Factors Associated with Rabies Post-exposure Prophylaxis in High-burden Districts, Central Highlands Region, Vietnam, 2020-2022

One Health

Background: In Vietnam, rabies is the second leading cause of death among infectious diseases, with an average of 77 deaths annually from 2017 to 2021. The Central Highlands region has had the highest rabies mortality rate during the past 5 years. We calculated the frequency of, and factors associated with receiving rabies post-exposure prophylaxis (PEP) in the two highest-burden districts of the Central Highlands region.

Methods: We conducted a cross-sectional survey in eight communes representing 71,424 persons using multi-stage cluster sampling and interviewed dog-bitten residents of all ages with a structured questionnaire. The outcome was incomplete PEP (i.e., missing any vaccination after any dog bite event). Covariates included socio-demographics, raising dogs, number of dog bites, survey sites, and level of knowledge and attitude. Poor rabies prevention attitude was defined as answering incorrectly to any five attitude questions on the danger of rabies, the importance of PEP, dog vaccination, dog registration, and the inefficacy of herbal-based rabies treatment. Poor knowledge was defined as answering incorrectly to any four knowledge questions. We used multivariable logistic regression to assess factors associated with incomplete PEP.

Results: Overall, 451 persons reported being bitten by dogs during May 2020–February 2022; 233 (51.7%) received all PEP vaccinations after every single dog bite event; 236 (52.3%) were <18 years; 180 (39.9%) practiced religion; 140 (31.0%) raised dogs; 369 (81.8%) presented with poor rabies prevention attitude, and 120 (26.6) could not pay for complete PEP. Factors associated with incomplete PEP included unaffordable vaccination (aOR: 2.7; 95% CI: 1.6–4.7), poor attitude (aOR: 1.9, 95% CI: 1.1–3.4) and practicing religion (aOR: 1.8, 95%CI: 1.1–2.9).

Conclusions: Only 52% of Central Highlands residents reported complete PEP. Rabies education campaigns addressing poor attitudes and making PEP more affordable should be considered to improve vaccination coverage and, ultimately, decrease rabies-related deaths.