Rabies is a viral disease that is preventable with vaccines but is nearly always fatal once clinical symptoms appear. The virus attacks the central nervous system, causing severe inflammation of the brain and spinal cord. It remains a significant public health challenge in India, transmitted to humans primarily through the saliva of infected animals. Its high fatality rate makes awareness of prevention and post-exposure protocols a matter of public safety.
Scope of the Rabies Problem
India accounts for an estimated 36% of the world’s rabies deaths, with the World Health Organization (WHO) estimating 18,000 to 20,000 deaths annually. Approximately 17.4 million animal bites are reported each year, though many more likely go unrecorded. The primary driver of this public health issue is the large population of free-roaming, unvaccinated dogs.
The problem is often more acute in rural areas, where 76% of rabies victims reside. In these regions, access to immediate medical care and awareness of appropriate post-bite procedures can be limited, contributing to higher fatality rates. Children under 15 are especially vulnerable, representing 30-60% of reported cases and deaths. Bites in children may go unreported to parents, delaying necessary medical intervention.
Transmission and Animal Vectors
The rabies virus is transmitted from an infected animal to a human through saliva, most commonly from a bite that breaks the skin. Transmission is also possible if saliva contacts an open wound, scratch, or the mucous membranes of the eyes, nose, or mouth.
After entering the body, the virus enters the peripheral nerves near the site of the bite. From there, it begins a slow journey along the nerves toward the central nervous system. This incubation period can range from a few weeks to several months, depending on the bite’s location and the amount of virus transmitted.
In India, infected dogs are the primary vector, responsible for 96-97% of all human rabies cases. Other mammals can also transmit the virus, including cats (about 2% of cases) and wildlife such as mongooses, jackals, and monkeys (about 1% of cases).
Post-Bite Medical Protocol
Immediate action after a potential rabies exposure is the most effective way to prevent the disease. The protocol involves immediate first aid and a medical consultation to begin Post-Exposure Prophylaxis (PEP), a treatment that is nearly 100% effective when administered promptly.
The first step is to thoroughly wash the bite or scratch area with soap and water for at least 15 minutes. This action significantly reduces the amount of virus at the entry site. After washing, an antiseptic like povidone-iodine should be applied to the wound.
Following first aid, seeking professional medical care is urgent. A healthcare professional will assess the wound and determine the appropriate course of PEP. This treatment consists of two main components: the rabies vaccine and, for more severe exposures, Rabies Immunoglobulin (RIG).
The rabies vaccine is given in a series of doses, with a common schedule involving injections on days 0, 3, 7, 14, and 28. For severe exposures, RIG is also administered to provide immediate antibodies at the wound site. This offers protection until the vaccine stimulates the body’s own immune response. As much of the RIG dose as is feasible is infiltrated directly into and around the wound.
Prevention Strategies for Travelers and Residents
The most straightforward prevention strategy is behavioral, centering on avoiding contact with animals, particularly free-roaming dogs. This includes refraining from petting, feeding, or attempting to handle any unfamiliar animal, regardless of whether it appears healthy. Parents should teach children to immediately inform an adult if they are bitten or scratched by any animal, as children may not always recognize the danger or report an incident.
For some individuals, medical prevention in the form of Pre-Exposure Prophylaxis (PrEP) is a recommended option. PrEP is advised for people at higher risk, such as long-term travelers, veterinarians, animal handlers, and those visiting remote areas with unreliable access to medical care.
The PrEP series consists of two doses given on days 0 and 7. While PrEP simplifies post-exposure treatment, it does not eliminate the need for medical attention after a bite. An individual who has received PrEP will still need two additional vaccine doses after an exposure but will not require Rabies Immunoglobulin (RIG).
National Control Efforts
India is tackling rabies through a national strategy aimed at eliminating dog-mediated rabies by 2030. The National Rabies Control Programme (NRCP) implements a multi-faceted approach to control the disease at its source.
A primary NRCP strategy is the mass vaccination of dogs to interrupt the virus’s transmission cycle. This “One Health” approach, which connects human and animal health, also includes Animal Birth Control (ABC) initiatives to manage the free-roaming dog population.
The NRCP also works to strengthen health systems by ensuring the availability of vaccines and immunoglobulins, particularly in rural and underserved areas. The program promotes the use of cost-effective intradermal vaccination routes, which require less vaccine per dose, allowing more people to be treated.
Enhancing surveillance and public awareness are also components of the strategy. The government is working to make rabies a notifiable disease to improve data collection. Public awareness campaigns educate communities on wound washing, seeking prompt medical care, and responsible pet ownership.