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

A nationwide cross-sectional survey of adults attending outpatient clinics at nine university hospitals across Egypt found substantial gaps in knowledge and uptake of rabies prophylaxis, despite generally positive attitudes toward prevention. Among 1,777 respondents, 42.8% met the study’s threshold for good knowledge of rabies and rabies prophylaxis, while 88.5% had a positive attitude toward prophylaxis.

The questionnaire-based study recruited adults aged 18 years or older from university hospital outpatient clinics and waiting rooms in the Cairo, Coastal and Suez Canal, Delta, and Upper Egypt regions. Medical students, healthcare workers, and people younger than 18 were excluded. Recruitment used convenience sampling, and the analyzed sample included 1,777 respondents, with a median age of 35 years and an interquartile range of 23 years.

Participants completed a structured questionnaire developed through a literature review, review by two experts, and a pilot test involving 20 people who were excluded from the analysis. The instrument assessed demographic characteristics, rabies awareness and exposure history, knowledge, attitudes, prophylaxis practices, and perceived barriers. It was translated into Arabic and administered through standardized interviews by trained data collectors at all nine centers.

Knowledge was measured with 11 closed-ended questions, producing a score from 0 to 11. Respondents scoring at least 6 were classified as having good knowledge. The median knowledge score was 5, with an interquartile range of 3. Although 88.4% correctly identified the mode of rabies transmission, fewer respondents recognized rabies as a viral disease, named animals that transmit it, or identified signs of rabies in animals and humans. Specifically, 25.9% correctly identified rabies as viral, 13.1% could name the animals that transmit it, and 20.9% and 16.4%, respectively, knew the signs in animals and humans.

Knowledge scores differed across several participant groups in bivariate analyses. Good knowledge was reported by 50.7% of urban and 35.6% of rural respondents, and by 48.9% of men and 37.1% of women. It was also more common among people in occupations considered vulnerable to rabies exposure, at 66.2%, than among those in other occupations, at 32.7%. Respondents aware of rabies vaccination campaigns had a higher proportion of good knowledge than those without such awareness, 69.1% versus 40.5%, while the corresponding proportions were 56.1% and 41.3% among people with and without a previous animal bite or attack. These were statistical associations in the survey and do not establish that any factor caused the differences.

Attitudes toward rabies and prophylaxis were more favorable. The median attitude score was 7 on a scale of 0 to 7, and 88.5% of participants were classified as having a positive attitude. A total of 91.2% considered rabies a risk to human health, and 82% regarded it as fatal. Positive attitudes were associated with good knowledge, prior awareness of rabies, awareness of vaccination campaigns, occupational exposure, education, income, and age in bivariate analyses. The researchers reported no significant associations between attitude and either gender or previous discussion of rabies with a physician.

Prophylaxis practices were less complete. Among the 173 respondents, or 9.7% of the sample, who reported a previous animal bite or attack, 32, or 18.5%, did not receive post-exposure prophylaxis. Among those who began vaccination, 6.4% received the first dose more than 24 hours after exposure and 0.7% started one to two weeks later. Of 141 respondents who received post-exposure prophylaxis, 24, or 17%, did not complete the vaccine schedule. Uptake was highest in Upper Egypt, at 98%, and was associated with age, region, education, prior awareness of rabies, information from social media, discussion with a physician, awareness of campaigns, and knowledge level.

Pre-exposure prophylaxis was uncommon. The researchers classified 533 respondents, representing 30.0% of the sample, as potentially vulnerable to rabies exposure. Among them, 23, or 4.3%, had received pre-exposure prophylaxis, and 18 completed the vaccination schedule. Regional, urban-rural, educational, information-source, physician-discussion, campaign-awareness, and previous-attack variables were associated with uptake in bivariate analyses. The study did not report multivariable estimates that would establish independent associations or causal effects.

The most frequently reported barriers were lack of knowledge about the rabies vaccine, cited by 82.4% of participants, and lack of knowledge about rabies, cited by 81.7%. Other reported barriers were inadequate hospital facilities, at 43.1%; financial burden, 36.1%; fear of the procedure, 28.7%; discomfort dealing with healthcare staff, 13.8%; and previous negative experiences, 0.1%. When asked to select the single greatest barrier, 40.5% chose lack of knowledge about rabies, 23.4% lack of knowledge about the vaccine, 14% insufficient local-hospital facilities, 11.7% financial burden, 8% fear of the procedure, and 1.6% discomfort with healthcare staff.

The findings are based on a cross-sectional, questionnaire-based design and a convenience sample recruited from outpatient settings at nine university hospitals. Although the centers covered several regions, the sample was not a probability-based sample of Egypt’s general population, and the study does not establish changes over time or demonstrate that an intervention would improve prophylaxis uptake. The authors identified public education, improved access to vaccination services, and stronger healthcare facilities as areas for public-health action, while the observed data document deficiencies in knowledge, adherence to post-exposure prophylaxis, pre-exposure prophylaxis uptake, and access-related barriers.

Subject of Research: Knowledge, attitudes, practices, and barriers surrounding rabies prophylaxis among adults attending university hospitals in Egypt

Article Title: Rabies and rabies prophylaxis in Egypt: a nationwide cross-sectional study that calls for action

Article References: Helal, M. B., Saeda, M. A., Elshaar, A. G., Zayed, M. E., Abdelaziz, A. M., Mostafa, O. M., Adwy, E. S., Barakat, A., Abdelkader, I. M., Eldawody, B. A., Badrawy Ahmed, N. M., Noah, M., Aboismail, A., Mahmoud, A. M., & Allam, A. R. (2026). Rabies and rabies prophylaxis in Egypt: a nationwide cross-sectional study that calls for action. BMC Public Health, 26(1), Article 2979. https://doi.org/10.1186/s12889-026-29562-9

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29562-9

Keywords: rabies, rabies prophylaxis, post-exposure prophylaxis, pre-exposure prophylaxis, Egypt, cross-sectional study, public health, vaccination knowledge, healthcare access, knowledge attitudes and practices, prophylaxis, nationwide