The word rabies originates from the Latin word Rabere which means to rage or rave, and may or lytta, which means frenzy or madness. Rabies, a vaccine-preventable zoonotic viral disease, is a neglected tropical disease characterized by acute progressive encephalitis and is always fatal once signs and symptoms appear [1]. It is an extensively distributed viral zoonotic disease of major public health importance that affects humans and domestic and wild animals. Rabies is well known by the Nigerians based on the availability of various indigenous terms that the disease had been recognized in Nigeria including ciwon kare (Hausa), ara nikita (Igbo), and digbolugi (Yoruba) [2]. Dog is the principal reservoir that maintains and transmits the disease to other animals and man in Nigeria [3–7] from which an estimated 21,500 deaths occur in West and Central Africa [8]. The disease infects domestic and wild animals and is spread to people via infected saliva through bites, licking, or scratches [9]. Once symptoms develop, rabies is nearly always fatal [10]. Dogs are the source of 98% of human rabies deaths [10]. The occurrence of rabies in humans and domestic animals is well known, but the role that wild mammals play in its spread has not been determined [11]. Transmission of rabies to humans can be greatly reduced by health awareness and change of behavior towards the disease. Vaccination against rabies virus is a highly effective method of preventing rabies in humans and animals. Few countries (e.g., Japan, Australia, New Zealand, and The British Isles) are free of the disease due to successful eradication programs or their island status and enforcement of rigorous quarantine regulations [12]. It remains a disease with no cure and the survival of affected humans and animals is extremely rare [13]. Of concern also is that 40% of dog bite victims are children under 15 years of age who may not report minor scratches or dog bites to their caregivers and in cases where the offending dog is rabid the possibility of rabies infection resulting increases [14]. Children as a result of their curiosity, limited knowledge, and limited experience about dog behavior and most importantly inability to protect themselves from attacks from dogs may be partly responsible for the higher number of bites in the pediatric population [14]. Furthermore, children are more likely to suffer multiple bites including bites to the face and head that have high innervations with a higher propensity to contraction of rabies infection [15]. Most of the cases of dog bites were by stray dogs that attacked their victims aggressively without being provoked. Dog bites in humans are of public health importance globally, as 35%–50% of victims of rabid dog bites may contract rabies if adequate and timely pre and/or post-exposure prophylaxes are not administered [16]. In many countries of those continents, few activities are underway to prevent rabies occurrence in humans and to control rabies in dogs, even with the high death rates in humans resulting from rabies. Dog licensing, killing of stray dogs, muzzling, and other measures contributed to the elimination of rabies from the United Kingdom in the early 20th century. More recently, routine expansive vaccination of cats, dogs, and ferrets has been successful in combating rabies in many developed countries. Several cases of human rabies survivors were reported and documented in various studies, some of them include; in Texas, USA, a 17-year-old lady survived rabies exposure due to bats [17]; also in 2011, an 8-year-old girl survived rabies exposure due to cats at California, USA [18], and a 13-year-old girl also survived a rabid dog attack in India in 2011 [19], and these success were achieved due to different level of critical care and support given to the patients, but human rabies remains almost always fatal. Most of the cases of rabies in the present studies were from rural areas where poverty, ignorance, and poor dog ownership culture abound. Results from a study showed that the majority of the dogs involved in bites were poorly vaccinated or unvaccinated for rabies. Such low vaccination rates in dogs as in a similar study in Nigeria [20] are of serious public health concern as they mitigate against effective control of rabies in Nigeria compared to the most developed world where mass vaccination of domestic dogs has successfully eliminated or controlled domestic dog rabies. Almost all human deaths caused by rabies occur in Asia and Africa. It is estimated that about 60,000 human rabies deaths occur yearly following an encounter with rabid dogs. Developing countries with a large number of dogs, most of which movement is not restricted, account for approximately 98% of human rabies. The first documentation of rabies in Nigeria in humans was in 1912 and dogs in 1925 [21] and since then many authors [11,22–25] have established that the disease is endemic in the country with more recent reports showing that the prevalence of the disease is on the increase. Under reporting of rabies in endemic developing countries has resulted in the disease being ignored by medical professionals and subsequently poor assistance from the international community and donor agencies [26]. Therefore, information on vaccination and perception of rabies by the residents of selected local government areas (Agege and Ikeja) has the benefit of enabling the health agencies to better evaluate and plan for a more efficient and effective rabies control program. The overall objective of this study was to evaluate the situation of rabies and compliance with anti-rabies vaccination as a control program among humans and animals in the study area.

Dog bites in humans are a major public health problem globally. Millions of people are bitten by dogs annually making dog bites of great concern to people. A total of 347 cases of dog bite were reported to LASUTH between the years of 2012 to 2018 although this may not be an exact representation of dog bite cases as not all cases are reported to the hospital. This number is particularly high when compared to the findings of Hambolu et al. [31] in a previous study that reported 196 dog bite cases from 3 senatorial districts in Lagos state. There was a steady decline in reported cases from 75 in 2012 to 32 in 2016; this was followed by an increase to 49 in 2017 and 45 in 2018.Local dogs are in most cases free roaming which increases interaction with humans and the likelihood of dog bites occurring. This study confirms that dog bites at risk of transmitting rabies is still a menace in Lagos State. The frequency of dog bites increased significantly during the rainy season, from March to October the reason of which is not evident. This finding is not in line with the results of similar studies [11,32–34] which noted that most outbreaks of rabies occurred during the dry season which coincides with the breeding season of dogs in most parts of Nigeria when the aggressive behavioral change of male dogs during mating can contribute to biting. Similarly, nursing bitches are naturally aggressive and can bite humans to protect their newly born puppies. There was high a prevalence of dog bites among young adults in this study (25–40 years). This may be connected to the fact that this demography tends to have more frequent unsupervised contact with dogs as they are adults. This finding is not consistent with other reports [10,33–36] of children being the major victims of, and more vulnerable to, dog bites. A similar study [32] conducted in Lagos demonstrated that the majority of dog bite victims were adults, this is consistent with the findings of this study. The male-female ratio showed a female gender bias in the sex distribution of dog bites victims which could be explained by the physical ability of males to outrun an offending dog or in most cases defend themselves by fighting off offending dogs while most females are usually scared at the sight of dogs and therefore more likely to exhibit inappropriate actions such as screaming and running that incites predatory behavior in dogs putting themselves at a disadvantaged position. This agrees with the findings of Omoke and Chukwueloka [37] where females were more affected by dog bites, but does not agree with similar studies in Ogoja [32], Sokoto [38], and other parts of Africa [39] where males are more affected than females. Anti-rabies vaccination coverage for this study was inadequate as the rate was lower than the 70% total vaccination coverage recommended by the WHO [31] required to achieve herd immunity, especially in adult dogs to prevent rabies outbreaks. This constitutes a higher risk of rabies transmission to humans and is consistent with the findings of Hambolu et al. [31] in a previous study carried out in Lagos State. This low vaccination level indicates that the populace may not be aware of or do not consider the threat dogs pose in the epidemiology of rabies. It also indicates that a large proportion of dog the population in Lagos state is at risk of being infected with the rabies virus. A higher percentage of male dogs (52%) were vaccinated against the female dogs (48%). This sex variation could be a result of male: female ratio dominance. Male dogs are more popular than female dogs as a result of their increased aggression and thus effectiveness as guard dogs and for hunting purposes. This finding agrees with the findings of Isek et al. [32]. There was also age variation within the vaccinated dog population. Dogs within the 3–12 months age range had the highest vaccination rates. This may be as a result of consistent advice to vaccinate dogs from 3 months old. These findings are consistent with previous studies [32] and are not consistent with studies [40] that found that pups less than 3 months were less likely to be vaccinated due to reasons such as a lack of awareness about vaccinations. This study also assessed the knowledge of rabies and factors associated with/affecting rabies vaccination coverage among residents and dog owners of the study area. In regards to rabies awareness, the majority (78.2%) of the respondents had satisfactory knowledge of rabies and knew how to recognize the clinical signs of mostly the furious form of rabies in dogs. This finding is not surprising considering the severity and endemic status of the disease as well as routine awareness programs mostly targeted at dog owners and handlers. This is supported by the finding of similarly high levels of awareness in studies conducted in other places where the disease is also endemic including Sokoto, Nigeria [41]. Respondents showed an acceptable knowledge on the perceived threats of rabies and the frequency of anti-rabies vaccination in dogs. The result of this study showed that the attitude of respondents towards the prevention of rabies via routine vaccination of dogs among dog owners was affected by certain factors such as the cost of the vaccine, distance to a veterinary healthcare facility, ease of handling their dogs as well as breed of the dog. Despite cost being a factor, most dog owners still had their dogs vaccinated against rabies; this could be attributed to the keeping purpose of the dog as most dog owners owned exotic and mixed breeds of dogs which are mostly kept for their monetary value in terms of breeding. This finding is not in agreement with a similar study by Isek et al. [32] where the majority of the vaccinated dogs were local breeds. Despite the cost of vaccine being a factor as well as distance, it was observed that a higher number of dog owners were still in compliance with the routine vaccination practice for maximum protection and prevention of rabies. This can majorly be attributed to the keeping purpose of dogs as most breeders are required to vaccinate their dogs before they can mate their dogs with other dogs or sell off the resultant puppies.

This study showed that dog bites are still a common occurrence among young adults which could serve as a potential source of the spread of the rabies virus if the bite was from a rabid dog. Despite the implication and severity of reported rabies cases in Nigeria, basic control measures such as vaccinating dogs against the disease are still very inadequate. Although the majority of the respondents in this study were aware of rabies, they had little knowledge on the cause of rabies, forms of rabies, and prevention of the disease. Furthermore, the respondents’ attitude towards rabies prevention practices were non satisfactory. Given that bites from rabid dogs are responsible for over 95% of the annual 59,000 human deaths, sustainable elimination of human deaths due to rabies by 2030, requires reduction of the primary transmission risk (dog bite from rabid dogs), through mass dog vaccination, prompt exposure reporting and improved PEP access for bite victims. Understanding the budgetary implications on the national economy and the commitment required from the governing bodies on a national scale is of paramount importance to establish and sustain effective control and preventive measures.

Rabies risk, coupled with welfare concerns suggests the need for continued advocacy towards legislation prohibiting the dog trade in Nigeria and elsewhere. The high-risk community groups such as children, butchers, and adult males need to be educated on responses to dog bite exposure to reduce the impact of this invariable fatal but preventable disease. Moreover, there is a need for mandatory dog vaccination and the implementation of a national rabies program to attain the WHO recommended vaccination coverage of at least 70%. There is a need to establish rabies diagnostic centers in the country’s six geopolitical zones [42]. Local inclusion of dog bite occurrence by disease surveillance and notification officers, with related community surveillance tools, can help in rabies/dog surveillance. In addition, there is a need for investment into pathogen discovery by enhancing laboratory-based surveillance for wildlife rabies, understanding its potential role in Nigeria, and the need for quantitative research to understand the various risk factors for disease perpetuation.

Rabies control programmes should be carried out routinely using communication platforms that speaks to all. Education on dog behaviour, responsible pet ownership, and bite prevention should be made an essential extension of a rabies control programme. Rabies campaign programmes should include education on forms of rabies as most respondents were familiar with just the furious form of rabies. There is a need for private owned veterinary clinics to improve on record keeping especially as it relates to dog bites/rabies. Government and other stakeholders should step up education of the public especially dog owners on rabies prevention, in addition to organizing annual free or subsidized mass dog vaccination campaigns.

Data collection was from referred health centers therefore generalization of findings not feasible. No access to records from some private veterinary hospitals.

This study provides evidence on dog bite being a menace affecting both young adults and children. This study provides feedback on the status of anti-rabies vaccination as a control program. Evidence to support the need for continued investment in rabies control programs to support WHO to end human rabies death by 2030.

The research team wishes to express its profound gratitude to all the staff of the State Veterinary Hospital in Agege and Lagos State University Teaching Hospital located at Ikeja as well as several private hospitals sampled.

The authors declare no competing interests regarding the publication of this paper.

No funding or grant was received in the course of conducting this research as such it was a self-sponsored study.