Urban Animal Exposures and Rabies Post-Exposure Prophylaxis in Istanbul, Turkey: Insights from a Metropolitan Emergency Department

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.