Delay in initiation of rabies post-exposure vaccination and influencing factors in Gondar zones of Ethiopia

Rabies is a viral zoonotic disease of warm-blooded animals, which is preventable through proper administration of post-exposure prophylaxis (PEP). In controlling rabies, delays in initiating post exposure vaccination (PEV) are a challenge in endemic regions. A study was conducted to assess the delay in initiation of PEV and identify associated factors in Ethiopia. Data was collected by face-to-face interviews from 260 dog bite victims or their guardians between January and June, 2025 using a questionnaire. Post exposure vaccination was considered delayed if it was initiated after 48 hours of the exposure incident. The prevalence of delayed initiation of PEV was calculated as a percentage from the number of individuals who initiated PEV after 48 hours and the total number of individuals exposed to rabies. Factors associated with delay were identified using logistic regression models. The prevalence of delayed in initiation of rabies PEV was 86.1% (224/260); 13.9% (36/260) of participants commenced vaccination within 48 hours of exposure. Severity of bite and ownership of biting animal were factors associated with the outcome. Deep bite (OR = 0.22, 95% CI: 0.07 - 0.66, P = 0.008) and bitten by stray dogs (OR = 0.51, 95% CI = 0.27 - 0.95, P = 0.033) reduced delay in initiation of PEV. Majority of respondents (88.5%) are aware of the existence, the signs (71.5%), the way of transmission (75.4%), and the fatal nature (96.5%) of rabies, and the need for PEV (95.4%). Another majority believe that the cost of the vaccine is fair and PEV is effective (95%), and and costs of the vaccination (76.2%) was not a reason for delay. In conclusion, the study outlined that respondents know many aspects of rabies control and had fewer barriers to uptake the PEV; however, the delay in initiating PEV was high. This underscores that respondents may not be aware of the risk of delay. Therefore, interventions focusing on the risk of delayed PEV initiation are needed.