Rabies post-exposure treatment in metropolitan Sydney residents, 2013-2023: A retrospective case-series analysis

The nature and frequency of rabies and Australian Bat Lyssavirus (ABLV) exposures requiring post-exposure treatment (PET) in metropolitan Sydney residents has not previously been described. We assessed the trends in PET use in this population, the nature of exposures, geographic distribution, and timeliness and completeness of PET provided, comparing between local and overseas exposures.

A retrospective case series analysis of potential rabies and ABLV exposures in residents of Sydney Local Health District reported to the public health unit between January 1, 2013 and December 31, 2023.

Data were available for 595 exposed persons; 477 (80 %) were overseas exposures, and 118 (20 %) were local ABLV exposures. PET was administered in 587 (99 %) exposures. Overseas exposures were mostly due to bites from monkeys, and the majority occurred in Asia (92 %), specifically in Indonesia. Local exposures were mostly due to megabat injuries. Bat testing occurred following 25 % of local exposures, with a 20 % ABLV positivity rate. Inadequate wound management was reported in 45 % of exposures. PET was markedly delayed (commenced greater than 14 days after exposure or a mid-schedule delay) in 26 % of overseas and 7 % of local exposures and incomplete in 15 % of overseas and 4 % of local exposures. Only 8 % of exposed persons received pre-exposure prophylaxis (PrEP).

Cost reduction strategies and measures to improve adherence and accessibility to PET, such as prepositioned stock and standing orders, should be explored. Improving public health risk communication about animal avoidance and appropriate treatment if exposed may also reduce delayed and incomplete PEP. Australian travelers to rabies-endemic countries should be routinely counselled on the benefits of PrEP.