A Clinical Analysis of Rabies Post-Exposure Prophylaxis After Animal Bite Cases in the Republic of Korea Armed Forces

Many studies on rabies and animal bites have been conducted in the private sector; however, there are no studies on the epidemiological characteristics of animal bites and the appropriateness of rabies post-exposure prophylaxis (PEP) in the Republic of Korea (ROK) Armed Forces. Therefore, this study aimed to analyze epidemiological characteristics of animal bite cases, status of treatment, and rabies PEP to assess the risk of rabies exposure in the military and identify areas requiring improvement within the military medical system.

This retrospective study was conducted using the medical records of patients with animal bite-related diagnoses who visited 18 military hospitals in the ROK between January 1, 2012 and December 31, 2019. Demographic and clinical variables were obtained, and exposure to animal bites and rabies vaccination status were assessed. Descriptive statistical analysis was conducted; counting data were expressed as the number and percentage, and measurement data were expressed as the mean  ±  SD.

In total, 297 patients visited military hospitals to treat animal bites. More than 20 animal bites occurred annually; however, no human and animal rabies cases were reported. Most of the participants were male (94.9%), and the mean age was 23 ±  5 years. The most frequent sites of bites were the hands and fingers (70.0%), followed by the legs (10.4%). Cats were responsible for 42.1% of bites, followed by dogs (41.8%). Regarding PEP, category II was the most common criterion (72.1%) according to the World Health Organization criteria. Patients in Category II required immediate rabies vaccination; however, some of them (36.4%) did not receive any PEP. Moreover, 46.1% of patients visited hospitals more than 24 hours after an animal bite.

Most animal bites were from dogs and cats, with hands and fingers being the most common sites in the Korean Armed Forces. Hence, this study postulates that bites occur mainly during hand contact with animals, necessitating precaution. Considering the time gap between the animal bite and the hospital visits and the high proportion of patients receiving inadequate management, it is necessary to more robustly engage the military command system in preparation and response training and expectations. Strengthening awareness among commanders and soldiers regarding the clinical severity and potential risk of rabies should be done, and practical strategies such as routine surveillance, risk assessment of rabies, and secure herd immunity in wildlife by spraying baits and mandatory vaccination should be done. Instituting periodic training and competency assessment of military medical personnel, especially in emergency departments where frequent rotations occur, and ensuring uninterrupted availability and proper management of rabies vaccines and human rabies immunoglobulin in all military healthcare facilities can also be helpful. Thus, practical efforts and awareness improvement are needed to provide an appropriate PEP that meets the relevant criteria and minimizes the misuse of medical resources.