Rabies is a deadly viral infection that spreads through the saliva of infected animals, with dogs accounting for 99% of human rabies cases worldwide. Despite a reduction in rabies-related deaths in recent years, a Lancet study reveals that 5,726 human rabies deaths occur in India annually. The fatal nature of rabies makes immediate medical intervention crucial after potential exposure.
 

Why Immediate Medical Help is Vital

Rabies has a 100% fatality rate once symptoms appear. As highlighted by Dr. Mohammed Hussain, popularly known as The Cancer Doctor, "Rabies has a 100% death rate. So never hesitate to visit your doctor after a dog bite. Don’t take chances." Even minor scratches from potentially rabid animals require urgent care. While many believe that the anti-rabies vaccine alone is sufficient, experts stress that rabies immunoglobulin (RIG) is vital in severe cases to provide immediate protection.
 

How the Rabies Vaccine Works

The Anti-Rabies Vaccine (ARV) helps the immune system generate antibodies that combat the rabies virus. It contains an inactivated (killed) form of the virus, which trains the body to recognize and fight the infection.
 

Types of Rabies Vaccination

1. Pre-exposure prophylaxis (PrEP):

   • Recommended for individuals at high risk such as veterinarians, animal handlers, and travelers to rabies-endemic areas.
   • Helps build immunity in advance.

2. Post-exposure prophylaxis (PEP):

   • Given after a bite or scratch to prevent the virus from spreading to the nervous system.
   • PEP includes a series of vaccine doses and, in severe cases, RIG to provide immediate protection.

Why is Rabies Immunoglobulin (RIG) Important?

Rabies Immunoglobulin (RIG) is an injection containing ready-made antibodies that neutralize the virus at the wound site, preventing its spread to the central nervous system. Dr. Sanket Mankad, Infectious Diseases Consultant at Shalby Hospitals, Ahmedabad, explains that RIG is vital for individuals who haven’t been vaccinated before exposure. “RIG offers immediate protection while the body’s immune system takes time to build its own response,” he says. The rabies vaccine requires 7 to 14 days to stimulate the body’s immunity, leaving a window for the virus to spread if RIG is not administered. Without RIG, there’s a higher risk of the virus reaching the nervous system before the vaccine becomes effective.
 

Standard Treatment Protocol After a Dog Bite

According to World Health Organisation (WHO) guidelines, these steps should be taken immediately after exposure to a potential rabies infection:

1. Immediate Wound Care:

   • Wash the wound thoroughly with soap and running water for at least 15 minutes.
   • Apply antiseptics like iodine or 70% alcohol to reduce viral load.

2. Seek Medical Care Promptly:

   • Visit a healthcare facility to assess the need for vaccination and RIG.

3. Categorise the Exposure:

   • Category I: Touching or feeding animals, licks on intact skin – No treatment needed.
   • Category II: Minor scratches or nibbling on unbroken skin – Vaccine required.
   • Category III: Deep bites, wounds, or contamination of mucous membranes – Vaccine and RIG required.

4. Rabies Vaccination Schedule (PEP):
   WHO recommends the 4-dose intramuscular regimen on Days 0, 3, 7, and 14.

   • For immunocompromised individuals, a 5th dose on Day 28 is also recommended.
   • If a person has had Pre-exposure prophylaxis (PrEP) before the bite, only 2 doses (Day 0 and Day 3) are required, and RIG is unnecessary.

5. RIG Administration:
   RIG should be injected directly into and around the wound for maximum effectiveness.

6. Timeframe for RIG Administration:

   • Within 7 days of the first vaccine dose – Most effective and recommended.
   • After 7 days – Generally not required as the vaccine starts producing sufficient antibodies by then.

If RIG is not administered within this period, the risk of the virus reaching the nervous system rises significantly.

Challenges in Accessing Rabies Immunoglobulin in India

Despite the availability of rabies vaccinations, access to RIG remains a challenge in many parts of India, especially in rural regions. Dr. Neha Rastogi Panda, Consultant-Infectious Diseases at Fortis Memorial Research Institute, Gurugram, highlights that Human Rabies Immunoglobulin (HRIG) is often expensive, while Equine Rabies Immunoglobulin (ERIG) is a more affordable alternative but is still challenging to obtain. A standard rabies vaccine costs approximately ₹300 to ₹400, while immunoglobulin injections range from ₹4,000 to ₹6,000, making affordability a major concern. In addition, poor awareness about proper post-exposure protocols and the lack of adequate cold chain storage for RIG in remote areas further complicates access. Rabies is entirely preventable with the correct medical response. Following WHO guidelines, washing the wound thoroughly, seeking immediate medical care, and understanding the necessity of RIG in severe cases are crucial steps in protecting yourself from this deadly virus. Public awareness campaigns, improved RIG distribution, and better healthcare training are essential to reducing rabies fatalities in India. While rabies remains a serious threat, timely intervention can save lives.