Nationwide registry-based analysis of rabies exposures in Iran: Epidemiological patterns and post-exposure prophylaxis adherence
6 affiliations
- 1Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Department of Community and Family Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- 2Vaccine Research Center, Iran University of Medical Sciences, Tehran, Iran
- 3School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- 4Department of Sociology & Anthropology, Nipissing University, North Bay, Ontario, Canada
- 5Zoonosis Control Department, Ministry of Health and Medical Education, Tehran, Iran
- 6Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
Abstract
Background: Animal bites remain an important public health issue in Iran. Understanding their epidemiological patterns and examining how registry-recorded cases are managed in relation to the Iranian rabies protocol and World Health Organization recommendations can provide insight into clinical practice and documentation quality within the national bite registry. Such analyses help identify strengths and gaps in protocol adherence and data completeness. Methodology/Principal findings: We conducted a secondary analysis of 507,404 animal bite cases recorded in the national rabies registry between March 2022 and September 2023. The unit of analysis was registry-recorded exposure visits. Data on demographics, exposure characteristics, and clinical management were examined to describe epidemiological patterns and assess documented adherence to recommended post-exposure prophylaxis (PEP) practices. Males accounted for 73.6% of cases. The largest age group among all patients was 31–40 years, comprising 19.8% of cases. Dogs were responsible for 76.2% of exposures and cats for 20.8%. Northern provinces such as North Khorasan (773 per 100,000) and Golestan (767 per 100,000) recorded the highest incidence. Wound irrigation was documented in 94.3% of patients, and 96.4% received the first vaccine dose within 48 hours. Overall, 68.1% received three vaccine doses and 24.2% four doses. Rabies immunoglobulin was administered to 95.6% of Category III exposures, though inappropriate use was also observed in Category I (6.1%) and II (4.7%). Deviations from vaccine regimens and misclassification of exposure categories were identified, and among bat-related exposures only 36.8% were classified as Category III, with 38.7% receiving immunoglobulin. Conclusions/Significance: Among registry-recorded animal bite attendees, rapid initiation of PEP and frequent appropriate use of rabies immunoglobulin in severe exposures were documented. However, gaps in documentation, vaccine dosing accuracy, and exposure classification indicate areas for improvement. These findings reflect patterns within the national bite registry and should not be interpreted as a comprehensive evaluation of all surveillance system attributes. Strengthening provider training, reinforcing protocol adherence, and improving data quality within the registry could support national rabies control efforts and inform broader prevention strategies aligned with global elimination goals. Author summary: Rabies is a preventable disease, but it continues to pose risks in many parts of the world, including Iran. Animal bites are the main source of exposure, and understanding both their patterns and how they are managed is important for protecting communities. We analyzed over half a million reported bite cases across Iran to identify populations at highest risk and to evaluate adherence to recommended post-exposure prophylaxis practices. Our findings showed that most patients received timely wound care and vaccination, and almost all severe cases were treated with rabies immunoglobulin, which demonstrates the system’s ability to respond quickly. However, we also found some problems. In certain cases, wound washing was not recorded, vaccine schedules were not always followed, and some patients were classified into the wrong exposure category. For example, people exposed to bats were not always treated according to international guidelines. By highlighting both the strong points and the gaps, this study provides evidence that can help improve rabies prevention in Iran. Better training for healthcare workers, stricter adherence to protocols, and closer integration with measures such as dog vaccination and school-based education will further strengthen national efforts and bring the country closer to eliminating rabies.
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BibTeX
@article{babaee2026nationwide,
title = {{Nationwide registry-based analysis of rabies exposures in Iran: Epidemiological patterns and post-exposure prophylaxis adherence}},
author = {Ebrahim Babaee and Arash Yousefzadeh Eshkoori and Babak Eshrati and Marzieh Nojomi and Mohammad Reza Shirzadi and Mehran Asadi-Aliabadi and Amirhesam Moosazadeh},
journal = {PLOS Neglected Tropical Diseases},
year = {2026},
month = sep,
doi = {10.1371/journal.pntd.0014751},
url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014751},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Nationwide registry-based analysis of rabies exposures in Iran: Epidemiological patterns and post-exposure prophylaxis adherence
AU - Ebrahim Babaee
AU - Arash Yousefzadeh Eshkoori
AU - Babak Eshrati
AU - Marzieh Nojomi
AU - Mohammad Reza Shirzadi
AU - Mehran Asadi-Aliabadi
AU - Amirhesam Moosazadeh
PY - 2026
DA - 2026/09/30
JO - PLOS Neglected Tropical Diseases
DO - 10.1371/journal.pntd.0014751
UR - https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014751
AB - Background: Animal bites remain an important public health issue in Iran. Understanding their epidemiological patterns and examining how registry-recorded cases are managed in relation to the Iranian rabies protocol and World Health Organization recommendations can provide insight into clinical practice and documentation quality within the national bite registry. Such analyses help identify strengths and gaps in protocol adherence and data completeness. Methodology/Principal findings: We conducted a secondary analysis of 507,404 animal bite cases recorded in the national rabies registry between March 2022 and September 2023. The unit of analysis was registry-recorded exposure visits. Data on demographics, exposure characteristics, and clinical management were examined to describe epidemiological patterns and assess documented adherence to recommended post-exposure prophylaxis (PEP) practices. Males accounted for 73.6% of cases. The largest age group among all patients was 31–40 years, comprising 19.8% of cases. Dogs were responsible for 76.2% of exposures and cats for 20.8%. Northern provinces such as North Khorasan (773 per 100,000) and Golestan (767 per 100,000) recorded the highest incidence. Wound irrigation was documented in 94.3% of patients, and 96.4% received the first vaccine dose within 48 hours. Overall, 68.1% received three vaccine doses and 24.2% four doses. Rabies immunoglobulin was administered to 95.6% of Category III exposures, though inappropriate use was also observed in Category I (6.1%) and II (4.7%). Deviations from vaccine regimens and misclassification of exposure categories were identified, and among bat-related exposures only 36.8% were classified as Category III, with 38.7% receiving immunoglobulin. Conclusions/Significance: Among registry-recorded animal bite attendees, rapid initiation of PEP and frequent appropriate use of rabies immunoglobulin in severe exposures were documented. However, gaps in documentation, vaccine dosing accuracy, and exposure classification indicate areas for improvement. These findings reflect patterns within the national bite registry and should not be interpreted as a comprehensive evaluation of all surveillance system attributes. Strengthening provider training, reinforcing protocol adherence, and improving data quality within the registry could support national rabies control efforts and inform broader prevention strategies aligned with global elimination goals. Author summary: Rabies is a preventable disease, but it continues to pose risks in many parts of the world, including Iran. Animal bites are the main source of exposure, and understanding both their patterns and how they are managed is important for protecting communities. We analyzed over half a million reported bite cases across Iran to identify populations at highest risk and to evaluate adherence to recommended post-exposure prophylaxis practices. Our findings showed that most patients received timely wound care and vaccination, and almost all severe cases were treated with rabies immunoglobulin, which demonstrates the system’s ability to respond quickly. However, we also found some problems. In certain cases, wound washing was not recorded, vaccine schedules were not always followed, and some patients were classified into the wrong exposure category. For example, people exposed to bats were not always treated according to international guidelines. By highlighting both the strong points and the gaps, this study provides evidence that can help improve rabies prevention in Iran. Better training for healthcare workers, stricter adherence to protocols, and closer integration with measures such as dog vaccination and school-based education will further strengthen national efforts and bring the country closer to eliminating rabies.
SN - 1935-2735
ER -