Introduction

Dog bites are considered to be a public health problem affecting 1.5% of the US population annually. Each year in US 4.7 million people get bitten by dogs, with 800.000 bites requiring medical attention and 370.000 bites severe enough to be treated in Emergency departments.¹ Comparable ratios are found in Europe with 250.000 people reported bitten annually in UK and 100.000 in Belgium, representing 1 % of the population bitten annually.² It is estimated that 50 % of dog bites remain unreported^3,4, so the true quantity of the problem remains difficult to quantify.⁵

Hazard versus Companionship?

Despite the hazards due to trauma and bites, dogs remain very popular pets: for example in UK and in US, respectively 20 and 40% of families were found to own at least one dog, and in the state of Sao Paulo as many as 53% of the households were dog owners.^6,7,8 So therefore it appears equally important to stress the popularity, the health benefits, happiness and companionship of pet dogs for their owners and children of the family. Dog owners are reported to be more active and seek less medical attention then non-owners. In addition, dog companionship facilitates a wide range of social interactions with people of all ages, genders and ethnicities, regardless the appearance of the dog or the companion. Children whose families own a dog are reported to be more popular with peers, are more empathic, a higher self esteem and generally consider life to be more fun and have a more positive outlook. Dogs can be a primary focus of conversation between dog walkers and even passers-by might engage with dog owners about their dogs. This is especially important for the elderly who are at risk of social isolation, because many old people consider their dog as only true friends.⁹

As animal health care takers, veterinarians have a crucial role in providing accurate information and practical advice on safe methods to live with a pet dog, to retain the benefits of dog ownership and yet reducing the risks of potential hazards.^6,10,11

Who Gets Bitten?

Dog bite data can be categorized as relating to the victim (race, age, gender, race, injuries, and consequences), the dog size, breed, age, gender, health, hormone status, social type, consequence etc) and context (geographic location, place, time, season, human-animal interaction etc). Because dog bite data can be obtained in 'various ways', the specific source may significantly affect the results and examples on bias in data on dog and victim characteristics can be observed between surveys.¹²

To cite a common example: according to data obtained from hospitals and emergency departments, children are reported twice at risk than adults^4,13, and severe injuries, particularly involving the neck and face, occur most frequently in young children.^13,14 In veterinary caseloads and otherwise sourced bite report surveys, adults are reported to be twice as often victim of dog bites than children.¹⁵ It appears important to acknowledge that we have no information on the aetiology of the bias in results. It has been suggested that perhaps owners relinquish a dog that injured a child.¹⁵ A survey by Kahn et al (2003) found that only 24% of the dogs that had bitten a child were presented to a veterinarian, which supports this hypothesis. Because dog bite data will influence the way we identify "risk factors" and will guide us in developing new prevention strategies, it is essential to recognize the importance of data to the circumstances leading to a bite injury. It appears equally important to exchange knowledge between professions and academics in order to understand on 'what are we measuring', 'how to interpret the findings' and how to deduce 'risk factors'.

Fatal Outcomes

In third world countries, Rabies--a fatal virus infection--is causing 55,000 human deaths a year. Surveys indicate that bite accidents with domestic dogs are the source of infection for the vast majority (>95%) of cases.¹⁶ In Western world, dog bite fatalities are rare.^17,18 In the Netherlands each year approximately 1 person dies following a dog bite, while 11 fatalities occur due to sport and 23 following household accidents.¹⁹ Unfortunately the majority of victims of serious dog bites and fatalities are young children²⁰ triggering a media hype that focuses on "aggressive breeds", influencing governments to consider breed specific legislation as a preventative measure. So therefore our profession should promote and support research in dog bite trigger factors in order to move forward and offer more constructive suggestions for safe human-dog relationships and primary prevention of dog bites.²¹

Public Health and Public Safety

According to hospital based surveys, the majority of dog bites happen in familiar surroundings, involving a family member (mostly a young child) bitten by the family pet, 86% of the bites appear to be triggered by an interaction from the child towards the pet dog.^13,14 A Belgian study investigating follow up in children brought into ED for dog bites, found out that in 55% of severely injured children showed one or more symptoms from post traumatic stress syndrome.²² Unfortunately, follow up data on how children or adults being attacked in the street experience the injury, the dog or the combination 'dog walked by man' are lacking. Because dog bites in public places mostly happen by surprise, without warning and /or interaction from the victim with the dog, it is assumed that this may contribute to a feeling of insecurity of people being attacked once.^14,19 The fact that dog bites that happen in public places receive a lot of media attention and happen to be magnified, may contribute to the perception of "dogs being dangerous" or feeling "unsafe" versus dogs.

Dog Attacks and Public Safety

The most difficult and emotive aspect of to public hazard caused by dogs is the fear of dog bites and dog attacks. Although these terms have different meanings, public safety regulations tend to ambiguously classify dog attacks with bites.

A dog attack may mean a dog rushing or chasing without any bite or physical contact at all, while a bite generally results in the bruising or breaking of skin because of the contact with the dog's teeth.⁹ In Australia for example, no burden of proof is required to substantiate a dog attack: councils can declare a dog dangerous with one disputed allegation. Being declared dangerous might impose draconian physical penalties on the dog, like muzzling, confinement or even euthanasia. Similar rules do not generally exist for other pet animals when threatening or harming a human being (e.g., horse, cat). Even poisonous creatures or exotic pets escape from these harsh regulations.⁹

It is assumed that dog regulations in public spaces exist because there is a widespread community concern about dog aggression that influences legislators. Of though only 20% of the dog bites, occur outside the private home, the majority of people appear to be concerned of being bitten by a dog in a public place.²³ And while the vast majority of dog bites that occurs in the home require medical attention only 5% of victims bitten in public places suffers from a serious injury, while 55% does not sustain any injury.

Urban safety regulations, prohibition dogs to run off leash in open space and parks is based on the assumption that these locations are the target areas for people to be chased, or attacked by dogs. Research data indicate that only 9% of the bites happen in parks or open places. The majority of these incidents happened because the dog was not adequately confined (51%) or the dog is wandering at large in vicinity to the dog's home (31%); By contrast more than half of the dog attacks occur in the street and 30 % occur on private property.²³ The objective of public safety and the methods likely leading to well mannered dogs (e.g., exercise and socialization) are best achievable trough social marketing and collaborative management rather than via the present "big stick" legal approach of banning dogs in public spaces.⁹

Tackling Prevention

According to human preventive medicine only sustained interventions have sustained effects. Sustainability is enhanced by focusing upon underlying causes and contexts of behaviour, and embedding or integrating prevention and promotion initiatives into ongoing systems, institutions and organizations, so that they become a natural part of people's everyday lives (Bond & Hauf 2004). On this moment in time, the research of risk factors and causes for dog bites to humans should be considered as a growing area of new and exciting research. It is assumed that a dog's tendency to bite depends on multiple interacting factors²⁴ related to heredity, early experience, later socialization, training and education, medical health, behavioural health and victim behaviour. These must be considered in the context of human social and cultural factors that have been shown to influence human-dog interactions.²⁵

References

1.  CDC Data (2008): http://www.cdc.gov/ncipc/duip/biteprevention.htm

2.  Gisle L, et al. (2001): Health enquiry by interview, Belgium 2001, Epidemiology Department 2002; Brussels; Scientific Institute of Public Health IPH REPORTS N° 2002-22

3.  Overall K, Love M. (2001) Dog bites to humans-demography, epidemiology, injury and risk. JAVMA, Vol 218, no 12 June 15, 2001

4.  Kahn A, et al (2004) Prevalence of dog bites in children. A telephone survey. Eur J Pediatr (2004) 163: 424

5.  Shuler C, et al ( 2008) Canine and human factors related to dog bite injuries. JAVMA vol 232, No 4, feb 15, 2008

6.  Westgarth C, et al ( 2008) Dog-human and dog-dog interactions of 260 dog-owning households in a community in Cheshire. Vet Rec 2008 Apr 5; 162(14): 436-42

7.  PFMA 2008

8.  Alves, et al (2005) Estimation of the dog and cat population in de state of Sao Paulo. Rev Saude Publica 2005; 39(6)

9.  Miller R, Howell G. (2007) Regulating consumption with bite: Building a contemporary framework for urban dog management. J Bus Res (2007), doi:10.1016/jbusres.2007.07.006

10. Love M, Overall K. (2001) How anticipating relationships between dogs and children can help prevent disasters. JAVMA, Vol 219, no 4 August 15, 2001

11. Hemsworth S, Pizer B (2006) Pet ownership in immunocompromized children--a review of the literature and survey of existing guidelines. Eur J Oncol Nurs 2006 Apr; 10(2):117-27 Epub Apr 3

12. De Keuster T, Butcher R. ( 2008) Preventing dog bites: risk factors in different cultural settings. Vet J 2008 Aug ; 17(2) :155-6

13. Schalamon, et al. (2006) Analysis of dog bites in children who are younger than 17 years. Pediatrics 117, 374-379.

14. Kahn A, et al. (2003) Child victims of dog bites treated in emergency departments. European Journal of Pediatrics 2003; 162:254-258)

15. Guy N, et al. (2001) Risk factors for dog bites to owners in a general veterinary caseload. AABS 74(201)29-42

16. Cleveland S, et al. (2006) Canine vaccination-Providing broader benefits for disease control; Veterinary Microbiology 117(2006)43-50

17. Healey D. (2007) Fatal dog bites in New Zealand. N Z Med J 2007 Aug 10; 120(1259):U2659

18. Raghavan M. (2008) Fatal dog attacks in Canada, 1990-2007. Can Vet J 2008;49(6):577-81

19. LNV statistics (2008) 

20. Sacks J, Lockwood R, Hornreich J, Sattin R. (1996) Fatal dog attacks, 1989-1994). Pediatrics 1996 Jun; 97(6Pt1):891-5

21. Bond LA, Hauf AM. (2004), Taking stock and putting stock in primary prevention: characteristics of effective programs. The Journal of Primary Prevention; 2004; 24 (2):199-221

22. Peters V, et al. (2004) Post-traumatic stress disorder following dog bites in children. The Journal of Pediatrics 2004; 144 :121-2

23. Gilchrist J, et al. (2008) Dog bites, still a problem? Inj Prev. 2008 Oct;14(5):296-301.

24. American Veterinary Medical Association, A community approach to dog bite prevention. Journal of the American Veterinary Medical Association 218:1732-1749.

25. Messam L, et al. (2007) The human-canine environment: A risk factor for non-play bites? Vet J 2008 Aug; 177(2):205-15 Epub 2007 Oct 15