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

Abstract 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 of nine university hospitals across Egypt. The survey assessed participants’ KAP regarding rabies prophylaxis and identified barriers to its uptake. Results: Among 1,777 participants responded to the survey, only (42.8%, n= 761) had good knowledge about rabies and rabies prophylaxis, while the majority (88.5%, n= 1,574) exhibited a positive attitude toward rabies prophylaxis. Knowledge was higher among those who had awareness campaign about rabies in their geographic areas (69.1% vs 40.5%, p < 0.001) and those who had been previously bitten or attacked by animals (56.1% vs 41.3%, p < 0.001). Of the participants (9.7%, n= 173) reported a history of animal bites; however, (18.5%, n= 32) of bite victims did not receive post-exposure prophylaxis, and (17%, n= 29) did not complete the vaccine schedule. Pre-exposure prophylaxis 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 rabies (82.4%, n= 1,463) and the vaccine (81.7%, n= 1,451), as well as inadequate hospital facilities (43.1%, n= 765). Conclusions: Despite a generally positive attitude toward rabies prophylaxis, the knowledge and adherence to prophylactic measures, including preexposure 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.