Abstract
BACKGROUND: Rabies continues to pose a significant public health challenge in China. Here we reported the risk factors associated with the failure to initiate post-exposure prophylaxis (PEP) vaccination in China for period 2016-2020. It is essential for identifying strategies to decrease the incidence of these preventable fatalities. METHODS: We analyzed data from 1,733 case investigations in China between 2016 and 2020. Chi-squared tests and logistic regression analyses were utilized to identify factors associated with the failure to initiate PEP vaccination. RESULTS: A majority of the incidents (n = 1,295; 84.3%) involved animal bites, with dog wounds constituting 94.0% of these cases (n = 1,437). Domestic animals from the victims' own residences accounted for 48.5% (n = 690) of human rabies cases, followed by free-roaming animals at 34.4% (n = 489). Among the domesticated animals, 95.7% (n = 779) had not been vaccinated against rabies. Category III wounds were present in 66.1% (n = 952) of all cases. In the multivariable model, factors occupation, exposure category, and source of attacking animal were significantly associated with failure to initiate PEP vaccination. However, only 4.3% (n = 41) received rabies immunoglobulin (RIG), and a mere 1.2% (n = 11) underwent complete PEP vaccination in addition to RIG administration. The median incubation period for rabies was recorded at 72 days, with an interquartile range (IQR) of 35.0-173.0 days. CONCLUSIONS: The majority of individuals affected by rabies did not pursue PEP vaccination, especially those with category II wounds or those bitten by domestic animals from their own households. To decrease mortality from rabies, it is imperative to launch prevention campaigns directed at these groups. Furthermore, enhancing the regular vaccination of domestic dogs is crucial for long-term control of the disease.