Animal Bite and Deficiencies in Rabies Post-Exposure Prophylaxis in Tehran, Iran

Rabies post-exposure prophylaxis (PEP) is an effective measure if administered immediately. We evaluated the primary health care provided after animal bite and determined the deviations from rabies PEP protocol. This 6-year population-based cross-sectional study was conducted in Tehran, the capital of Iran, from April 2006 to March 2012. The study population included people who referred to health centers of Tehran, seeking PEP. The data were extracted from rabies registry databases using a checklist of items according to the context of the health records. All statistical analyses were performed at a significance level of 0.05 using Stata software, version 11. Of 22,766 cases of animal bite, 84.5% were men, 31.9% were aged 21–30 years, and 66.3% lived in urban areas. Most cases were the result of a dog bite (81.7%), mostly at midday (29.9%), and more frequently in spring (27.9%) and summer (27.7). Legs (45.6%) and hands (43.4%) were the most common sites of animal bite. The PEP was associated with a variety of shortcomings as follows. A majority of cases who had indication of receiving a 5-dose vaccination schedule had received only three doses. Most of the cases with a wound in the head and neck and many of cases with deep wounds had not received immunoglobulin. A number of cases needed to receive one-mL dose of vaccine while they had received 0.5-mL doses. According to our results, rabies PEP is not well monitored and the preventive measures are associated with some insufficiencies and deviations from the national PEP protocol which must be taken into consideration by public health authorities to ensure that rabies surveillance is efficient.