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Systematic review of dog bite prevention strategies
  1. Natasha Duncan-Sutherland1,
  2. Abbey C Lissaman2,
  3. Michael Shepherd3,4,
  4. Bridget Kool5
  1. 1Adult Emergency Department, Auckland Hospital, Auckland, New Zealand
  2. 2Department of Physiology, The University of Auckland, Auckland, New Zealand
  3. 3Starship Children's Emergency Department, Starship Foundation, Auckland, New Zealand
  4. 4Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
  5. 5Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
  1. Correspondence to Dr Natasha Duncan-Sutherland, Adult Emergency Department, Auckland Hospital, Auckland, New Zealand; quavernote{at}


Background The prevention of dog bites is an increasingly important public health topic, as the incidence of serious injury continues to rise.

Objectives To evaluate the effectiveness of interventions to prevent dog bites and aggression.

Methods Online databases were searched (PubMed, Cochrane Library, Embase and Google Scholar), using the search terms: dog/s, canine, canis, kuri, bite/s, bitten, aggression, attack, death, fatal, mortality, injury/ies, prevention, intervention, for studies between 1960 and 2021. All study designs were considered. Outcomes of interest were the incidence of dog bites or dog aggression. Non-English studies, and those without full-text access were excluded.

Results Forty-three studies met the review criteria, including 15 observational and 27 interventional studies. Fifteen studies investigating dog-control legislation, including leash laws, stray dog control and infringements indicated this can reduce dog bite rates. Breed-specific legislation had less of an effect. Six studies investigating sterilisation, showed while this may reduce dog bites through a reduction in the dog population, the effect on dog aggression was unclear. An alcohol reduction programme showed a significant reduction in dog bite rates in one study. Seven studies assessing educational approaches found that intensive adult-directed education may be effective, with one study showing child-directed education was not effective. Eight studies on dog training (two police-dog related), and six evaluating dog medication or diet were generally low quality and inconclusive.

Conclusions Multiple strategies including effective engagement with indigenous communities and organisations will be required to reduce dog-bites and other incidents involving dog aggression. This review provides some evidence that legislated dog control strategies reduce dog bite rates. Available evidence suggests greater restrictions should be made for all dogs, rather than based on breed alone. Due to a burden of child injury, protection of children should be a focus of legislation and further investigations. Prevention strategies in children require redirection away from a focus on child-directed education and future research should investigate the effectiveness of engineering barriers and reporting strategies.

  • Education
  • Legislation
  • Animal bites
  • Public Health
  • Engineering

Data availability statement

All data relevant to the study are included in the article. Not applicable.

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Data availability statement

All data relevant to the study are included in the article. Not applicable.

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  • Contributors The design of this review was developed by BK, ND-S and MS. The online database search was carried out by ACL. Screening, selection for inclusion and analysis of studies was undertaken by ACL and ND-S. The body of the article was composed by ACL and ND-S. ND-S is responsible for the overall content as guarantor.

  • Funding Starship Foundation. Registered Charity CC24272. Award number: A+ 9001. SF2137.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.