Love Bites: An Open Dialogue on Dog Bite Injuries and Prevention

Let's start with some scary statistics:

• An estimated 4.5 million people are bitten by dogs every year. Most of them are children.

• Of all reported animal bites in the US, dog bites account for 85% to 90%. This means almost all bites requiring a trip to the emergency room are from dogs.

• Out of all of the infinite reasons a person might have to visit the ER, 1% are from dog bites. To give a better perspective of what this means, 1% of ER visits in 2014 were from boys (less than 15 years old) with headaches. Both dog bites and headaches are problems so common that the CDC has a category for them in the yearly report!

And as if that isn't enough to scare you, consider this: 70% of those receiving dog bite injuries knew the dog. The majority of bites requiring medical care are from Fido in the backyard and Fluffy next door. The majority of bites are from our pets. In order to understand the problem, let's start with looking at the risks.

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What are the risks to humans bitten by dogs?

As previously mentioned, children are most commonly bitten by dogs. Generally, these bites result in injuries to the head and neck. Adolescents and adults are generally better able to see the change in behavior that leads to a bite and defend themselves, resulting in injuries to the hands, arms, and legs.
All bite wounds are considered "grossly contaminated," a fancy phrase that simply means that between the bacteria on human skin and the bacteria in a dog's mouth, an open dog bite wound is at risk of developing infection. Common bacterial culprits found in infections associated with dog bites include species of Staphylococcus, Streptococcus, Pasteurella, Capnocytophaga, Moraxella, Corynebacterium, and Neisseria. Generally speaking, immediate medical care lowers the risk of bacterial infection. Unless the bite is in a location of high risk, most wounds are left open and not even treated with oral antibiotic therapy.

The greater risk in dog bites is actually the mechanical trauma of the bite. Small dogs generally aren't strong enough to cause wounds requiring medical attention. Larger dogs have a larger bite, and they can cause skin tears, punctures, scratches, dislocation of smaller or larger joints, and crush injuries. In addition, their teeth may break or carry other foreign particles into the wounds. Depending on the severity of the injury, the mechanical trauma of a dog bite may require extensive care from multiple doctors.

Other rare, but severe, complications of dog bites include: tetanus, post-traumatic stress disorder, septic arthritis, osteomyelitis, extensive soft tissue injury with scarring, hemorrhage, gangrene, sepsis, meningitis, endocarditis, and death. 10-20 animal bite victims die every year!

 

Rabies:

Additionally, any dog bite must be reported due to the risk of rabies. Rabies is a virus that can be transmitted from the saliva of an infected animal through a bite wound. It is 100% fatal if left untreated, and 100% preventable with dog vaccination and immediate exposure treatment. Dogs with rabies may show various signs, including not eating, abnormal behavior, stumbling, paralysis, strange vocal sounds, foaming at the mouth, and seizures.

But here's the kicker about rabies - despite state laws requiring regular rabies vaccination in both cats and dogs, despite risk of pet exposure to rabid wildlife, only 45% of dogs involved in bites requiring an ER visit are vaccinated against it! If bitten by a seemingly healthy animal, rabies vaccination of the victim would only be recommended if the dog develops signs of rabies during a 10-day quarantine period. However, if the dog is ill or can't be held in quarantine, the victim will undergo immediate post-exposure prophylaxis, consisting of anti-rabies antibody administration and four rabies vaccine injections over the span of 14 days. This treatment costs roughly $1,000!

 

What are the risks to dogs biting humans?

With all of the horrible risks for the bitten human, why do we even care what happens to the dog? The answer is simple - 70% of people knew the dog that bit them. The majority of dog bite incidents occur with family and neighborhood dogs. These are the pups that sleep at the foot of our beds and go jogging with us in the morning. These are the dogs that play fetch with our children in the back yard and roll on their backs for belly rubs every night. These are trusted family members!

Sadly, regardless of whether or not the dog involved in a bite case shows any signs of rabies, a mandatory 10-day quarantine will be instituted for observation, even if the dog is up-to-date on its rabies vaccination. If the dog appears healthy and can be isolated from other animals for 10 days, it may be able to stay in the home. If the owner is unable or unwilling to accommodate that, the dog will be quarantined by local animal control officials. For a dog, this quarantine period can be very scary, especially if its owners are fearful when handling the dog or if the dog must be contained by local officials in an unfamiliar environment.

Tragically, many of these dogs will be surrendered to shelters. The ASPCA cites that 10% of dogs surrendered to shelters are surrendered due to changing family dynamics and behavior issues including aggression and biting. Only 35% of dogs that enter shelters are adopted... and 31% of dogs that enter shelters are euthanized. One bite incident can result in a dog being surrendered to a shelter, labeled as aggressive, and either living its life in a cage or being euthanized.

Some owners may even prefer to have the dog euthanized by a veterinarian instead of taking it to a shelter. For humans, a dog bite can be painful and traumatizing. For the dog, a bite incident is a matter of life and death.

What should I do if someone is bitten by a dog?

Go to see a doctor immediately! Even waiting as little as 8 hours to go to the emergency room is associated with a higher risk of developing infection. Ideally, the biting dog should be isolated from all other mammals as soon as possible. In the event that the dog can't be contained (stray dog, escaped dog, etc.), call local police or animal control to report the incident. You should not try to contain an unfamiliar dog by yourself! Leave it to the professionals

What causes a dog to bite?

This is a complicated topic. In incidents of dog bites requiring medical attention, 50% self-report that the bite was unprovoked. This may seem like a rather significant statistic, but people who are bitten are not often educated in animal behavior.

Dogs may bite when they are injured, ill, frightened, angry, or abused. Most often, dogs give many warning signs. However, the majority of these signs are subtle. Many people will only recognize a dog is likely to bite when the dog growls and shows its teeth.

What are the signs that my dog is uncomfortable or frightened?

Time for a quick lesson in dog body language! Here are some of the most common behaviors broken down into a few categories.

 

Anxiety:

Any of these signs indicate that your dog is uncomfortable with the current situation. Taking action now to remove the dog from the situation could prevent escalation. Displacement behaviors occur when an anxious dog wants to take action (run away, growl, bite), but is restraining itself. The conflict results in a dog doing a behavior that is not appropriate given the situation.

One paw raised = worried, uncertain

Half Moon/Whale Eye =  wants to be left alone

Yawning (when not tired) = displacement behavior

Licking chops (when there's no food) = displacement behavior

Shaking (when not wet or dirty)

 

Avoidance:

Some dogs may feel anxious and try to communicate more directly by indicating their desire to avoid the situation. Some signs that a dog is trying to avoid the situation are getting up and leaving, turning its head away, hiding, barking and retreating, rolling on it back in submission, tucking its tail between its legs, pinning its ears back, panting heavily, leaving room to urinate/defecate. A dog that is trying to avoid a situation should not be forced to stay or punished for its behavior. Immediate recognition of these signs can help you to allow the dog to de-escalate and find a safer activity/place.

 

BIC (Bite Is Coming!):

A dog may make the decision to bite spontaneously, but some dogs give clear indications before striking. A dog intending to bite will suddenly freeze and become stiff, stand with its legs spread wide in the front while its head is low and looking at its target, and curl its lip to show teeth, possibly growling. If you see this, stop all contact and interaction immediately. Give the dog a safe exit, do not make eye contact, and move away slowly.

 

Arousal:

This emotional state, unlike the others, is not unpleasant to a dog. Arousal occurs when a dog is interested or intensely focused on something like the mailman, a leaf, or a squirrel. During this time, a dog will not want attention. Signs include ears perked forward, mouth closed, intense eyes, tense body leaning forward, high tail with slow wagging. Even if a dog in arousal isn't feeling threatened, it should not be bothered or petted, as a distraction may be irritating enough for a dog to suddenly snap.

This short video from Zoom Room gives a great review of body language in happy, anxious, and aggressive dogs:

 

What can I do to prevent dog bites? 

Educate yourself and your children! The easiest way to prevent dog bites is to start at home. Learn to recognize stress and anxiety behaviors in dog body language and teach children how to behave and interact appropriately with dogs. There are many materials available to help educate the population most at-risk of dog bite injuries - children. My personal favorites are by veterinary behaviorist, Dr. Sophia Yin:

In addition to teaching children how to appropriately interact with dogs, they should be instructed on how to approach new dogs and how to behave when a dog approaches them. The American Academy of Family Physicians provides these directives in teaching children safety around dogs:

What do I tell my children about dogs?

• Don't go near strange dogs.

• Never bother a dog that is eating, sleeping, or caring for puppies.

• Tell an adult about any stray dogs.

• Always have an adult with you when you play with a dog.

• Never tease a dog.

• Never pet a dog without first letting it smell you.

 What should I tell my children to do when a dog approaches them?

• Don't run away and scream.

• Stand very still, "like a tree."

• Avoid making direct eye contact with the dog.

• If you fall or are knocked down, act "like a log."

• When the dog understands that you are not a threat, it will probably walk away.

• If a dog bites you, tell an adult right away.

What can be done to prevent dog bites on a larger scale?

Although almost all family doctors agree that more education on pet-related hazards is necessary, less than 20% counsel their patients or their own family about them. Public schools spend almost no time at all on pet safety education. What can be done?

The AVMA recently released a community-approach program for dog bite prevention. In the program outline, the AVMA illustrates that dog bites aren't simply an incidental problem - dog bites place strain on the health care system, local government, litigation, animal control, and shelters. By involving all aspects of the community, including doctors, veterinarians, lawmakers, shelters, and schools, a dialogue can be opened to promote safe practices around dogs.

Is breed-specific legislation (BSL) helpful towards preventing dog bites?

 

Nope. Sorry for the short-and-sweet answer, but the American Veterinary Medical Association (AVMA) has released a statement on BSL:

"Any dog can bite, regardless of its breed, and more often people are bitten by dogs they know. It's not the dog's breed that determines risk -- it's the dog's behavior, general size, number of dogs involved and the vulnerability of the person bitten that determines whether or not a dog or dogs will cause a serious bite injury. Dogs can be aggressive for all sorts of reasons. A dog that's bitten once can bite again, and a dog that's never bitten could still bite."

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While working for a zoo and teaching volunteers to work with various animals, a common question was, "can it bite?" I would always respond the same way: Anything with a mouth can bite. Anything with claws and nails can scratch. Anything with a stinger can sting. Anything with arms or legs or wings or a tail can hit. We can't always control animals, but can control our safety. 

SOURCES: 
1. Ellis, Robert and Carrie Ellis. "Dog and Cat Bites," American Family Physician. 2014 Aug 15; 90(4): 239-243.
2. Samai, Kathryn and Brian J. Kimbrell. "Bites, Animal and Human," The 5-Minute Clinical Consult Standard, 24e. Wolters Kluwer, 2016.
3. CDC. "Emergency Department Summary Tables," National Hospital Ambulatory Medical Care Survey: 2011. <http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2011_ed_web_tables.pdf>
4. ASPCA. "Shelter Intake and Surrender," Pet Statistics. <https://www.aspca.org/animal-homelessness/shelter-intake-and-surrender/pet-statistics>