{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:32:00Z","timestamp":1787725920318,"version":"build-2784847793"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Prompt care-seeking after rabies exposure is essential for effective post-exposure prophylaxis (PEP). This study aimed to identify independent factors associated with care-seeking delay and to map the full PEP pathway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively enrolled 27,930 patients attending the rabies PEP clinic at Santan Hospital, Tianjin, between February 2022 and January 2026. Delay was defined as &amp;gt;12 h from exposure to registration. Multivariable logistic regression, combined with XGBoost and SHAP, identified independent factors for delay and quantified their relative importance. Restricted cubic splines examined the non-linear relationship between age and delay. Subgroup analysis assessed the stability of the association of grade III exposure with more prompt care-seeking. A Sankey diagram traced the PEP pathway.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The delay rate was 29.7%. Eight independent factors were identified. Adults had a 34% higher risk of delay than children (aOR = 1.34, 95% CI: 1.22\u20131.47,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). Grade III exposure was associated with more prompt care-seeking (aOR = 0.69, 95% CI: 0.65\u20130.73,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). Previous rabies vaccination (aOR = 1.17, 95% CI: 1.11\u20131.23,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001) and inadequate wound management (aOR = 1.57, 95% CI: 1.31\u20131.88,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001) were associated with higher delay risk. Age showed a non-linear relationship with delay risk, with adults at highest risk. The Sankey diagram showed that inadequate wound management was rare in the PEP pathway, and the two-dose booster schedule achieved a much higher completion rate than the standard schedule.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings suggest that adults may face the highest risk of care-seeking delay, and that improving healthcare access for adults and promoting simplified vaccination schedules may be key to improving PEP quality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1911137","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:03:48Z","timestamp":1787724228000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Temporal trends and determinants of delayed care-seeking after rabies exposure: a 27,930-patient analysis in Tianjin"],"prefix":"10.3389","volume":"14","author":[{"given":"Shuai","family":"Li","sequence":"first","affiliation":[{"name":"Department of Emergency, Santan Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuangyan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Santan Hospital","place":["Tianjin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.biologicals.2020.01.008","article-title":"Towards rabies elimination in the Asia-Pacific region: from theory to practice","volume":"64","author":"Rupprecht","year":"2020","journal-title":"Biologicals"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2261","DOI":"10.1016\/S0140-6736(22)02487-4","article-title":"A call to accelerate an end to human rabies deaths","volume":"400","author":"Thumbi","year":"2022","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","first-page":"taaf111","DOI":"10.1093\/jtm\/taaf111","article-title":"Delays in rabies post-exposure prophylaxis abroad","volume":"32","author":"de Feij","year":"2025","journal-title":"J Travel Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"102873","DOI":"10.1016\/j.tmaid.2025.102873","article-title":"Delayed and incomplete rabies post-exposure prophylaxis among international travelers: a seven-year retrospective study at an emergency center in eastern Thailand","volume":"67","author":"Singkam","year":"2025","journal-title":"Travel Med Infect Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"4563","DOI":"10.4103\/jfmpc.jfmpc_302_25","article-title":"Factors associated with delay in initiating postexposure prophylaxis for rabies prevention in a district of Madhya Pradesh, India: 2023","volume":"14","author":"Gupta","year":"2025","journal-title":"J Family Med Prim Care"},{"key":"B6","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1093\/trstmh\/trae002","article-title":"Prevalence of delayed initiation of rabies postexposure prophylaxis and factors influencing it among animal bite victims from Eastern Uttar Pradesh, India","volume":"118","author":"Khan","year":"2024","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"B7","article-title":"Expert consensus on rabies post-exposure prophylaxis in children (2025 edition)","year":"2026","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"B8","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s40249-023-01082-3","article-title":"Progress towards dog-mediated rabies elimination in PR China: a scoping review","volume":"12","author":"Shen","year":"2023","journal-title":"Infect Dis Poverty"},{"key":"B9","doi-asserted-by":"publisher","first-page":"taaa240","DOI":"10.1093\/jtm\/taaa240","article-title":"Delayed rabies post-exposure prophylaxis treatment among Dutch travellers during their stay abroad: a comprehensive analysis","volume":"28","author":"Verdoes","year":"2021","journal-title":"J Travel Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"s2","DOI":"10.1111\/hiv.12424","article-title":"British HIV association guidelines on the use of vaccines in HIV-positive adults 2015","volume":"17","author":"Geretti","year":"2016","journal-title":"HIV Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"115437","DOI":"10.1016\/j.jviromet.2026.115437","article-title":"Stability analysis of rabies virus in the environment","volume":"346","author":"Zhang","year":"2026","journal-title":"J Virol Methods."},{"key":"B12","doi-asserted-by":"publisher","first-page":"595678","DOI":"10.3389\/fmicb.2021.595678","article-title":"Rabies virus-induced autophagy is dependent on viral load in BV2 cells","volume":"12","author":"Wang","year":"2021","journal-title":"Front Microbiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1186\/s12985-025-02784-w","article-title":"Participation of host cell proteins in inclusion bodies of non-segmented RNA virus infected cells: a molecular insight","volume":"22","author":"Sarkar","year":"2025","journal-title":"Virol J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"7252","DOI":"10.1073\/pnas.89.15.7252","article-title":"Delineation of putative mechanisms involved in antibody-mediated clearance of rabies virus from the central nervous system","volume":"89","author":"Dietzschold","year":"1992","journal-title":"Proc Natl Acad Sci USA"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2736","DOI":"10.1128\/jvi.65.5.2736-2738.1991","article-title":"Direct entry of rabies virus into the central nervous system without prior local replication","volume":"65","author":"Shankar","year":"1991","journal-title":"J Virol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1474","DOI":"10.1186\/s12889-026-27015-x","article-title":"A retrospective analysis of rabies post-exposure prophylaxis in Kapilvastu District, Nepal","volume":"26","author":"Adhikari","year":"2026","journal-title":"BMC Public Health"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e00583","DOI":"10.34172\/jrhs.2023.118","article-title":"Epidemiologic aspects of animal bite, rabies, and predictors of delay in post-exposure prophylaxis: a national registry-based study in Iran","volume":"23","author":"Khazaei","year":"2023","journal-title":"J Res Health Sci"},{"key":"B18","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1007\/s13337-025-00928-8","article-title":"Epidemiological profile and factors associated with the delay in initiation of post exposure prophylaxis of animal bite cases at the tertiary care hospital, New Delhi: a hospital based study","volume":"36","author":"Kumar","year":"2025","journal-title":"Virus Dis"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1721","DOI":"10.3760\/cma.j.cn112338-20250808-00568","article-title":"Expert consensus on the clinical application of anti-rabies virus monoclonal antibody (2025 edition)","volume":"46","year":"2025","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e167","DOI":"10.1016\/S1473-3099(22)00641-7","article-title":"Human rabies despite post-exposure prophylaxis: a systematic review of fatal breakthrough infections after zoonotic exposures","volume":"23","author":"Whitehouse","year":"2023","journal-title":"Lancet Infect Dis"},{"key":"B21","doi-asserted-by":"publisher","first-page":"49","DOI":"10.12688\/aasopenres.13311.3","article-title":"Delays in initiating rabies post-exposure prophylaxis among dog bite victims in Wakiso and Kampala districts, Uganda","volume":"4","author":"Kisaka","year":"2022","journal-title":"AAS Open Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"61","DOI":"10.4314\/rjmhs.v6i1.8","article-title":"Factors associated with delayed rabies post-exposure prophylaxis among dog bite victims in Nyagatare District, Rwanda, 2017 to 2019","volume":"6","author":"Mugwaneza","year":"2023","journal-title":"Rwanda J Med Health Sci"},{"key":"B23","doi-asserted-by":"publisher","first-page":"102870","DOI":"10.1016\/j.tmaid.2025.102870","article-title":"Travel-related potential rabid animal post-exposure consultation at the Thai Travel Clinic, Hospital for Tropical Diseases, Bangkok, Thailand","volume":"66","author":"Charoenwisedsil","year":"2025","journal-title":"Travel Med Infect Dis"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e0012874","DOI":"10.1371\/journal.pntd.0012874","article-title":"Incidence, risk factors, and control of Rabies in Ethiopia: a systematic review and meta-analysis","volume":"19","author":"Regassa","year":"2025","journal-title":"PLoS Negl Trop Dis"},{"key":"B25","doi-asserted-by":"publisher","first-page":"668","DOI":"10.3760\/cma.j.issn.0253-9624.2019.07.004","article-title":"Expert consensus on rabies exposure prophylaxis","volume":"53","author":"Yin","year":"2019","journal-title":"Zhonghua Yu Fang Yi Xue Za Zhi"},{"key":"B26","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/j.jaccao.2021.08.002","article-title":"Radiation-associated coronary disease in young cancer survivors: the beat goes on; we must preserve it","volume":"3","author":"Bates","year":"2021","journal-title":"JACC CardioOncol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.3760\/cma.j.cn112338-20230905-00127","article-title":"Interpretation of the national regulation for the rabies exposure prophylaxis (2023 edition)","volume":"44","author":"Liu","year":"2023","journal-title":"Zhonghua Liu Xing Bing Xue Za Zhi"},{"key":"B28","doi-asserted-by":"publisher","first-page":"ciaf662","DOI":"10.1093\/cid\/ciaf662","article-title":"Rabies despite post-exposure prophylaxis in high-burden settings: vaccine failure or gaps in healthcare delivery?","volume":"6","author":"Lodha","year":"2025","journal-title":"Clin Infect Dis"},{"key":"B29","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1093\/cid\/ciad304","article-title":"Side-by-side comparative study of the immunogenicity of the intramuscular and intradermal rabies post-exposure prophylaxis regimens in a cohort of suspected rabies virus exposed individuals","volume":"77","author":"Auerswald","year":"2023","journal-title":"Clin Infect Dis"},{"key":"B30","doi-asserted-by":"publisher","first-page":"126128","DOI":"10.1016\/j.vaccine.2024.07.029","article-title":"Corrigendum to \u201cRandomized, blind, controlled phase III clinical trial: assessing the immunogenicity and safety of freeze-dried human rabies vaccine (vero cell) with a 4-dose regimen (2-1-1) in a 10-60 year-old demographic\u201d [Vaccine (2024) 26059]","volume":"42","author":"Jin","year":"2024","journal-title":"Vaccine"},{"key":"B31","doi-asserted-by":"publisher","first-page":"5500","DOI":"10.1016\/j.vaccine.2018.06.061","article-title":"Rabies vaccines: WHO position paper, April 2018\u2014Recommendations","volume":"36","year":"2018","journal-title":"Vaccine"},{"key":"B32","doi-asserted-by":"publisher","first-page":"100006","DOI":"10.1016\/j.ijidoh.2023.100006","article-title":"Rabies post-exposure prophylaxis delivery to ensure treatment efficacy and increase compliance","volume":"1","author":"Nadal","year":"2023","journal-title":"IJID One Health"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e270","DOI":"10.1097\/INF.0000000000004765","article-title":"Cytomegalovirus colitis in 2 patients with kindler syndrome","volume":"44","author":"Al-Hinai","year":"2025","journal-title":"Pediatr Infect Dis J"},{"key":"B34","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/j.wneu.2024.10.117","article-title":"Barbed versus conventional suture for spinal surgery: a systematic review and meta-analysis","volume":"193","author":"Pustilnik","year":"2025","journal-title":"World Neurosurg"},{"key":"B35","doi-asserted-by":"publisher","first-page":"e2101165118","DOI":"10.1073\/pnas.2527439122","article-title":"A megastudy of text-based nudges encouraging patients to get vaccinated at an upcoming doctor's appointment","volume":"118","author":"Milkman","year":"2021","journal-title":"Proc Natl Acad Sci U S A"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e15","DOI":"10.1017\/S0950268824000049","article-title":"Rabies vaccination adherence and associated factors among rabies-exposed patients in Shenzhen, China: a hospital-based cross-sectional study","volume":"152","author":"Lu","year":"2024","journal-title":"Epidemiol Infect"},{"key":"B37","doi-asserted-by":"publisher","first-page":"108556","DOI":"10.1016\/j.pec.2024.108556","article-title":"Myths and misinformation associated with vaccine incompleteness: a survey study","volume":"131","author":"Kallas-Silva","year":"2025","journal-title":"Patient Educ Couns"},{"key":"B38","doi-asserted-by":"publisher","first-page":"100980","DOI":"10.1016\/j.onehlt.2025.100980","article-title":"A persona-based exploration of rabies post-exposure prophylaxis seeking behavior and its implication for communication strategic planning: evidence from Thailand","volume":"20","author":"Yamabhai","year":"2025","journal-title":"One Health"},{"key":"B39","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1007\/s40506-020-00244-3","article-title":"Use of \u201cSocial Media\u201d-an option for spreading awareness in infection prevention","volume":"13","author":"Madhumathi","year":"2021","journal-title":"Curr Treat Options Infect Dis"},{"key":"B40","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1016\/j.cmi.2025.01.011","article-title":"Multimodal strategies for the implementation of infection prevention and control interventions-update of a systematic review for the WHO guidelines on core components of infection prevention and control programmes at the facility level","volume":"31","author":"Sonpar","year":"2025","journal-title":"Clin Microbiol Infect"},{"key":"B41","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s12873-025-01270-4","article-title":"The impact of media on surge capacity in emergency departments: a study on rabies vaccination uptake","volume":"25","author":"Alpar","year":"2025","journal-title":"BMC Emerg Med"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1911137\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:03:51Z","timestamp":1787724231000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1911137\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":41,"alternative-id":["10.3389\/fpubh.2026.1911137"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1911137","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"article-number":"1911137"}}