2.43%)
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 n Semi professional 7 (3.41%)
Clerical, shop owner, 3 (1.46%)
farm owner
Skilled worker 9 (4.39%)
Semi-skilled worker 40
(19.51%)
Unskilled 48
(23.41%)
Unemployed* 93
(45.36%)
(*Includes students also
**include more than 7 year of age who cannot read, write and
understand any language)
 The study reveals that a majority of
participants were males (74%), indicating a
higher rate of animal bite incidence amongst
males.

 The most affected age group was 21 to 30

years (28.78%), followed by 31 to 50 years
(40.08%), suggesting that young and middle
aged adults are more prone to animal bite,
possibly due to higher outdoor activity or
occupational exposure.

 In term of educational background, the highest

proportion had education up to high school
(24.37%), followed by illiterate individuals
(12.43%) and primary school (20.39%).

Table No. 2: Characteristics of animal bite

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(n=205)

Study Group N (%)

variable
Name of Dog 178
animal (86.82%)
Cat 20 (9.75%)
Rat 7 (3.41%)
Type of Pet 27 (13.17%)
animal Stray 178
(86.82%)
Type of bite Provoked 13 (6.34%)
Unprovoked 192
(93.65%)

 The most common biting animal was the dog

(86.82%), followed by cat (9.75%) and rat
(3.41%).

 The majority of bite were caused by stray

animal (86.82%) and most bite were unprovoked
(93.65%). This shows that stray dogs are serious
public health risk.

Table no. 3: Wound washing practice amongst

people of animal bite (n=153)

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 wound washing practice

25%
(52)

75% (153)

yes no

Wound washing Group N (%)

practice
Wound washed Only water 95 (62.09%)
with Water and 36 (23.52%)
soap
Anti-septic 22 (14.37%)
liquid
Duration of 2 minutes and 30 (19.60%)
wound washing below
3-5 minutes 106 (69.28%)
10 minutes 17(11.11%)
and above

 In wound washing practice, majority (62.09%)

washed the wound with only water, while only
23.52% used water and soap, which is the
recommended method.
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  Particularly the most common wound washing
duration was 3-5 minutes (69.28%) but 19.60%
persons washed for 2 minutes and below, which
is inadequate.

Table No. 4: Time gap between animal bite & 1st

dose of anti-rabies vaccine (n=205)

Time gap N (%)

Within 30 minutes 37 (18.04%)
30 minutes to 1 31 (15.12%)
hours
1 hours to 2 hours 36 (17.56%)
2 hours to 24 hours 78 (38.04%)
After 24 hours 23 (11.21%)
(Delayed)

 For the time gap between animal bite and first

dose of ARV, significant proportion of individuals
received the first dose of the anti-rabies vaccine
within 2 to 24 hours of animal bite (38.04%),
which is suboptimal for effective rabies
prevention. Alarmingly, 11.21% persons
received the vaccine after 24 hours,
indicating a delay in post exposure
prophylaxis.

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Table No. 5: Association between gender &
delayed vaccination

Associati N N (not Total Result

on of (delaye delaye
gender & d) d) Chi-
delayed square=2.3
vaccinati 75 (P=0.05,
on chi-square
Male 14 138 152 table
Female 9 44 53 value=3.84)
Total 23 182 205

Interpretation:

There is no statistically significant association

between gender and delayed vaccination based on
chi-square test.

Table No.6: Association between education and

delayed vaccination

Associatio N N (not Tota Result

n of (delaye delaye l
education d) d) Chi-
& delayed square=0.002
vaccinatio 3 (P=0.05, chi-
n square table
High 11 86 97 value=3.84)
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school
and above
Below 12 96 108
high
school
Total 23 182 205

Interpretation:

There is no statistically significant association

between education and delayed vaccination based
on chi-square test.

Table No. 7: Reasons for delayed administration

of ARV (n=23)

Reasons N (%)
Unaware of ARV 1st dose 14
timing (60.86%)
Busy with other work 5 (21.73%)
Don’t aware about ARV center 4 (17.38%)
location & timing

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 Reasons for delayed vaccination
16

14

12

10

 The most common reason cited for delayed

administration was lack of awareness about
timing 1 dose of ARV (60.86%), followed by
st

being busy with other works (21.73%), other less

common reason included distance to the vaccine
center and lack of awareness about center
timing.

Table no. 8: Practice of applying any other

substances on wound (n=42)

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 Practice of applying any other Substance N (%)
substances on wound Red chili 28
powder (66.66
%)
Turmeric 9
powder (21.42
Red chilli powder (66.66%)
Turmeric powder (21.42%) %)
Other (11.90%)
Other 5
(11.90
 Amongst 42 %)
individuals, who used
other substances except water, 66.66% apply
red chili powder, which is a harmful traditional
practice.

 Other used Turmeric powder (21.42%) and

other substances like garlic, bam and malam
(11.90%).

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 CONCLUSION

 From our study we have concluded that

38.04% of individuals received the first dose of
anti-rabies vaccine within 2 to 24 hours after the
bite.

 We have also documented that only 18.04%

received the vaccine within the first 30 minutes,
while 11.21% had a delayed response beyond 24
hours.

 These findings highlight the need for increased

awareness, early reporting, and timely access to
ARV services to improve post-exposure
prophylaxis outcomes.

 We revealed that 75% of individuals washed

their wound after an animal bite. Amongst this
most of participants (69.28%) washed the wound
for 3-5 minutes or less, indicating that
inadequate wound hygiene may compromise
rabies prevention efforts.

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 RECOMMENDATIONS

 Targeted Education: Raise awareness

through education programs, especially for
working-age men and people with low education
levels, to reduce rabies risk.

 Post-Exposure Awareness: Inform the

public about the importance of getting
immediate post-exposure treatment using social
media, posters, and charts.

 Improve ARV Access: Increase awareness of

anti-rabies vaccine (ARV) schedules and
locations. Make services more accessible and
improve communication.

 Promote Safe Wound Care: Educate people

to clean wounds properly and avoid using
harmful traditional substances.

 Community Education: Teach proper wound

hygiene and explain the dangers of using
traditional remedies for rabies prevention.

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 BIBLIOGRAPHY

1. Park K. Park’s Textbook of Preventive and Social

Medicine. 27 ed. Jabalpur: Bhanot publishers;
th

2023. p. [302-304].

2. S. tamanna, D. Yasmin, Sumon, M. Mujibur, Amit

Kumar, Das TK, et al. (2023). Evaluating
adherence to government recommendations for
post-exposure rabies vaccine among animal bite
victims: A hospital based study in Bangladesh.
PLOS Glob Public Health 3(11). 1-2.

3. Sudarshan, M. K., Mahendra, B. J.,

Madhusudana, S. N., Ashwath Narayana, D. H.,
Rahman, A., Rao, N. S., & Gangaboraiah.(2006)
assessing the burden of human rabies in India:
results of a national multi-center epidemiological
survey. International Journal of Infectious Diseases,
11(1), 29–35.

4. Kole, A. K., Roy, R., & Kole, D. C. (2017).

Assessment of delay in initiating post-exposure
prophylaxis against rabies among animal bite
cases. Journal of Family Medicine and Primary
Care, 6(3), 465–469.

5. Mehta, A. R., Patel, K. B., & Shah, R. A. (2019).

Determinants of delay in initiating post-exposure
30 | P a g e
prophylaxis among animal bite victims in Gujarat.
National Journal of Community Medicine, 10(4),
178–182.

ANNEXURE
Time gap between animal bite and first dose of
anti-rabies vaccine amongst people with animal
bite visiting ARV clinic of Sir-T Hospital, Bhavnagar.

QUETIONNAIRE

1.Name:
2.Age (in completed years):
3.Gender
Male
Female
4.Education
a) Graduate and above
b) Post High school diploma
c) High school
d) Middle school
e) Primary school or literate
f) Illiterate
5.Occupation:
6.Date of animal bite:
7.Time of animal bite:
8.Type of animal
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 a) Dog
b) Cat
c) Rat
d) Other (specify):
9.Category of animal
a) Stray animal
b) Pet animal
10. The bite was
A. Provoked
B. Unprovoked
11. Date of first dose of ARV:
12. Time of first dose of ARV:
a) Within 30 minutes
b) 30 minutes to 1 hour
c) 1 hour to 2 hours
d) 2 hours to within 24 hours
e) After 24 hours
13. Have you washed wound after bite:
a) Yes
b) No
If yes, Wound washed with
a) Only water
b) Water and soap
c) Anti-septic liquid
If yes, Duration of wound washing (in
minutes) …

14. Application of any others substances on wound

a) Yes
b) No
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 If yes, then specify
Red chili powder
Turmeric powder
Other

15. Time between animal bite and 1st dose is more

than 24 hours - (Delayed)
a) Yes
b) No
If yes, reason for delay:
a) Unaware of ARV 1st dose timing
b) Busy with other works
c) Took more time to find vaccine center
d) Suffering due to animal bite
e) Other sickness
f) Distance to the vaccine center
g) Don’t know about timing of ARV center
h) Government holiday
i) Others (attending office, bad weather)

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