When the dog bites: Understanding the scale of a growing public health issue

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A dog and small toddler sit in companionable silence looking out a misty grey window

Researchers at the University, Dr John Tulloch (PhD 2019), a vet and epidemiologist, and Dr Carri Westgarth (PhD 2008), a senior lecturer in human-animal interaction, have published recently on the topic of dog bites. Dog bites are an issue that is continuing to grow despite education and public health campaigns; here John tells us more about the research.

John completed his PhD at the University as part of the National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections. His doctoral studies focused on appraising health datasets to appraise their Lyme disease surveillance potential in the UK. It was this work that introduced him to the power of big data and electronic health records.

John’s core research question is in using epidemiological methods to understand how animals impact human health and society, and he has a particular interest in animal-related injuries: “Having spent time in and out of clinical practice I noticed the number of friends and colleagues who had been injured by animals whilst working with them, including myself” (John broke a rib whilst calving a cow!). John wants to understand the scale of the problem, who is being injured, and the context of the injuries. He says that “by doing this we can implement risk minimisation practices so that we can continue to work and live with animals happily and safely”.

John has recently led a study to analyse the incidence and socio-demographics of patients admitted to English NHS hospitals for dog bites over a 20-year period (1998 – 2018). Across all ages, annual hospital admission rates for dog bites rose from 6 to 15 per 100,000 people, with more than 8,000 admissions in 2018.

Although children up to 14 years old made up 25% of admissions, their incidence rate remained relatively stable with no obvious change to annual trend (averaging 14 admissions per 100,000 people a year). In contrast, the rates in adults tripled across the 20-year period from 5 to 15 admissions per 100,000 people, with the biggest increase seen in women between the ages of 35-64.

John said that “This study presents just the tip of the iceberg, as it only includes injuries severe enough to require hospital admission. Dogs provide large benefits to society, especially in these difficult times where they can provide great companionship. However, working and living with animals can pose an injury risk.”

Until now, dog bite prevention strategies have mainly focused on high-risk groups, such as children and those that encounter dogs through their work, such as postal workers. However different strategies may be needed to tackle the rise in adults, but further work is needed to better understand what is driving this increase in dog bites in England, and specifically in adults, to enable the development of appropriate prevention strategies.

The University of Liverpool is part of Merseyside Dog Safety Partnership (MDSP). A collaboration of organisations including local authorities, the police, Royal Mail, Dog’s Trust, RSPCA, PDSA, and local hospitals such as Alder Hey. MDSP aims to improve dog bite prevention and thus help communities keep their dogs, children, family and friends safe.

John tells us that “at an MSDP meeting during lockdown the team from Alder Hey reported they had noticed an increase in A&E attendance for dog bites. So, we worked together to analyse emergency department attendance data between January 2016 and September 2020 to see how big an increase there had been”

From May – July 2020, dog bite attendance in children rose threefold from an average of 15 cases a month (pre-first lockdown) to a peak of 44 cases in July. The proportion of overall emergency department attendances due to dog bites also quadrupled during this period to more than 1 in 100 (1.33%) by July. By September 2020, case numbers had returned to normal, coinciding with schools reopening. John says that “These findings suggest that the extended periods of time that children spent at home, during lockdowns and school closures, may have led to a large and worrying number of children attending A&E for dog bites.”

This last year has been a hard time for vets, their clients, and their pets. Routines have been disrupted and many young dogs will be unfamiliar with life outside of lockdown. John reminds us that “most dog bites occur in the family home and are caused by a dog the victim knows. We must all get better at reading the signs that a dog is uncomfortable or unsure of a situation, this will enable you to remove the dog or yourself away from the situation, and thus potentially prevent a bite.”

Dog bites are a big problem, with over 8000 people being admitted to hospital each year, and costing NHS England a minimum £71 million annually. Twenty-five percent of those admitted are children under the age of 14 and they predominately receive open wounds to the head.

John finishes “as a profession we can help owners and the general public to get better at ‘talking’ to dogs by understanding their body language and responding to dogs’ signals in the appropriate way.” There are resources on both the MDSP and Dogs Trust to help with this.