Anti-rabies vaccine alone is not enough when children suffer deep stray dog bites, says DPH

The Hindu

04-07-2025

Citing two recent rabies deaths despite vaccination in Kerala, the Directorate of Public Health (DPH) and Preventive Medicine reiterated the need to train healthcare workers to identify the dog bite category and administer rabies immunoglobulin (RIG) appropriately along with anti-rabies vaccine (ARV).
Re-emphasising the set of scientific guidelines that healthcare workers should strictly adhere to, the directorate said two boys, who were bitten by stray dogs in Kerala, died despite being vaccinated. The reasons for their deaths could be a delay in starting post-exposure prophylaxis (PEP), improper wound cleaning, skipping of doses, failure to administer RIG for category III exposures (transdermal bites or scratches, licks on broken skin), and improper vaccine storage or administration as recommended by the manufacturer.
In a communication to district and city health officers, T.S. Selvavinayagam, Director of Public Health, said rabies PEP is life-saving only if done properly. Proper wound care, timely and complete vaccination, RIG (if indicated), and the storage of vaccines at proper temperatures are crucial, he said. They should be aware that rabies is a deadly viral infection that affects the brain and nervous system, and is almost always fatal once symptoms appear, for which the PEP must be administered correctly and promptly. Standard guidelines for rabies vaccination after a suspected or confirmed dog bite should be strictly followed.
Elaborating the possible reasons for rabies death despite vaccination, the directorate said if a child had deep or bleeding wounds, RIG should be administered along with ARV. RIG neutralises the virus at the site of wound, especially in the initial days before vaccine-induced antibodies develop. Without RIG, the virus can spread to the nervous system, even if ARV is given later, it said.
Key reasons
If there is a delay in starting PEP even by a few days, especially with severe bites near the face or head, the vaccine may not prevent the disease. Missed or delayed dose of the vaccine and incorrect administration (wrong injection site or route of administration) could also be a cause. Improper cleaning of wounds is another possible cause, as the first and most important step is thorough washing with soap and water for at least 15 minutes.
The directorate added that children were at a higher risk as the immature immune system might respond less robustly.
Listing out the guidelines for PEP, the directorate said the bite should be assessed — category I (touching/feeding animals, licks on intact skin-no PEP required), category II (minor scratches/abrasions without bleeding-vaccine only) and category III (vaccine and RIG).