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Human hospitalisations due to dog bites in Ireland, 1998-2013: Implications for current breed specific legislation

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The aim of this study was to examine the efficacy of the current breed specific legislation in Ireland by investigating all dog bite hospital admissions throughout Ireland since that legislation was introduced. Data for statistical analyses were acquired through the National Hospital In-Patient Enquiry Scheme. In years 1998-2013, a total of 3164 human hospitalisations (admissions for dog bite) occurred in Ireland. Incidence of hospitalisations increased over this period (P <0.001). Male humans were at greater risk than females of dog bite hospitalisation (P = 0.015). Children under 10 years were identified as an at-risk group. The present legislation is not effective as a dog bite mitigation strategy in Ireland and may be contributing to a rise in hospitalisations. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Title: Human hospitalisations due to dog bites in Ireland (1998-2013):
implications for current breed specific legislation
Author: Páraic Ó Súilleabháin
PII: S1090-0233(15)00163-X
DOI: http://dx.doi.org/doi:10.1016/j.tvjl.2015.04.021
Reference: YTVJL 4490
To appear in: The Veterinary Journal
Accepted date: 16-4-2015
Please cite this article as: Páraic Ó Súilleabháin, Human hospitalisations due to dog bites in
Ireland (1998-2013): implications for current breed specific legislation, The Veterinary Journal
(2015), http://dx.doi.org/doi:10.1016/j.tvjl.2015.04.021.
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1
Short Communication 1 2 Human hospitalisations due to dog bites in Ireland (1998-2013): Implications for 3 current breed specific legislation 4 5 6 Páraic Ó Súilleabháin a,*
7 8 a School of Psychology, National University of Ireland, Galway, University Road, Galway, 9 Ireland 10 11 12 13 14 * Corresponding author. Tel.: +353 91524411. 15 E-mail address: p.osuilleabhain1@nuigalway.ie (P. Ó Súilleabháin). 16
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2
Highlights 17
There was a significant increase in incidences of hospitalisation of humans due to dog 18
bites in Ireland from 1998 to 2013. 19
Children under 10 years of age are at increased risk for dog bites. 20
Current legislation may be contributing to the rise in hospitalisations. 21
Breed specific legislation is not effective in Ireland. 22
Abstract 23
The aim of this study was to examine the efficacy of the current breed specific 24
legislation in Ireland by investigating all dog bite hospital admissions throughout Ireland 25
since that legislation was introduced. Data for statistical analyses were acquired through the 26
National Hospital In-Patient Enquiry Scheme. In years 1998-2013, a total of 3164 human 27
hospitalisations (admissions for dog bite) occurred in Ireland. Incidence of hospitalisations 28
increased over this period (P < 0.001). Male humans were at greater risk than females of dog 29
bite hospitalisation (P = 0.015). Children under 10 years were identified as an at-risk group. 30
The present legislation is not effective as a dog bite mitigation strategy in Ireland and may be 31
contributing to a rise in hospitalisations. 32
33
Keywords: Breed-specific legislation; Dangerous dogs; Dog bites; Ireland; Dog breed 34
identification 35
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Governments frequently utilise dog breed specific legislation or non-breed specific 36
legislation to reduce injuries and fatalities from dog bites. Breed specific legislation prohibits 37
ownership or places restrictions on certain breeds of dogs categorised as ‘dangerous’ or ‘able 38
to inflict greater injuries’1. Non-breed specific legislation frequently includes measures 39
promoting responsible dog ownership coupled with an education programme2. 40
41
Breed-specific legislation is increasingly viewed as inappropriate and lacking a 42
scientific basis (AVMA, 2001; Collier, 2006; Ott et al., 2008; Cornelissen and Hopster, 2010; 43
Patronek et al., 2013). No differences have been found in aggression or factors leading to 44
biting between dog breeds frequently legislated for and other breeds, suggesting that there is 45
no validity in breed specific lists (Collier, 2006; Ott et al., 2008). Patronek et al. (2013), 46
investigating 256 dog bite related fatalities in the USA over a 10 year period, found that 47
fatalities were associated with preventable factors under the control of both the owners and 48
victims. 49
50
This study examined whether reductions in the incidence of dog bite hospitalisations 51
have occurred since the introduction of the latest breed-specific legislation in Ireland (Control 52
of Dogs Act 1998 Regulations3). Dog bite hospitalisations were defined as human beings 53
admitted as day or in-patients with a primary diagnosis of dog bite, not including those who 54
attended accident and emergency departments. Data were collated and made available by the 55
Healthcare Pricing Office4. Statistics were made available from the introduction of the latest 56
legislation in 1998 until 2013 for all hospitals in Ireland (Table 1). The analysis was 57
1 See: Irish Statute Book: http://www.irishstatutebook.ie/1998/en/si/0442.html (accessed 21 October 2014).
2 See: The Responsible Pet Ownership Bylaw: http://www.calgary.ca/CSPS/ABS/Pages/Animal-
Services/Responsible-pet-ownership-bylaw.aspx (accessed 21 October 2014)
3 See: Irish Statute Book: http://www.irishstatutebook.ie/1998/en/si/0442.html (accessed 21 October 2014).
4 See: Healthcare Pricing Office: http://www.hpo.ie (accessed 21 October 2014).
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conducted using SPSS (IBM) and examined the annual incidence, expressed as number of 58
dog bite hospitalisations of human beings per 100,000 population5. 59
60
There was a total of 3164 human hospitalisations due to dog bite from 1998 to 2013, 61
with a 45% increase in numbers hospitalised; the incidence increased by 21% over the same 62
period. The effect of year on number of hospitalisations was assessed using Poisson 63
regression, with year as the unit of analysis and year number fitted as a continuous variable. 64
The natural log of population size was fitted as the offset. Visual observation and Durbin-65
Watson statistics suggested no autocorrelation in incidence between years; thus, the analysis 66
did not account for autocorrelation in residuals. 67
68
The incidence of dog bites increased significantly with year (P < 0.001; incidence 69
1.015; 95% confidence interval, CI, 1.007-1.022); thus, incidence was estimated as being 70
1.5% higher than the previous year. Pearson’s correlation coefficient revealed a significant 71
positive correlation between incidence and year (r = 0.52, P = 0.02). Incidences were 72
calculated for human males and females separately based on population estimates6. A 73
Wilcoxon signed-rank test revealed that males (median incidence 4.98 dog bite 74
hospitalisations per 100,000 population) had greater annual incidence across years in 75
comparison to females (median incidence 4.29 per 100,000; P = 0.015). Across years, an 76
averaged 14% of the population were children < 10 years of age, but this age group 77
accounted for 49% of all hospitalisations. 78
5 See: Central Statistics Office, Population and Migration Estimates:
http://www.cso.ie/en/releasesandpublications/er/pme/populationandmigrationestimatesapril2014/#.VD_h5xYm9
Wh (accessed 21 October 2014).
6 See: Central Statistics Office, StatBank:
http://www.cso.ie/px/pxeirestat/statire/SelectTable/Omrade0.asp?Planguage=0 (accessed 21 October 2014).
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79
The objective of the Control of Dogs Act 1998 Regulations is to reduce the incidence 80
and severity of bites from specific dog breeds (11 total, including mixes and strains) deemed 81
capable of inflicting injury requiring hospitalisation more frequently than all other breeds. 82
The regulation of these breeds should have resulted in a decreased incidence of 83
hospitalisations, whereas a significant increase in incidence was observed. The absence of a 84
marked decrease in incidence could be due to increased medical attention seeking behaviour 85
over the study period; however, this appears unlikely, given the severity of bites within the 86
present study requiring hospital admission beyond treatment solely in accident and 87
emergency departments. 88
89
Current regulations may be contributing to increases in hospitalisations due to dog 90
bites. Regulating breeds places restrictions on dogs that pose little risk and ignores the 91
possibility that any breed is capable of inflicting serious injuries; for example, fatalities have 92
been caused by dogs that fall into the toy breed categorisation (Collier, 2006). Ott et al. 93
(2008) indicated that the breeds currently regulated in Ireland do not possess higher levels of 94
aggression in comparison with other domestic breeds. Breed legislation can mislead the 95
general public into believing that unregulated breeds are less capable of inflicting serious and 96
fatal injuries (Clarke et al., 2013). 97
98
Regulating dogs based on breed to reduce injuries resulting in hospitalisations and 99
fatalities is contrary to scientific evidence (AVMA, 2001; Cornelissen and Hopster, 2010) 100
and compounded by research highlighting the inaccuracy of breed identification, making 101
current regulations unenforceable (Voith et al., 2013). For example, a dog genetically may be 102
50% a legislated breed and yet lack the genes responsible for coat, muzzle length, size and 103
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ear properties assumed to be typical of the breed (Voith et al., 2013), rendering accurate 104
breed identification impossible. Simpson et al. (2012) recommended refraining from 105
attempting to identify a dog’s breed or mix of breeds due to the high frequency of 106
misidentification. Incorrect breed identification may also have serious legal implications for 107
the identifier, not least in terms of reputation, court costs and damages. 108
109
If non-breed specific legislation is not enacted in Ireland, the author contends 110
hospitalisations will continue to rise, resulting in fatalities. Prior to the abolition of breed 111
specific legislation in The Netherlands during 2006 and 2007, hospitalisation incidence were 112
1.5 dog bite hospitalisations per 100,000 population annually (Cornelissen and Hopster, 113
2010). In Ireland during the same period, incidences were an average of 4.75 dog bite 114
hospitalisations per 100,000 population annually and rising (5.64 per 100,000 in 2013). Non-115
breed specific legislation has been successful worldwide (Oswald, 1991) and the introduction 116
of such legislation in Ireland is recommended. An education programme for children is 117
warranted and should adhere to science-based principles (Ó Súilleabháin, 2015). 118
119
Conflict of interest statement 120
The author of this paper has no financial or personal relationship with other people or 121
organisations that could influence the content of the paper. 122
123
Acknowledgements 124
The author wishes to thank the Healthcare Pricing Office and the Central Statistics 125
Office for their assistance sourcing the data. 126
127
References 128
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AVMA (American Veterinary Medical Association), 2001. A community approach to dog 129 bite prevention. Journal of the American Veterinary Medical Association 218, 1732-130 1749. 131 132 Clarke, T., Cooper, J., Mills, D., 2013. Acculturation - perceptions of breed differences in 133 behavior of the dog (Canis familiaris). Human-Animal Interaction Bulletin 1, 16-33. 134 135 Collier, S., 2006. Breed-specific legislation and the pit bull terrier: Are the laws justified? 136 Journal of Veterinary Behavior: Clinical Applications and Research 1, 17-22. 137 138 Cornelissen, J.M.R., Hopster, H., 2010. Dog bites in The Netherlands: A study of victims, 139 injuries, circumstances and aggressors to support evaluation of breed specific 140 legislation. The Veterinary Journal 186, 292-298. 141 142 Ó Súilleabháin, P., 2015. Training methods and dog-owner interaction as a public health risk 143 factor for dog bites. Zoonoses and Public Health. doi: 10.1111/zph.12195. 144 145 Oswald, M., 1991. Report on the potentially dangerous dog program: Multnomah County, 146 Oregon. Anthrozoos 4, 247-254. 147 148 Ott, S.A., Schalke, E., von Gaertner, A.M., Hackbarth, H., 2008. Is there a difference? 149 Comparison of Golden retrievers and dogs affected by breed-specific legislation 150 regarding aggressive behavior. Journal of Veterinary Behavior: Clinical Applications 151 and Research 3, 134-140. 152 153 Patronek, G.J., Sacks, J.J., Delise, K.M., Cleary, D.V., Marder, A.R., 2013. Co-occurrence of 154 potentially preventable factors in 256 dog bite-related fatalities in the United States 155 (2000-2009). Journal of the American Veterinary Medical Association 243, 1726-156 1736. 157 158 Simpson, R.J., Simpson, K.J., VanKavage, L., 2012. Rethinking dog breed identification in 159 veterinary practice. Journal of the American Veterinary Medical Association 241, 160 1163-1166. 161 162 Voith, V.L., Trevejo, R., Dowling-Guyer, S., Chadik, C., Marder, A., Johnson, V., Irizarry, 163 K., 2013. Comparison of visual and DNA breed identification of dogs and inter-164 observer reliability. American Journal of Sociological Research 3, 17-29. 165
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Table 1
Descriptive statistics for dog bite hospitalisations and population sizes in Ireland by year from 1998 to 2013.
1998
2000
2001
2002
2003
2004
2005
2006
2007
2009
2010
2011
2012
2013
Dog bite incidencea
4.65
3.77
4.76
4.16
4.55
4.92
3.94
4.42
5.07
4.24
5.03
5.68
5.43
5.64
Total number of hospitalisations
172
143
183
163
181
199
163
187
222
192
229
260
249
259
Population b
3,703,100
3,789,500
3,847,200
3,917,200
3,979,900
4,045,200
4,133,800
4,232,900c
4,375,800
4,533,400
4,554,800
4,574,900
4,585,400d
4,593,100d
Patient type
Day
e
e
e
e
8
e
9
15
8
e
9
e
13
17
In-patient
e
e
e
e
173
e
154
172
214
e
220
e
236
242
Dog bite incidencea
Male
5.44
3.40
5.59
4.01
4.86
4.62
4.03
5.10
5.66
4.21
5.70
6.21
5.51
6.11
Female
3.86
4.14
3.93
4.31
4.24
5.21
3.86
3.73
4.49
4.26
4.36
5.16
5.35
5.17
Total hospitalisations
Male
100
64
107
78
96
93
83
108
124
95
129
141
125
139
Female
72
79
76
85
85
106
80
79
98
97
100
119
124
120
Age group
0-9
100
73
95
82
94
102
73
83
102
92
101
120
101
109
10-19
15
19
26
23
17
22
12
18
29
22
30
31
22
46
20-29
11
e
8
9
e
12
10
14
18
12
15
19
15
12
30-39
11
11
6
6
18
e
9
10
11
14
26
17
22
26
40-49
10
10
15
13
10
13
22
16
19
16
16
17
24
19
50-59
7
9
9
13
8
15
16
13
17
14
14
23
27
21
60-69
7
6
8
e
15
14
9
6
e
13
14
17
14
12
70-79
e
e
7
9
9
11
e
20
11
e
e
e
14
14
80 years and older
e
6
9
e
e
e
e
7
e
e
e
e
10
e
In-patient mean length of stay (days)
2.7
2.4
2.2
2.6
2.6
2.3
2.2
2.6
2.1
1.8
2.8
2.0
2.7
2.3
a Number of dog bite hospitalisations per 100,000 population of human beings.
b Population numbers are rounded to the nearest 100 by the Central Statistics Office (http://www.cso.ie/en/releasesandpublications/er/pme/populationandmigrationestimatesapril2014/#.VD_h5xYm9Wh).
c Up to and including 2005, the annual population estimates are on a de facto basis (people present in the country on census night). From 2006 onwards, the concept of usual residence (people usually resident and present in the State on census night
plus absent people who are usually resident in Ireland) is used.
d Preliminary.
e Missing data.
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DANGEREOUS DOGS ; AGGRESSIVENESS ; LEGISLATION ; PUBLIC HEALTH ; BEHAVIOR ; DOGBITE ; RISK MANANAGMENT Risk assesment. Identification of danger. Emission X exposition = Probability of Risk. Risk consequences. Behavioural Evaluation. Behavioural Medicine. Dogs. French Law. Law Proposal. Law of 06/01/1999 and Law of 2007 and Law of 2008.
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Background: Surgical specialists in plastic, head and neck, hand, trauma surgery, and emergency medicine physicians bear the burden of treating the most serious injuries caused by animals. Most of these incidents result from an attack by a known dog, and breed has been proposed, but not proven, to be a controllable factor. The authors summarize the peer-reviewed literature on dog bites in the United States, specifically as related to the breeds implicated. Methods: A systematic review of all peer-reviewed publications reporting on dog bites in the United States was performed. MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Library searches were conducted through May 8, 2018, for studies from the United States implicating a specific dog breed as responsible. Results: Forty-one articles met inclusion criteria, the majority of which were single-institution retrospective reviews. Main outcomes were any dog bite reported in the peer-reviewed literature where a specific breed was implicated. Secondary measures included dog bites reported in areas where breed-specific legislation was enacted. The most common pure breed identified was German Shepherd, followed by Pit Bull-type breeds (i.e., American Staffordshire Terrier, American Pit Bull Terrier, Staffordshire Bull Terrier, American Bully), Labrador, Collie, and Rottweiler, respectively. Pit bull-type and German Shepherd breeds are consistently implicated for causing the most serious injuries to patients in the United States across heterogeneous populations, and this remained consistent across multiple decades. Conclusions: The authors' results indicate that German Shepherd and Pit Bull-type breeds account for the largest subset of pure breeds implicated in severe dog bites inflicted on humans in the medical literature. The role and complexity of mentioning breed in relation to human injuries are also discussed.
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Behavioral breed differences in dogs are frequently attributed to largely genetic factors. An alternative hypothesis to explain perceived breed-specific behavioral differences uses the concept of acculturation. A key feature of acculturation is the Contact Hypothesis involving experience of other cultures, with limited contact resulting in beliefs based on stereotypic images of a group. A survey was developed to investigate if personal perception of breed behavior is associated with the informant’s relationships with dogs. This was tested using statements premised on somatotypic (or appearance based) assumptions, including breed-specific behavioral characteristics such as intelligence, original function and aggressive tendencies, and the validity of breed-specific legislation. 166 surveys were returned from 5 targeted populations expected to vary in contact with dogs. Their responses to each statement was recorded on a 4-point Likert scale from strongly agree to strongly disagree. The results were consistent with the prediction that level and quality of contact influenced tendency to believe breed stereotypes. Those with limited contact with dogs were more likely to agree with breed-specific legislation, and that certain breeds were more aggressive than others. In contrast responses related to intelligence, or breed’s original form and function were not influenced by respondent’s experience of dogs. These findings suggest increased positive contact can overcome potential misconceptions regarding dogs. In particular, where there is a negative emotional component to a breed’s image such as aggression or potential danger, then those with limited positive contact tend to base their beliefs on popular somatypic stereotypes.
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As part of an evaluation of Dutch breed specific legislation, data were collected from dog bite victims (1078) and dog owners (6139) using Internet surveys. The incidence rate of dog bites and details of incidents (victims, injuries, circumstances and aggressors) are reported and the justification for using breed specific measurements to deal with dog bites are considered. For aggressors, attack records for breed groups and popular breeds were established by calculating breed risk indices using a reference population. Several breeds and breed groups were over- and under-represented in the biting population and there was a mismatch between risk indices and the then-current legislation. Mitigation strategies should not be based on attack records (since this would lead to the rejection of a significant proportion of the canine population) but on the circumstances of the incidents. Preventative measures must focus on a better understanding of how to handle dogs.
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Objective: To examine potentially preventable factors in human dog bite-related fatalities (DBRFs) on the basis of data from sources that were more complete, verifiable, and accurate than media reports used in previous studies. Design: Prospective case series. Sample: 56 DBRFs occurring in the United States from 2000 to 2009. Procedures: DBRFs were identified from media reports and detailed histories were compiled on the basis of reports from homicide detectives, animal control reports, and interviews with investigators for coding and descriptive analysis. Results: Major co-occurrent factors for the 256 DBRFs included absence of an able-bodied person to intervene (n = 223 [87.1%]), incidental or no familiar relationship of victims with dogs (218 [85.2%]), owner failure to neuter dogs (216 [84.4%]), compromised ability of victims to interact appropriately with dogs (198 [77.4%]), dogs kept isolated from regular positive human interactions versus family dogs (195 [76.2%]), owners' prior mismanagement of dogs (96 [37.5%]), and owners' history of abuse or neglect of dogs (54 [21.1%]). Four or more of these factors co-occurred in 206 (80.5%) deaths. For 401 dogs described in various media accounts, reported breed differed for 124 (30.9%); for 346 dogs with both media and animal control breed reports, breed differed for 139 (40.2%). Valid breed determination was possible for only 45 (17.6%) DBRFs; 20 breeds, including 2 known mixes, were identified. Conclusions and clinical relevance: Most DBRFs were characterized by coincident, preventable factors; breed was not one of these. Study results supported previous recommendations for multifactorial approaches, instead of single-factor solutions such as breed-specific legislation, for dog bite prevention.
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Between 2000 and 2002, legislation in Lower Saxony insinuated a special dangerousness of certain dog breeds, and controls were imposed on them. Exemption was only possible if the dogs passed a standardized temperament test. In a previous study, test results of 415 dogs belonging to breeds affected by the legislation were analyzed. Ninety-five percent of the dogs showed no indication of disturbed aggressive communication or aggressive behavior in inappropriate situations. Because a control group was not available at that time, these results referred to a comparison between the affected breeds. In this study, golden retrievers were tested and used as control group. Seventy golden retrievers were tested in the temperament test. The order of testing was: veterinary examination, learning test, situations of dog–human-, dog–environment-, and dog–dog-contact, and obedience. Levels of escalation in aggressive behavior were scored using a scale of 1–7. A total of 58.57% of the dogs did not show aggressive behavior (Scale 1). Forty percent displayed aggressive behavior referring to Scale 2, and 1.43% showed aggressive behavior referring to Scale 5. A total of 98.57% of the dogs reacted appropriately, and 1.43% displayed aggressive behavior in inappropriate situations. In the previous study, 95% of the animals reacted appropriately, whereas 5% displayed excessive aggressive communication or aggressive behavior in inappropriate situations. Comparing the results of golden retrievers and breeds affected by the legislation, no significant difference was found. A scientific basis for breed specific lists does not exist. Therefore, legislation in Lower Saxony was changed, and breed lists were withdrawn.
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In April 1986, a five-year-old boy was fatally mauled by a pit bull terrier in Multnomah County, (Portland) Oregon. This tragic event sparked concern over how effectively the public was being protected from the hazards posed by aggressive dogs. In June 1986, a new ordinance was passed that identifies and regulates potentially dangerous dogs. In the first three years of the program, 1,652 dogs were classified as potentially dangerous, and restrictions were placed on the ownership of these animals. A pretest-posttest evaluation methodology examining the rate of recidivism was used to measure the program's effectiveness in limiting the opportunity for identified potentially dangerous dogs to repeat their behavior. In the five years prior to the implementation of the program, 25% of those dogs that had caused injury to people or other animals through attacking or biting repeated that same behavior within one year. After the implementation of the program, that rate of repeat incidence has been reduced to 7%.
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After more than a century as an uncontroversial dog (Jessup, 1975), the American pit bull terrier has developed a notorious reputation as a dangerous breed since 1980, with consequent restrictions placed upon it by jurisdictions in Australia and elsewhere. Studies in the United States have indicated that the "pit bull" is responsible for a significant number of human fatalities resulting from dog attack, but the data on which such studies are based are flawed by methodological shortcomings. Using absolute numbers of dog attacks by breed in Australia, data on attacks on human beings reveal the pit bull terrier to be exceeded by several other breeds. Regardless, the primary problem is that reliable data do not exist for the number of attacks relative to breed population. Of 19 human fatalities in Australia over the past two decades, none has involved a dog verified to be an American pit bull terrier. The evidence does not sustain the view that this is a uniquely dangerous breed, and breed-specific laws aimed to control it have not been demonstrated by authorities to be justified by its attack record.