Cat-Related Injuries and Rabies Exposure: A Three-Decade Retrospective Analysis from the Zagreb Antirabies Clinic...

Cat-related injuries are a frequent reason for antirabies consultation, but long-term data on their epidemiology and management remain limited, particularly in European settings that have transitioned from endemic sylvatic rabies to officially rabies-free status. We retrospectively analysed registry data on all patients examined for cat-related injuries at the Zagreb Antirabies Clinic, the Croatian Reference Centre for Rabies, between 1995 and 2025. Among 24,107 animal-related consultations, 3147 (13.1%) involved cats. Most patients were female (64.8%), and children under 18 years of age accounted for 14.7% of the patients. The offending cat had a known owner in 48.5% of cases and was unknown in 45.9%. Records associated with laboratory-confirmed rabid cats accounted for 4.8%, all from 1995 to 2012. Post-exposure prophylaxis (PEP) was administered to 37.6% of patients, and human rabies immunoglobulin (HRIG) to 2.9%. Hospitalisation was rare (1.1%), while injuries most often involved the fist and fingers (59.5%). PEP administration was strongly associated with the rabies risk status of the offending cat, increasing from 8.7% for known-owner cats to 62.0% for unknown cats and approximately 87% for suspected or laboratory-confirmed rabid cats (p < 0.001). In multivariable analysis, animal status remained the principal factor independently associated with PEP (adjusted odds ratio for unknown versus known-owner cats approximately 18), whereas patient characteristics had limited effect. HRIG use declined below 1% in 2015-2025, paralleling the elimination of sylvatic rabies in Croatia. Continued structured exposure assessment remains relevant despite rabies-free status, particularly when cats are unknown or unavailable for observation.