All you need to know about: rabies

The Hindu

3 days ago

The Supreme Court's recent ruling directing the Delhi government and local bodies to immediately capture stray dogs, detain them in pounds created across the national capital territory and never let them loose back into public spaces, has ignited a controversy. One of the points the court made was about children lost to rabies due to stray dog bites. What is rabies and what is the extent of the public health burden caused by it? Here is all you need to know about rabies.
What is rabies?
Rabies is a deadly, fatal, zoonotic viral disease. The rabies virus (RABV) is generally transmitted through the bite or scratch of an infected animal. Rabies infects mammals, including dogs, cats, livestock and wildlife. Other animals that carry rabies include: bats, raccoons, skunks and foxes.
According to the World Health Organization (WHO) however, dog bites and scratches cause 99% of the human rabies cases. In rare cases, rabies is transmitted through the infected saliva of an animal coming into contact with an open wound or mucous membranes such as in the eyes or mouth.
What makes this virus dangerous is that once clinical symptoms begin, there is no cure: it is fatal. However, rabies can be prevented through prompt vaccination after exposure. The WHO classifies rabies as a neglected tropical disease (NTD) and states that children between the ages of 5 and 14 are frequent victims.
What are the signs and symptoms of rabies?
The rabies virus has an incubation period. This means it can spend several days or weeks (up to two or three months) in the body before symptoms appear. The incubation can period can vary based on factors such as the location of the wound. It is during the next phase, when the virus travels to the central nervous system, known as the prodromal phase that symptoms appear. Initial symptoms may be similar to those of the flu and may include: fever, headaches, discomfort, vomiting, weakness and prickling or tingling at the site of the bite.
The disease then progresses into a severe form, usually about two weeks after the first symptoms. At this stage, the acute neurologic phase, the rabies virus begins damaging the brain and spinal cord. In a majority of people symptoms of 'furious rabies' appear, and these include aggressive behaviour, hallucinations, hyperactivity, fear of water (hydrophobia), excessive salivation, fear of air or drafts and delirium.
A smaller number of patients have symptoms of 'paralytic rabies' which involves paralysis of the muscles and weakness, starting from the site of the bite and progressing to the rest of the body, eventually leading to a coma. Furious rabies usually lasts a few days while paralytic rabies can last longer. The WHO states that the paralytic form of rabies is often misdiagnosed, contributing to the under-reporting of the disease.
What is the vaccination available?
There are currently no WHO-approved tools to diagnose rabies prior to the onset of clinical symptoms, making it crucial to see a healthcare provider immediately after a bite, scratch or contact with a wild animal, or a potentially infected pet animal. Healthcare providers must make an accurate risk assessment to decide on vaccination. The wound must be cleaned gently and thoroughly as well.
Vaccines for rabies are: pre-exposure prophylaxis (PrEP) which is recommended for people in high-risk professions where they may come into contact with infected animals or those travelling to such areas and post-exposure prophylaxis (PEP), which is given after exposure, and which prevents the virus from entering the central nervous system. It is important to note that taking the PrEP does not mean that PEP is not needed: even those who have taken the PrEP must seek care after exposure.
As listed under the WHO - Prequalification of Medical Products, as of 2024, there are only three WHO pre-qualified human rabies vaccines available globally: RABIVAX-S by Serum Institute of India Pvt. Ltd., VaxiRab N by Zydus Lifesciences Limited, and VERORAB by Sanofi Pasteur.
What do you do if bitten or scratched by an animal?
If you've been bitten by animal that may have rabies, or even scratched or licked it is important to seek medical attention. Wash the wound thoroughly with soap and water and then go to your healthcare provider, giving as much detail as possible about the animal and the kind of contact.
The post exposure prophylaxis (PEP) rabies vaccine usually consists of four shots over 14 days. Your doctor may also give you shots of human rabies immunoglobulin, given into or around the wound in order to give the body antibodies to destroy the virus around the wound. (This is not taken if a vaccination has already been taken prior to exposure).
If treatment is availed of promptly after exposure, it is usually effective at preventing rabies.
What is the situation in India?
In India, there were more than 37 lakh cases of dog bites and 54 suspected human rabies deaths reported during 2024, according to a written reply given by S.P. Singh Baghel, Minister of State for Fisheries, Animal Husbandry and Dairying to the Lok Sabha. A January 2025 research paper, 'Estimates of the burden of human rabies deaths and animal bites in India, 2022–23: a community-based cross-sectional survey and probability decision-tree modelling study' however found that the estimated human rabies death occurring annually in India was 5,726. It also found gaps in vaccine access and completion of vaccine courses.
The WHO notes that India is endemic for rabies, and accounts for 36% of the world's rabies deaths.