Nationwide registry-based analysis of rabies exposures in Iran: Epidemiological patterns and post-exposure prophylaxis adherence

Background Animal bites remain an important public health issue in Iran. Understanding their epidemiological patterns and examining how registry-recorded cases are managed in relation to the Iranian rabies protocol and World Health Organization recommendations can provide insight into clinical practice and documentation quality within the national bite registry. Such analyses help identify strengths and gaps in protocol adherence and data completeness. Methodology/Principal findings We conducted a secondary analysis of 507,404 animal bite cases recorded in the national rabies registry between March 2022 and September 2023. The unit of analysis was registry-recorded exposure visits. Data on demographics, exposure characteristics, and clinical management were examined to describe epidemiological patterns and assess documented adherence to recommended post-exposure prophylaxis (PEP) practices. Males accounted for 73.6% of cases. The largest age group among all patients was 31–40 years, comprising 19.8% of cases. Dogs were responsible for 76.2% of exposures and cats for 20.8%. Northern provinces such as North Khorasan (773 per 100,000) and Golestan (767 per 100,000) recorded the highest incidence. Wound irrigation was documented in 94.3% of patients, and 96.4% received the first vaccine dose within 48 hours. Overall, 68.1% received three vaccine doses and 24.2% four doses. Rabies immunoglobulin was administered to 95.6% of Category III exposures, though inappropriate use was also observed in Category I (6.1%) and II (4.7%). Deviations from vaccine regimens and misclassification of exposure categories were identified, and among bat-related exposures only 36.8% were classified as Category III, with 38.7% receiving immunoglobulin. Conclusions/Significance Among registry-recorded animal bite attendees, rapid initiation of PEP and frequent appropriate use of rabies immunoglobulin in severe exposures were documented. However, gaps in documentation, vaccine dosing accuracy, and exposure classification indicate areas for improvement. These findings reflect patterns within the national bite registry and should not be interpreted as a comprehensive evaluation of all surveillance system attributes. Strengthening provider training, reinforcing protocol adherence, and improving data quality within the registry could support national rabies control efforts and inform broader prevention strategies aligned with global elimination goals.