Bites (Human and Animal)—Child Care and Schools

Animal Bites/Rabies

Animal bites are common. Dog bites account for 90% of bite wounds, perhaps because dogs are very common pets and have a great deal of contact with humans. Many adults allow interactions between children and dogs. Children can behave unpredictably, and dogs have normal protective instincts. The combination can result in injuries for children. The rate of infection after dog bites is 5%. After cat bites, the rate of infection is as high as 80%. (See Infections Caused by Interactions of Humans With Pets and Wild Animals in Chapter 8 for a discussion of diseases spread by cats, including "cute" kittens.)

An animal bite that breaks or punctures the skin needs immediate wound care to reduce the risk of infection. The wound should be washed out with water and then promptly evaluated by a health professional for the following reasons:

• First, there is a chance of developing a bacterial infection. The longer the animal's mouth germs stay in the wound, the greater the potential of infection that will need antibiotics. Some wounds require preventive antibiotics. The health professional needs to decide whether the wound should be left open or closed with materials such as special tape or stitches. All animal bites need to be watched closely for signs of infection until they are fully healed.

• Second, the situation in which the animal bite occurred should be evaluated for the possibility of transmission of rabies. Although any mammal bite can transmit rabies, bites of some wild animals (eg, bats, raccoons, skunks, foxes, coyotes, bobcats) and some stray and unvaccinated pet dogs and cats are of greatest concern for transmitting the rabies virus. Wild animals should not be kept or allowed to visit child care facilities or schools. Children should not have direct contact with wild animals in any setting. Rodents (mice, squirrels, and gerbils), bats, and rabbits can, but rarely do, carry rabies (woodchucks are an exception). Rabies has occurred in animals in petting zoos, pet stores, animal shelters, and county fairs.

Rabies is a very serious viral infection that infects the nervous system. The virus spreads from a rabies-infected animal's saliva into the bite site. Rabies is usually transmitted by the bite of wild animals. However, the virus can be spread by unimmunized pets and, in rare cases, immunized pets that have been infected with the rabies virus. The possibility that an animal is infected with rabies is greatest when the animal is unimmunized and the bite was unprovoked. If a pet or wild animal bites and breaks the skin, the situation requires urgent medical attention. Because the rabies virus spreads from the animal's saliva and enters the bite site, the bite wound should be immediately and thoroughly cleaned as soon as possible. The bitten person should be referred for immediate evaluation by a health professional. If possible, the animal should be observed by a veterinarian for signs of rabies.

Report all suspected exposure to rabies promptly to public health authorities and be sure health professionals are involved in deciding about appropriate treatment right away. Signs or symptoms of rabies in humans include anxiety, difficulty swallowing, seizures, and paralysis. Once signs or symptoms develop, rabies is nearly always a fatal disease.