Analysis of the current status of animal-related injuries in the Taihu Lake region: a quality assessment of post-exposure prophylaxis in 40,222 Cases (2023–2025) and implications for areas with no reported indigenous human rabies cases

Background The Taihu Lake region, a highly urbanized area in the Yangtze River Delta, experiences a high prevalence of animal‑related injuries. Within this region, Wuxi has reported no indigenous human rabies cases for over a decade. Against China’s 2024–2025 rabies resurgence, any decline in post-exposure prophylaxis (PEP) quality in zero-case areas could become a weak link that ignites epidemic resurgence. This study evaluated first-visit PEP quality in the region, explored the possible risk of what we term “prevention fatigue”—a silent decline in PEP quality in areas with no reported indigenous human rabies cases—and proposed targeted intervention strategies. Methods In this retrospective cross-sectional study, we included 40,222 first‑visit cases of animal‑related injuries at our hospital from January 2023 to December 2025. Outcomes included non-use of passive immunization in Grade III exposures, failure of standard first-visit care, and delayed presentation. Multivariable logistic regression examined associations and interaction effects. Results Grade III exposures accounted for 60.5% (24,322/40,222) of all cases. Among these, the passive immunization rate was 55.5%, and the standard first‑visit care rate was 45.3% (11,019/24,322). Young adults (15–44 years, aOR = 2.17), scratches (vs. bites, aOR = 1.20), and delayed presentation (aOR = 1.49) were independently associated with incomplete PEP delivery. Significant interactions were found for age group × injury type ( P < 0.001), animal × delayed presentation ( P < 0.001), and exposure site × delayed presentation ( P = 0.019). From 2023 to 2025, passive immunization rates among Grade III exposures increased from 52.8% to 60.1% (P for trend < 0.001), whereas standard first-visit care rates were 44.5%, 42.8%, and 48.4% across the three years (P for trend < 0.001); delayed presentation decreased from 37.9% to 31.9% (P for trend < 0.001). Conclusions Persistent gaps in PEP compliance were observed in this region with over a decade of no indigenous human rabies cases. Young adults, patients with scratch injuries and delayed consultation constituted overlapping high-risk groups. We put forward two sentinel surveillance indicators and stratified intervention strategies, stressing that Grade III scratches require the same protective management as bite wounds.