Rabies: the cruel and expensive disease of India’s most impoverished, PgII

Key Highlights:

• India accounts for a third of global rabies deaths, with approximately 20,000 fatalities annually.
• Rabies is endemic in India, primarily transmitted through dog bites, disproportionately affecting impoverished populations.
• Post-exposure prophylaxis (PEP) involving wound washing, anti-rabies vaccination (ARV), and rabies immunoglobulin (RIG) is crucial after a bite.
• The Supreme Court in November 2025 directed states to relocate stray dogs from public areas to shelters after sterilization and vaccination.
• Shortages of RIG and ARV, coupled with high costs, limit access to treatment, especially for children under 15.
• Two novel rabies monoclonal antibodies (RmAbs) have been produced in India and are currently under pharmacovigilance.

Detailed Insights:

• Rabies is a neurotropic viral disease that travels through peripheral nerves to the spinal cord and brain, leading to paralysis and cardio-respiratory failure.
• High-risk groups include daily wage workers, waste collectors, and rural populations, facing challenges in awareness, accessibility, and affordability of PEP.
• A 2025 study revealed that 20.5% of dog bite victims did not receive ARV, and nearly half of those who received a dose did not complete the full course.
• The lack of seriousness on the part of hospital staff to attend to dog bite injury, prompting the patient to approach a local private nursing home, ranks foremost.
• RIG, essential for severe bites, is scarce and expensive (₹5,000-₹20,000), leading many to seek ineffective treatments from unqualified individuals.
• India produces 50 million doses of ARV annually, while needing 60 million, with 15 million doses being exported.
• Proposed solutions include neutering and vaccinating stray dogs, ensuring accessible PEP, compensating treatment expenses, and establishing quality shelters.

Key Concepts Involved:

• Rabies: A fatal viral disease transmitted through saliva, typically via animal bites, affecting the central nervous system.
• Post-Exposure Prophylaxis (PEP): Immediate treatment after exposure to rabies, including wound washing, vaccination, and immunoglobulin administration.
• Rabies Immunoglobulin (RIG): An antibody injection providing immediate, passive immunity against the rabies virus at the site of the bite.