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Post-Exposure Rabies Prophylaxis in Children: Real-World Practices From an 11-Year Retrospective Study in Türkiye
Ahu Kara-Aksay1,2, Gizem Avcı Demirciler1, Nilay Lemay3
1Department of Pediatric Infectious Diseases, Health Sciences University, İzmir Tepecik Training and Research Hospital, İzmir, Türkiye.
Insights
Rabies post-exposure prophylaxis (PEP) in children shows gaps in risk assessment and inconsistent practices. Standardized risk evaluation and improved clinical guidance are needed for this fatal, yet preventable, disease.
Area of Science:
- Public Health
- Infectious Diseases
- Pediatrics
Background:
- Rabies is a fatal viral disease preventable with timely post-exposure prophylaxis (PEP).
- Understanding pediatric rabies exposure and PEP practices in endemic urban areas is crucial for public health.
- Current practices may have inconsistencies affecting disease prevention.
Purpose of the Study:
- To describe rabies exposure characteristics in children.
- To evaluate risk categorization and real-world PEP practices among pediatric patients.
- To identify areas for improvement in rabies prevention strategies for children.
Main Methods:
- Retrospective study of children (<18 years) with rabies-risk contact from January 2013 to October 2023.
- Data extracted from the provincial rabies surveillance system in İzmir.
- Included demographics, exposure details, animal species, risk category, and PEP administration (vaccination, rabies immunoglobulin, tetanus).
Main Results:
- 3732 children included; most exposures involved dogs and cats.
- 48.8% presented on the same day; 0.9% presented after >30 days.
- Risk categorization documented in only 33.6%; rabies immunoglobulin (RIG) given to 2.6%.
Conclusions:
- Significant gaps exist in documenting rabies risk in children.
- Variability in pediatric rabies post-exposure prophylaxis practices was observed.
- Standardized risk assessment and enhanced clinical guidance are necessary for effective rabies prevention.
Aim:
Rabies is a universally fatal yet preventable disease when post-exposure prophylaxis (PEP) is administered promptly and appropriately. To describe exposure characteristics, risk categorization and real-world PEP practices among children in an endemic urban setting.
Methods:
We conducted a retrospective study of children (< 18 years) presenting with rabies-risk contact between January 2013 and October 2023. Data were extracted from the provincial (İzmir) rabies surveillance system and included demographics, exposure type, time to presentation, animal species, risk category, wound care, rabies vaccination, rabies immunoglobulin (RIG) and tetanus prophylaxis.
Results:
A total of 3732 children were included (median age 9 years, IQR 5-13), with 63.3% being male. Most exposures involved dogs (49.8%) and cats (44.8%) and occurred in İzmir. Same-day presentation occurred in 48.8% of cases, while 0.9% presented after more than 30 days. Risk categorization was documented in only 33.6% of patients, most commonly Category II (61.5%) and Category III (30.5%). RIG was administered to 2.6% of patients and more frequently after wild animal exposures.
Conclusion:
Substantial gaps in risk documentation and variability in pediatric rabies PEP practices were observed, highlighting the need for standardized risk assessment and improved clinical guidance.
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