Risk factors for adverse events following rabies vaccination: a multivariate analysis of real-world data.

Purpose: To investigate independent risk and protective factors associated with adverse reactions following rabies vaccination in a Chinese population; to develop and validate a predictive nomogram for clinical utility; to support risk stratification management in clinical practice. Methods: A retrospective analysis was conducted on data from 806 patients who visited the Animal Bite Outpatient Clinic of Ningbo Ninth Hospital between September 2023 and August 2025. Variables were screened using LASSO regression, and a multivariate logistic regression-based nomogram model was constructed. The model's performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis, and ten-fold cross-validation. Results: This study identified high-risk exposure grade (OR = 1.37), bilateral deltoid vaccination (OR = 4.93), history of allergy (OR = 5.07), and delayed wound management (OR = 2.13) as significant risk factors ( Conclusion: This study is the first to identify bilateral deltoid vaccination as an independent risk factor for adverse reactions to rabies vaccine. The constructed nomogram model demonstrates high accuracy in identifying high-risk individuals. Clinically, it is recommended that high-risk exposure patients receive single-site vaccination combined with a 4-dose regimen, with wound management completed within 24 h. Enhanced monitoring is advised for hypertensive patients to mitigate potential risks.