{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:51:39Z","timestamp":1791525099368,"version":"4.3.4"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"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>Background<\/jats:title>\n                    <jats:p>Rabies is an almost invariably fatal, vaccine-preventable zoonosis. Rabies immunoglobulin (RIG) is recommended for Category III exposures, yet real-world RIG utilization remains poorly characterized. This study examined temporal trends and factors associated with RIG utilization and delayed presentation among Category III exposure patients in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective study was conducted using clinical records of Category III exposure patients presenting to a high-volume rabies prevention clinic in Hangzhou, China, from 2015 to 2024. Calendar year 2018 was treated as a temporal reference year for descriptive comparison. Multivariable logistic regression identified factors associated with RIG non-administration and delayed presentation (&amp;gt;24\u202fh post-exposure).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 14,270 eligible cases were analyzed. Overall RIG utilization was 37.54%, declining from 53.09% in 2015 to 7.14% in 2022. RIG non-administration was independently associated with male sex (OR 1.20, 95% CI 1.11\u20131.29), age 18\u201359\u202fyears (OR 3.25, 95% CI 2.95\u20133.59), exposure at home (OR 1.47, 95% CI 1.33\u20131.63), presentation in 2018 (OR 2.38, 95% CI 2.01\u20132.82) and in 2019\u20132024 (OR 4.49, 95% CI 3.96\u20135.09), and delayed presentation (OR 1.43, 95% CI 1.32\u20131.55). The overall delayed presentation rate was 34.47%; independent risk factors included age 18\u201359\u202fyears (OR 1.37, 95% CI 1.24\u20131.52), exposure at home (OR 1.57, 95% CI 1.41\u20131.74), and presentation in 2018 (OR 1.61, 95% CI 1.40\u20131.86) and in 2019\u20132024 (OR 1.77, 95% CI 1.62\u20131.94).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>RIG utilization was low and showed marked temporal variation during 2015\u20132024, and one third of patients presented more than 24\u202fh after exposure. Both outcomes were concentrated among working-age adults and domestic exposure settings. These findings describe service utilization patterns and identify subgroups in which gaps in PEP delivery are concentrated; targeted risk communication and routine monitoring of RIG utilization and presentation timeliness are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1916685","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T05:30:05Z","timestamp":1791523805000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Rabies immunoglobulin utilization and delayed presentation following category III rabies exposure: a 10-year retrospective study in Hangzhou, China"],"prefix":"10.3389","volume":"14","author":[{"given":"Jing","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Infectious Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiwei","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Control and Prevention, Hangzhou Center for Disease Control and Prevention (Hangzhou Health Supervision Institution)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health and The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Hangzhou Occupational Disease Prevention and Treatment Hospital","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanli","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of General Medicine, Hangzhou Occupational Disease Prevention and Treatment Hospital","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"5500","DOI":"10.1016\/j.vaccine.2018.06.061","article-title":"Rabies vaccines: WHO position paper, April 2018\u2013recommendations","volume":"36","year":"2018","journal-title":"Vaccine"},{"key":"ref2","year":""},{"key":"ref3","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.ijid.2022.10.046","article-title":"Global burden of rabies in 204 countries and territories, from 1990 to 2019: results from the global burden of disease study 2019","volume":"126","author":"Gan","year":"2023","journal-title":"Int J Infect 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