 "Dog, rabies")
A nationwide study by the Indian Council of Medical Research–National Institute of Epidemiology (ICMR-NIE) has revealed that India continues to lose over 5,700 lives annually to rabies, despite high levels of awareness and vaccine uptake. The survey, conducted across 60 districts and 15 states, found that nearly 9.1 million animal bites occur each year, with children under 14 and the elderly most frequently affected.
Even though 80 per cent of dog bite victims received at least one dose of the anti-rabies vaccine, the report raises alarm over the lack of access to complete post-exposure prophylaxis (PEP), especially rabies immunoglobulin (RIG), which can be life-saving in severe exposures.
What is rabies?
Rabies is a lethal viral infection that attacks the central nervous system and is nearly always fatal once symptoms appear. Dogs are responsible for most human cases. After exposure, whether a bite or a minor scratch, a medical emergency emerges.
Rabies remains lethal and severely underreported: ICMR
The ICMR study, which used household-level data, estimates that 5,726 human rabies deaths occur in India every year. The highest incidence of dog bites was found among:
- Children aged 0–14 years
- Elderly above 60 years
- Males
Despite India’s ambitious goal to eliminate rabies by 2030 under the National Action Plan for Rabies Elimination (NAPRE), these findings expose serious gaps in access, awareness, and post-bite care.
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Rabies immunoglobulin is the missing link: ICMR
While vaccines are widely promoted, RIG remains severely underused and unavailable, particularly in public health settings. The ICMR study found that most dog bite victims received incomplete treatment, and few received RIG—a crucial biological that offers immediate protection before the vaccine takes effect.
Experts emphasise that without RIG, even vaccinated individuals can succumb to rabies, especially in deep bite wounds or Category III exposures. While rabies vaccine is available for free of cost at most government hospitals and urban primary health centres (UPHCs), RIG is usually available only in tertiary care government hospitals, such as Aiims, Delhi, Guru Teg Bahadur Hospital, Delhi, Sion Hospital (Lokmanya Tilak), Mumbai, CMC Vellore, Tamil Nadu, Rajiv Gandhi Government General Hospital, Chennai.
How vaccine and RIG work together
Rabies vaccine contains inactivated virus that prompts your immune system to develop protective antibodies.
It is part of two protocols:
- Pre-exposure prophylaxis (PrEP): for high-risk individuals (such as veterinarians and travellers to high-risk areas)
- Post-exposure prophylaxis (PEP): for those bitten or scratched, delivered on Days 0, 3, 7, and 14 (plus Day 28 for immunocompromised individuals)
However, it requires about 7–14 days to build immunity, leaving a dangerous window if not supplemented.
Rabies immunoglobulin provides immediate, passive immunity by introducing ready-made antibodies directly to the wound site.
It is essential for Category III exposures—deep bites or contact with mucous membranes—as recommended by the World Health Organisation and other health experts.
According to experts, RIG should be administered within seven days of the first vaccine dose.
Without RIG, the rabies virus might reach the central nervous system before the vaccine can fully protect you—an almost certain path to fatality if the infection takes hold.
Current government response
The Ministry of Health and Family Welfare (MoHFW), along with the National Centre for Disease Control (NCDC), is implementing the National Rabies Control Programme (NRCP) to address these challenges through:
- Free provision of anti-rabies vaccine and RIG
- Mass dog vaccination campaigns
- Model anti-rabies clinics
- Awareness and training programmes
- Intersectoral coordination under a “One Health” approach
However, according to the Marching Towards Rabies-Free India report by MoHFW, availability of RIG still varies drastically between states, and only 20 states have declared human rabies a notifiable disease, leading to chronic underreporting and delayed interventions.
According to ICMR, rabies is 100 per cent fatal once symptoms begin—but also 100 per cent preventable with timely and complete treatment. Vaccination alone is not enough in severe cases and RIG must be administered within seven days of the first vaccine dose. According to MoHFW, the first line of defence is always immediate wound washing, followed by full PEP.
Despite targets, India’s rabies strategy faces major barriers
- Uneven access to vaccine and immunoglobulin
- Weak surveillance and underreporting
- Lack of lab-confirmed diagnoses
- Public misconceptions about treatment
- Fragmented coordination across health sectors
What are the common signs a dog may have rabies?
- Sudden, unprovoked aggression
- Attacking people or animals without reason
- Restlessness, snapping, biting at objects or air
- Excessive salivation or foaming at the mouth (due to paralysis of the jaw and throat muscles)
- Thick, sticky saliva may drip constantly
- Unusual behaviour or personality changes
- Friendly dogs becoming hostile
- Active dogs becoming lethargic or withdrawn
- Difficulty swallowing or hydrophobia (fear of water)
- Dogs may refuse to drink despite appearing thirsty
- Attempts to drink may trigger spasms or panic
- Staggering or paralysis
- Hind leg weakness
- Seizures or paralysis, especially near the end stage
- High-pitched growling or strange vocalisations
- Bark may sound distorted or unusual
- Whining, howling, or guttural noises
Steps to take after a dog bite
Immediate wound care
Gently wash the affected area with soap and running water for at least 15 minutes, then sanitise with an iodine or 70 per cent alcohol solution.
Seek medical attention
Go to the nearest large government hospital or a known tertiary medical college hospital. Health professionals will classify the injury. There are three WHO-defined categories of rabies exposure:
- Category I (Touching or feeding animals, or being licked on intact skin): No PEP required, but wash hands for hygiene and observe the animal.
- Category II (Minor scratches or nibbles): Vaccine is required.
- Category III (Deep wounds or mucosal exposure): Both vaccine and RIG are required.
For RIG, specifically ask if it’s available at the anti-rabies clinic or emergency room you visited. According to ICMR, MoHFW, and global medical experts, when it comes to rabies, it’s always better to act fast than to take chances—because once symptoms appear, it’s already too late.
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This content is for informational purposes only and is not a substitute for professional medical advice.
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