Rabies immunoglobulin utilization and delayed presentation following category III rabies exposure: a 10-year retrospective study in Hangzhou, China.

Authors

Jing Wang, Weiwei Cai, Jiaxin Chen, Jing Chen, Wanli Yang

Published in

Frontiers in public health. Volume 14. Pages 1916685. Epub Oct 09, 2026.

Abstract

Rabies is an almost invariably fatal, vaccine-preventable zoonosis. Rabies immunoglobulin (RIG) is recommended for Category III exposures, yet real-world RIG utilization remains poorly characterized. This study examined temporal trends and factors associated with RIG utilization and delayed presentation among Category III exposure patients in China.
A retrospective study was conducted using clinical records of Category III exposure patients presenting to a high-volume rabies prevention clinic in Hangzhou, China, from 2015 to 2024. Calendar year 2018 was treated as a temporal reference year for descriptive comparison. Multivariable logistic regression identified factors associated with RIG non-administration and delayed presentation (>24 h post-exposure).
A total of 14,270 eligible cases were analyzed. Overall RIG utilization was 37.54%, declining from 53.09% in 2015 to 7.14% in 2022. RIG non-administration was independently associated with male sex (OR 1.20, 95% CI 1.11-1.29), age 18-59 years (OR 3.25, 95% CI 2.95-3.59), exposure at home (OR 1.47, 95% CI 1.33-1.63), presentation in 2018 (OR 2.38, 95% CI 2.01-2.82) and in 2019-2024 (OR 4.49, 95% CI 3.96-5.09), and delayed presentation (OR 1.43, 95% CI 1.32-1.55). The overall delayed presentation rate was 34.47%; independent risk factors included age 18-59 years (OR 1.37, 95% CI 1.24-1.52), exposure at home (OR 1.57, 95% CI 1.41-1.74), and presentation in 2018 (OR 1.61, 95% CI 1.40-1.86) and in 2019-2024 (OR 1.77, 95% CI 1.62-1.94).
RIG utilization was low and showed marked temporal variation during 2015-2024, and one third of patients presented more than 24 h after exposure. Both outcomes were concentrated among working-age adults and domestic exposure settings. These findings describe service utilization patterns and identify subgroups in which gaps in PEP delivery are concentrated; targeted risk communication and routine monitoring of RIG utilization and presentation timeliness are needed.

PMID:
42920603
Bibliographic data and abstract were imported from PubMed on 24 Oct 2026.

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