Guideline Adherence of Post-Exposure Prophylaxis and Factors Associated with Vaccine Series Completion in Patients Presenting to the Emergency Department with Rabies-Risk Exposure

Abstract

Objective: This study aimed to retrospectively evaluate adherence to national guidelines in rabies post-exposure prophylaxis (PEP) administered to patients presenting with rabies-risk exposures to the emergency department, and to identify factors associated with completion of the vaccine series. Methods: Records of 343 patients presenting to the Emergency Department of Ağrı Training and Research Hospital between June 2025 and May 2026 were reviewed. The distribution of continuous variables was assessed using the Shapiro-Wilk test; the Mann-Whitney U, Kruskal-Wallis, chi-square, and Fisher's exact tests were used for between-group comparisons. Adherence of the administered prophylaxis to the 2019 Turkish Ministry of Health Rabies Prophylaxis Guideline was evaluated. Results: The median age of patients was 21.0 years (interquartile range [IQR]: 10.0-34.0), and 62.1% were male. Overall guideline adherence of the administered prophylaxis was found to be 54.5%; among Category III/IV exposures with an indication for rabies immunoglobulin (RIG), RIG was administered in only 14.0% of cases. The vaccine series completion rate was 72.9%, and among the 14 variables examined, only a history of prior prophylaxis was found to be significantly associated with completion (p=0.014). Rural residence, atypical exposure types, and milder wound categories were associated with longer delays in presentation to the emergency department, and presentations increased markedly during summer months. Conclusion: Adherence of rabies post-exposure prophylaxis practices to national guidelines, particularly regarding the indication for rabies immunoglobulin, was found to remain below the desired level. Strengthening physician education and reviewing RIG accessibility in the region were considered necessary

Keywords

• Rabies Vaccines
• Rabies Immunoglobulins
• Guideline Adherence
• Emergency Service
• Rabies

Supporting Institution

None

Ethical Statement

This study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Ağrı İbrahim Çeçen University Scientific Research Ethics Committee. Decision date: 25.06.2026 Decision number: 393 Reference number: E-95531838-050.99-182358

Thanks

None

Acil Servise Kuduz Riskli Temas Nedeniyle Başvuran Hastalarda Temas Sonrası Profilaksi Uygulamalarının Kılavuz Uygunluğu ve Aşı Serisini Tamamlamayı Etkileyen Faktörler

Abstract

Amaç: Bu çalışmada, acil servise kuduz riskli temas nedeniyle başvuran hastalarda uygulanan temas sonrası profilaksinin (PEP) ulusal kılavuza uygunluğunun ve aşı serisi tamamlanma oranını etkileyen faktörlerin retrospektif olarak değerlendirilmesi amaçlanmıştır. Yöntemler: Haziran 2025-Mayıs 2026 tarihleri arasında Ağrı Eğitim ve Araştırma Hastanesi Acil Servisi'ne başvuran 343 hastanın kayıtları incelenmiştir. Sürekli değişkenlerin dağılımı Shapiro-Wilk testi ile değerlendirilmiş; gruplar arası karşılaştırmalarda Mann-Whitney U, Kruskal-Wallis, ki-kare ve Fisher'in kesin testleri kullanılmıştır. Uygulanan profilaksinin T.C. Sağlık Bakanlığı 2019 Kuduz Profilaksi Rehberi'ne uygunluğu değerlendirilmiştir. Bulgular: Hastaların yaş ortancası 21,0 (çeyrekler arası aralık [IQR]: 10,0-34,0) yıl olup %62,1'i erkekti. Uygulanan profilaksinin kılavuza genel uygunluk oranı %54,5 olarak saptanmış; kuduz immünglobulini (RIG) endikasyonu bulunan Kategori III/IV temaslarda RIG uygulanma oranının yalnızca %14,0 olduğu belirlenmiştir. Aşı serisi tamamlanma oranı %72,9 olup, incelenen 14 değişkenden yalnızca önceki profilaksi öyküsü tamamlanma ile anlamlı ilişkili bulunmuştur (p=0,014). Kırsal ikamet, alışılmadık temas biçimleri ve hafif yara kategorileri, acil servise başvuruda daha uzun gecikme süresi ile ilişkilendirilmiş; başvurular yaz aylarında belirgin şekilde artmıştır. Sonuç: Kuduz temas sonrası profilaksi uygulamalarının, özellikle kuduz immünglobulini endikasyonu açısından, ulusal kılavuza uygunluğunun arzu edilen düzeyin altında kaldığı sonucuna varılmıştır. Bölgede hekim eğitiminin güçlendirilmesinin ve RIG erişiminin gözden geçirilmesinin gerekli olduğu düşünülmüştür.

Keywords

• Kuduz
• Kuduz Aşıları
• Kuduz İmmünglobulini
• Kılavuza Uyum
• Acil Servis

Supporting Institution

Yok

Ethical Statement

Bu çalışma Helsinki Deklarasyonu ilkelerine uygun olarak yürütülmüş ve Ağrı İbrahim Çeçen Üniversitesi Bilimsel Araştırmalar Etik Kurulu tarafından onaylanmıştır. Karar tarihi: 25.06.2026 Karar numarası: 393 Referans numarası: E-95531838-050.99-182358

Thanks

Yok

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