DOG BITES IN BOSNIA

Background. Rabies is a zoonosis that remains endemic in most parts of the world. Primary care physicians are in the first line of defence a gainst the disease. An increasing number of British practitioners and medical students are being exposed to the dangers of rabies through hu manitarian work on overseas attachments. Rabies is enzootic throughout Bosnia-Herzegovina and presents a hazard to the multinational troops currently deployed there. Aim. To describe the British Army's experien ce of animal bites and rabies prevention in Bosnia during the first si x months. of its current peace enforcement mission, and to make genera l recommendations on the good management of any rabies hazard at prima ry care level and under field conditions. Method Routine data from the Army's epidemiological database (ARRC 97) were reviewed, and theatre issues of rabies vaccine and immune globulin were used as a proxy meas ure for administered post-exposure prophylaxis. Results. A total of 62 animal bites were reported in British troops between December 1995 an d May 1996, of which 28 were unprovoked bites and resulted in the admi nistration of a course of rabies vaccine. Ten of these were severe bit es and rabies immune globulin (RIG) was administered in addition. The total cost of rabies post-exposure prophylaxis was US$6914.00. Conclus ion. The prevention of rabies has major human and resource implication s, and primary care staff involved in rabies post-exposure management need to be well supported in their clinical decision-making. Rabies pr otocols should be clear and unambiguous. The effective medical surveil lance of military or humanitarian missions in rabies-enzootic areas mu st include the prompt reporting of animal bites. The predeployment tra ining of medical teams should include an up-to-date assessment of the focal rabies threat.