Search Results (68)

Background: Rabies remains a major zoonotic disease worldwide, particularly in regions with large populations of free-roaming animals. In urban settings, animal-related injuries constitute a substantial healthcare burden and frequently result in the administration of rabies post-exposure prophylaxis (PEP). This study aimed to evaluate the epidemiological characteristics of animal exposures and real-world PEP practices in a metropolitan emergency department. Methods: This retrospective descriptive study included 1960 patients presenting to a tertiary metropolitan emergency department between 1 March and 1 September 2025 with suspected animal exposure. Demographic data, animal species involved, exposure mechanisms, animal ownership and vaccination status, time to presentation, and PEP practices were analyzed using descriptive statistics. Results: Most exposures were cat-related (86.3%) and were caused by scratching (81.5%). Nearly all injuries were superficial (99.8%), while deep injuries were rare (0.2%). The majority of animals were classified as strays (90.1%), and vaccination status was unknown in 81.2% of cases. Rabies immunoglobulin was administered to only 0.6% of patients; however, rabies vaccination was initiated in 98.8% of patients. Approximately 74.5% of patients presented within 24 h. Post-exposure animal observation was documented in only 20.2% of cases. Conclusions: Urban animal exposures in this metropolitan setting were predominantly superficial and cat-related, yet nearly all patients received rabies vaccination. Limited animal observation and incomplete vaccination documentation appear to constrain risk stratification and may contribute to the use of precautionary PEP. Strengthening surveillance systems, improving documentation, and implementing evidence-based risk-stratification strategies are essential for optimizing rabies prophylaxis practices in urban environments. Full article

Rabies is a fatal zoonotic disease once clinical symptoms develop. In Europe, sustained animal rabies control programs have led to a marked decline in animal rabies and subsequently human rabies cases; however, sporadic infections continue to occur. In July 2025, a fatal case of autochthonous (locally acquired) human rabies was confirmed in Romania following a stray dog bite in a patient who did not receive post-exposure prophylaxis (PEP). Here, we report the first molecular characterization of a human rabies virus (RABV) strain isolated in Romania and place it in the context of contemporaneously circulating animal-derived RABV strains. Rabies virus infection was confirmed intra vitam by fluorescent antibody testing and both conventional and real-time RT-PCR on cerebrospinal fluid and saliva, with postmortem confirmation on skin and brain tissue. Whole-genome sequencing was performed on the human isolate and on 22 animal-derived RABV strains collected in northern Romania in 2025. Phylogenetic analyses revealed that all recent Romanian sequences clustered within the North-East European (NEE) rabies virus phylogenetic group and segregated into two geographically distinct genetic clusters: a north-western cluster, closely related to strains from Slovakia and Poland, and a larger north-eastern cluster, linked to viruses circulating in eastern Romania and the Republic of Moldova. The human-derived RABV genome was grouped within the north-eastern cluster and showed the highest genetic similarity to animal viral strains from the same geographical area, supporting a local transmission event. This demonstrates the importance of integrating human viral genomic data into the national rabies surveillance framework. Full article

Background: Rabies is almost invariably fatal once clinical symptoms develop, yet it is preventable through canine vaccination and timely post-exposure prophylaxis (PEP). In rural Thailand, preventive behaviors likely depend on health literacy and contextual conditions that enable and reinforce protective action, but structural pathways remain unclear. Methods: We conducted a cross-sectional study among 750 adults in rabies-risk areas of Si Sa Ket Province, Thailand. A socio-ecological, One Health-informed structural equation model (SEM) examined associations among rabies-related health literacy skills (HLskill), service/system enabling conditions (ENAB), reinforcing community mechanisms (COMM), and rabies-prevention behaviors (BEHAV). Results: Model fit was acceptable (CFI = 0.948; TLI = 0.918; SRMR = 0.047; scaled RMSEA = 0.090). HLskill and COMM showed direct associations with BEHAV (β = 0.352 and 0.371, respectively), while ENAB was strongly associated with COMM (β = 0.939), indicating an indirect pathway through community reinforcement (β = 0.348; 95% CI [0.273, 0.424]). Conclusions: Rabies-prevention behaviors were associated with health literacy skills and reinforcing community mechanisms; service readiness operated primarily through community reinforcement. Rabies control should combine health literacy strengthening with community communication, coordinated dog vaccination, bite management, and timely PEP uptake. Full article

Objective: To explore healthcare professionals’ beliefs and concerns about doxyPEP by systematically reviewing the literature. Method: A systematic review of three bibliographical databases (CINAHL, EMBASE and MEDLINE) and MedRxiv in August 2024, updated in February 2026 explored healthcare professionals’ beliefs and concerns about doxyPEP. Three researchers independently reviewed full-text manuscripts for eligibility and narratively synthesized data. We used the Joanna Briggs Institute toolkit to assess risk of bias. This review was registered on PROSPERO (ID:CRD42024570646). Results: Eight manuscripts were included in the final review: five cross-sectional studies, two qualitative studies, and one mixed method study from the USA (n = 5), Australia (n = 1), Kenya (n = 1), and the UK (n = 1) published between 2020–2025 and including 1840 healthcare professionals. Healthcare professionals recognised the high burden of bacterial STIs and believed that doxyPEP should be made available to MSM. There was a strong willingness to provide doxyPEP to MSM with the support of national guidelines. Healthcare professionals suggest that implementing doxyPEP would be feasible with educational support, but were concerned about antimicrobial resistance, drug–drug interactions, pill burden, cost, implementation logistics and the effect on clinical service demands. They acknowledged the lack of research and access to doxyPEP for other groups, specifically trans people and cis-gendered women. They also highlighted the need for community involvement in the implementation of doxyPEP. Conclusions: This review highlights that healthcare professionals were willing and ready to provide doxyPEP; however, they have concerns including antimicrobial resistance, the effect on service capacity, and the lack of research on cis-gendered women and trans people. Patients and health professionals need to be involved in the implementation of doxyPEP. Full article

Rabies remains a zoonotic public health problem in Ghana despite the availability of effective preventive measures, including mass dog vaccination and timely post-exposure prophylaxis (PEP). We conducted a community-based cross-sectional mixed-methods study between June and December 2025 to assess rabies-related knowledge, risk perception, health-seeking behaviour following dog bites, and dog vaccination practices within a One Health framework. Structured face-to-face interviews were conducted with 450 adults from selected urban and rural communities in the Greater Accra, Ashanti, and Bono East regions, supplemented by focus group discussions. Quantitative data were analysed using descriptive statistics, chi-square tests, and multivariable logistic regression. Overall, 68% of respondents had heard of rabies; however, detailed knowledge of transmission and prevention was limited, with 189 (42.0%) correctly identifying dogs as the main source of transmission. Following suspected exposure, 162 (36.0%) reported using home remedies or traditional treatments. Dog vaccination coverage was 31.1%, below the level required to interrupt transmission. Educational level, place of residence, and prior dog-bite exposure were significantly associated with rabies knowledge, health-seeking behaviour, and vaccination practices (p < 0.05). This study provides updated evidence on community rabies knowledge, risk perception, and preventive practices, highlighting behavioural and structural gaps that may hinder effective control in Ghana. Full article

(1) Background: Human rabies continues to be a significant public health challenge and imposes a heavy disease burden. The epidemiological characteristics and post-exposure prophylaxis (PEP) of human rabies in Chongqing were analyzed to provide a scientific basis for its prevention and control in Chongqing. (2) Methods: Data and case investigation forms of the human rabies epidemic in Chongqing from 2016 to 2024 were collected and analyzed using descriptive epidemiological methods. (3) Results: From 2016 to 2024, 84 human rabies cases were reported in Chongqing, with an average annual incidence rate of 0.03 per 100,000 population. Among the cases, 72.6% were aged 45 and above. Farmers constituted the primary infected group (73.8%). Analysis of exposure patterns and PEP revealed that 92.4% of cases involved dog transmission, with domestic dogs responsible for 65.2% and stray dogs for 31.8%. After exposure, 51.5% received no treatment, while only 6 individuals were vaccinated against rabies. (4) Conclusions: Although rabies incidence in Chongqing is low, dogs remain the primary source, and post-exposure vaccination is often delayed. Strengthening health education and dog immunization is crucial for supporting the global “Zero by 30” target. Full article

Background: Rabies is a fatal yet preventable zoonosis. In Saudi Arabia, uneven surveillance and limited public awareness may delay post-exposure prophylaxis (PEP). In Makkah, where residents regularly encounter free-roaming dogs, knowledge gaps could elevate exposure risks. Objectives: This study aims to assess public knowledge, attitudes, and post-bite practices regarding rabies, including wound washing and access to PEP among adult residents of the Makkah Region, and to examine associations with pet dog ownership. Methods: A cross-sectional survey was conducted in the Makkah Region (March–June 2025). An online validated bilingual questionnaire targeted residents ≥ 18 years via social media. Descriptive statistics, chi-square tests, 95% confidence intervals, and binomial logistic regression were applied in IBM SPSS v26; p < 0.05 was significant. Results: Of 523 respondents, 91.8% lived in Makkah city, 52.8% were female, and the age distribution was 18–24 years (44.2%), 25–34 years (35.6%), 35–44 years (12.0%), and ≥45 years (8.2%). Pet dog ownership was rare (1.9%), yet 39.4% reported stray dogs in their communities. Overall, 60.6% knew what rabies is and 63.7% knew it is vaccine-preventable, but 52.2% wrongly believed that transmission occurs only via dog bites. Hospitals (79.7%) and health centers (79.2%) were the most cited vaccination sites; social media was the dominant information source (74.6%). No significant association was found between pet ownership and rabies awareness (all p > 0.05). In multivariable regression (n = 509), adequate rabies knowledge increased the odds of an appropriate intended response (AOR 1.85, 95% CI: 1.27–2.68). Participants aged 30–40 years and those >50 years had significantly lower odds (AOR 0.45, 95% CI: 0.24–0.85 and AOR 0.23, 95% CI: 0.09–0.56, respectively). Conclusions: Despite moderate awareness, critical misconceptions and inconsistent first aid intentions persist. Priority actions include clear, locally adapted education on immediate wound washing and prompt PEP, standardized bite management pathways across facilities, reliable access to vaccines and immunoglobulin, and targeted social media micro-campaigns. By identifying public misconceptions, knowledge gaps, and preferred communication channels, this study provides baseline evidence to guide community awareness programs, intersectoral collaboration, and One Health-based surveillance essential for Saudi Arabia’s progress toward the global “Zero rabies by 2030” goal. Full article

Background and Objectives: Although preventable, rabies represents a significant public health problem. An important part of prevention is the surveillance of people exposed to potentially rabid animals, carried out in the anti-rabies clinics of all public health institutes in Croatia. We aimed to analyze the burden of human animal-bite injuries, patient/biting animal characteristics, and the uptake of anti-rabies post-exposure prophylaxis (PEP). Material and Methods: This retrospective study used medical records data ranging from 2015 to 2024 for all patients in the anti-rabies clinics in Split-Dalmatia County, Croatia. Results: A total of 4105 patients reported contact with a potentially rabid animal. The majority of examined people (52.6%) were working-aged adults (20–60 years). The largest proportion of reported injuries were recorded on the lower limbs (34.9%) and hands/fingers (32.3%). No contact with a proven rabid animal was recorded. PEP was received by 37.7% of those examined. Although dog exposure (68.9%) most frequently led to post-exposure care-seeking, PEP was most common after rodent (91.2%) and bat (87.5%) exposures. Conclusions: Improving public health education is the most effective method of preventing dog bites and thus reducing bite injuries. Promoting responsible dog ownership and behavior around animals, as well as avoiding contact with unfamiliar animals, would likely reduce the need for PEP. The results of this study can also be used in planning health resources, primarily the availability of rabies vaccine and immunoglobulin. In addition, they emphasize the importance of rabies prevention and the continued implementation of all preventive measures in collaboration between the human and animal health sectors. This research may be useful to future public health policies for the control of zoonotic infectious diseases, especially from a “One Health” perspective. Full article

Rabies is endemic in Kazakhstan, with the primary reservoirs being wild canids, such as foxes and dogs, maintaining distinct sylvatic and urban cycles. This paper outlines three high-return priorities for rabies control in the country, informed by the epidemiological patterns of the disease, the national regulatory framework (Order No. 7-1/587), and evidence on the knowledge, attitudes, and practices (KAP) of the Kazakh population. The three priorities are (a) transition into a One Health, real-time surveillance system featuring standardized digital reporting and GIS-guided interventions; (b) implementation of biannual oral rabies vaccination (ORV) of foxes in high-risk districts, incorporating mandatory quality assurance (via tetracycline biomarkers and/or serology) aligned with EU/EFSA standards; and (c) adopt an urban strategy focused on dogs to increase vaccination coverage and reduce delays in human post-exposure prophylaxis (PEP). These measures align with the WOAH Terrestrial Code and the “Zero by 30” roadmap, leveraging existing national assets like risk maps and laboratory capacity, such as dFAT, RT-PCR, and sequencing. Kazakhstan’s predictable rabies pattern allows for targeting district-level strategies and transparent measurement of risk reduction, contingent on enforcing standardized reporting and rigorous quality assurance programs. The opinions introduced in this paper are based on the scientific evidence collected in Kazakhstan over the last decade and summarize the need for urgent actions to promote rabies control in the country. Full article

Background: Since the introduction of Pasteur’s rabies vaccine in 1885, rabies prophylaxis and post-exposure prophylaxis (PEP) have been widely administered globally under the recommendation of the World Health Organization (WHO). However, 124 documented cases of PEP failure had been reported worldwide between 1980 and 2023. Additionally, sporadic media reports from China showed occasional PEP failures between 2017 and 2024. Rabies remains a serious public health problem in over 150 countries and regions. Methods: In this review, we summarize PEP procedures recommended by the Advisory Committee on Immunization Practices (ACIP) and the WHO. We also analyze potential contributing factors to PEP failure, propose a concept of circulating antibodies, and discuss their roles in PEP. Furthermore, we summarize key guidelines for clinical trial design from the U.S. Food and Drug Administration (FDA) and China’s Center for Drug Evaluation (CDE), as well as the latest developments in monoclonal antibody (cocktail) therapies. Results: Adherence to core PEP practices, such as wound cleansing, infiltration of wounds with immunoglobulin (mAbs), and administration of vaccines, and broader societal involvement are crucial for preventing rabies infection in most cases. For high-risk exposures or immunocompromised individuals, the provision of circulating antibodies through high-dose human rabies immune globulin (HRIG) or mAbs is of utmost importance for preventing PEP failure. Conclusions: Early, high-concentration circulating antibodies are important for preventing PEP failure. Addressing the global issue of rabies requires involvement of the entire society. Only through collective efforts can we tackle this neglected disease and achieve WHO’s goal of “zero by 30”. Full article

Background: Many new mRNA-based vaccine candidates in liquid mRNA-LNP formulations are under development; however, their stability limitations necessitate frozen storage, posing a significant challenge for long-term storage and transportation. Methods: In this study, an mRNA-LNP rabies vaccine, ABO1005, was prepared, freeze-dried and stored at 2–8 °C for 12-month storage stability evaluation. The immunogenicity, vaccine potency (the NIH method), and protective efficacy of ABO1005 were assessed in mice or dogs and compared to a commercialized inactivated vaccine. Results: Research conducted in mice indicated that the lyophilized vaccine exhibited comparable immunogenicity to its liquid form counterpart. Furthermore, the vaccine candidate elicited a robust humoral response lasting at least 175 days, and the specific antibody titers were not affected by the pre-administration of hyperimmune serum. In comparison to the commercialized inactivated vaccine (HDCV or PVRV), ABO1005 elicited significantly higher levels of humoral and cellular immunity. Vaccine potency testing (NIH) revealed that the potency of ABO1005 at 15 μg/dose was 8.85 IU/dose, which is substantially higher than the standard required for the lot release of rabies vaccines for current human use. In a post-exposure prophylaxis (PEP) study in Beagle dogs, the lyophilized vaccine provided 100% protection for dogs following a two-dose regimen (D0-D7), whereas commercially approved inactivated vaccine offered 83% protection. After storage at 2–8 °C for 12 months, no notable changes were observed in the particle size, encapsulation efficiency, and integrity of mRNA or in the immunogenicity of the lyophilized vaccine. Conclusions: This study successfully developed a formulation and process of freeze-drying for a rabies mRNA vaccine, paving the way for future lyophilized mRNA vaccine development. Full article

Rabies, a viral encephalitis caused by rabies virus (RABV), is 100% fatal upon the onset of symptoms. Effective post-exposure prophylaxis (PEP) measures are available, but they are often difficult to access in low-income countries. WHO estimates about 59,000 deaths due to rabies globally, and the majority are contributed by developing countries. Hence, developing drugs for the treatment of post-symptomatic rabies is an urgent and unmet demand. It is worth noting that previous efforts regarding antiviral strategies, such as small-interfering RNA, antibodies and small-molecule inhibitors, against the rabies virus have failed to show efficacy in pre-clinical studies, especially when the virus has reached the central nervous system (CNS). Therefore, drug repurposing seems to be an alternative tool for the development of new anti-rabies drugs. We validated and used a high-throughput, FITC-conjugated antibody-based flow cytometry assay to expedite the identification of repurposable new drug candidates against the RABV. The assay was validated using ribavirin and salinomycin as reference compounds, which showed EC50 values of 10.08 µM and 0.07 µM, respectively. We screened a SelleckChem library comprising 3035 FDA-approved compounds against RABV (CVS-11) at 10 µM concentration. Five compounds (clofazimine, tiamulin, difloxacin, harringtonine and homoharringtonine) were active against RABV, with greater than 90% inhibition. Homoharringtonine (HHT) identified in the present study is active against laboratory-adapted RABV (CVS-11) and clinical isolates of RABV, with an average EC50 of 0.3 µM in both BHK-21 and Neuro-2a cell lines and exhibits post-entry inhibition. Full article

Background: Sexual assault victims involving penetration are at risk of contracting human immunodeficiency virus (HIV). Post-exposure prophylaxis (PEP) can effectively prevent HIV infection if initiated promptly within 72 h following exposure and adhered to for 28 days. Nonetheless, therapeutic adherence amongst sexual assault victims is low. Victim-centered care, provided by specially trained forensic nurses and midwives, may increase adherence. Methods: We conducted a retrospective case–control study to evaluate the impact of sexual assault center (SAC)—centered care on adherence to PEP compared to care received in the emergency department (ED). Data from January 2011 to February 2022 were reviewed. Multivariable logistic regression analysis was employed to determine the association between centralized specific care for sexual assault victims and completion of the 28-day PEP regimen. The secondary outcome assessed was provision of psychological support within 5 days following the assault. Results: We analyzed 856 patients of whom 403 (47.1%) received care at a specialized center for sexual assault victims. Attendance at the SAC, relative to the ED, was not associated with greater probability of PEP completion both in the unadjusted (52% vs. 50.6%; odds ratio [OR]: 1.06, 95% CI: 0.81 to 1.39; p = 0.666) and adjusted (OR: 0.81, 95%CI 0.58–1.11; p = 0.193) analysis. The care provided at the SAC was associated with improved early (42.7% vs. 21.5%; p < 0.001) and delayed (67.3% vs. 33.7%; p < 0.001) psychological support. Conclusions: SAC-centered care is not associated with an increase in PEP completion rates in sexual assault victims beyond the increase associated with improved access to early and delayed psychological support. Other measures to improve PEP completion rates should be developed. What is already known on this topic—Completion rates for HIV post-exposure prophylaxis (PEP) among victims of sexual assault are low. Specialized sexual assault centers, which provide comprehensive care and are distinct from emergency departments, have been suggested as a potential means of improving treatment adherence and completion rates. However, their actual impact on treatment completion remains unclear. What this study adds—This study found that HIV PEP completion rates in sexual assault victims were not significantly improved by centralized care in a specialized sexual assault center when compared to care initiated in the emergency department and continued within a sexually transmitted infection clinic. However, linkage to urgent psychological and psychiatric care was better in the specialized sexual assault center. How this study might affect research, practice or policy—Healthcare providers in sexual assault centers should be more aware of their critical role in promoting PEP adherence and improving completion rates. Policymakers should ensure that measures aimed at improving HIV PEP outcomes are implemented at all points of patient contact in these centers. Further research is needed to assess the cost-effectiveness of specialized sexual assault centers. Full article

HIV/AIDS remains a global public health concern, with a high prevalence in sub-Saharan Africa. The President’s Emergency Plan for AIDS Relief (PEPFAR) initiatives, including preexposure prophylaxis (PREP) and postexposure prophylaxis (PEP), significantly reduced HIV infections in South Africa and Nigeria. The suspension of United States (U.S.) foreign aid may impact these preventive measures. Although some emergency aid programs were exempted, uncertainty persists, impacting global health initiatives, especially in South Africa and Nigeria. This study investigates the public health impacts of the United States (U.S.) government’s January 2025 suspension of U.S. foreign aid, focusing on its implications for HIV prevention initiatives, such as PREP and PEP, in South Africa and Nigeria. We comprehensively searched keywords such as PEPFAR, PREP, PEP, HIV infection in South Africa or Nigeria, antiretroviral (ARV) drugs, public healthcare impact, 2025 Trump’s foreign aid withdrawal, titles, and abstracts in Google Scholar, PubMed, and Web of Science. The search results were screened from 500 to 150 included articles based on their relevance and quality assessment for inclusion. The review unveiled that Nigeria maintained a continuous increase in HIV/AIDS-related deaths and new HIV infections from 1990, reaching the climax between 1999 and 2005, showing approximately 110,000 HIV/AIDS-related deaths and 200,000 new HIV infections. Notably, due to the PEPFAR intervention in Nigeria, an improved decrease in both HIV/AIDS-related deaths (45,000) and new HIV infections (75,000) was experienced from 2010 to 2023. South Africa experienced a rapid increase between 1990 and 2003 in both HIV/AIDS-related deaths and new HIV infections, reaching the climax around the early 2000s, with about 520,000 new HIV infections and 260,000 HIV/AIDS-related deaths in 2005. Furthermore, there was a continuous decline from 2005 onwards, with 50,000 HIV/AIDS-related deaths and 150,000 new HIV infections by 2023. Therefore, the suspension of this aid threatens disruptions in ARV therapy, possible increases in HIV transmission, shortages in PREP and PEP, the retrenchment of healthcare workers, the suspension of non-governmental organization activities, and the reversal of gains in vulnerable populations, reversing progress toward the 95-95-95 vision, increasing morbidity and mortality rates and financial strain on healthcare systems in these two countries. We recommend proactive measures, such as increased budget allocations for healthcare reforms, exploring local vaccine and health product development and diversifying funding sources in Nigeria, and implementing universal healthcare coverage for South Africans to mitigate the adverse consequences of aid withdrawal. Full article

Background/Objective: Needlestick injuries (NSIs) are a significant source of bloodborne infections among nurses. This study aimed to assess the prevalence, contributing factors, and awareness of post-exposure prophylaxis (PEP) among Estonian nurses. Methods: This prospective cross-sectional study was conducted using an electronic questionnaire in September 2024. Results: The majority of the 211 nurses participating in this study were females aged 21 to 75 years. Notably, 57.1% (n = 109, aged 43.9 ± 12.2) had experienced an NSI in the past decade. Most injuries occurred during sharps’ disposal (33%) and with syringe needles (72%). Among those injured, 84% washed the area with water and soap, 80% used alcohol-based disinfectants, and 69% reported the incident. However, 20.6% did not report due to perceived insignificance or lack of follow-up actions. Additionally, 14.7% were unaware of the reporting requirement, and 8.8% did not know who to report to. Conclusions: Improved training and reporting practices are essential to reduce NSIs among nurses. Full article