Rabies and rabies prophylaxis in Egypt: a nationwide cross-sectional study that calls for action

BACKGROUND: Rabies is a fatal but preventable viral disease that poses a global health threat, especially in developing countries. Despite the high incidence of animal bites reported annually in Egypt, limited data exist regarding the knowledge, attitudes, and practices (KAP) of the general population toward rabies and rabies prophylaxis. METHODS: We conducted a nationwide cross-sectional study using a structured interview-based survey targeting individuals aged 18 years or older who attended outpatient clinics at nine university hospitals across Egypt. The survey assessed participants' KAP toward rabies and rabies prophylaxis and identified barriers to prophylaxis uptake. RESULTS: Among 1,777 participants who responded to the survey, only 42.8% (n = 760) had good knowledge about rabies and rabies prophylaxis, while the majority, 88.5% (n = 1,572), exhibited a positive attitude toward rabies prophylaxis. Knowledge was higher among those who reported awareness of rabies campaigns in their geographic areas (69.1% vs. 40.5%, p < 0.001) and those who had previously been bitten or attacked by animals (56.1% vs. 41.3%, p < 0.001). Overall, 9.7% (n = 173) of participants reported a history of animal bites or attacks; however, 18.5% (n = 32) of these participants did not receive post-exposure prophylaxis (PEP), and 17% (n = 24) did not complete the vaccine schedule. Pre-exposure prophylaxis (PrEP) uptake was low, with only 4.3% (n = 23) of high-risk individuals receiving it. Key barriers to rabies prophylaxis included lack of knowledge about the rabies vaccine, reported by 82.4% of participants, lack of knowledge about rabies, reported by 81.7%, and inadequate hospital facilities, reported by 43.1%. CONCLUSIONS: Despite a generally positive attitude toward rabies prophylaxis, knowledge and adherence to prophylactic measures, including pre-exposure and post-exposure prophylaxis, remain relatively inadequate in Egypt. Public health interventions, such as educational campaigns and improved accessibility to vaccination services, are needed to address these gaps and mitigate the public health burden of rabies.