Rabies is a fatal yet preventable zoonotic disease caused by the rabies virus, transmitted to humans primarily through the bite or scratch of an infected animal⁽¹⁾. Globally, rabies accounts for an estimated 59,000 human deaths annually, with India contributing nearly one-third of the total burden⁽²⁾. Children under 15 years are disproportionately affected, comprising up to 40% of all reported animal-bite victims, due to their smaller body size, curiosity toward animals, and limited ability to defend themselves⁽³⁾. In India, domestic and stray dogs remain the main reservoir, although cats, pigs, monkeys, and other animals also contribute to transmission⁽⁴⁾. Unprovoked bites, especially those on the face and upper extremities, pose the highest risk of rabies due to rich nerve supply and shorter incubation periods⁽⁵⁾. The World Health Organization (WHO) and the National Rabies Control Programme (NRCP) classify animal exposures into three categories, with Category III—including single or multiple transdermal bites or scratches, or contamination of mucosa with saliva—requiring immediate and complete post-exposure prophylaxis (PEP)⁽⁶⁾. PEP comprises three essential components: immediate and thorough wound washing, administration of rabies immunoglobulin (RIG) into and around the wound, and a full course of anti-rabies vaccine (ARV)⁽⁷⁾. The intradermal (ID) two-site regimen has proven to be highly effective, safe, and cost-efficient for use in high-volume government facilities⁽⁸⁾. Despite the availability of effective vaccines and guidelines, delayed presentation, inadequate wound cleaning, and incomplete PEP remain critical gaps, particularly in low-resource settings. This case series highlights the clinical presentation, management, and outcomes of severe paediatric Category III animal-bite injuries presenting to a tertiary-care teaching institute in Western Maharashtra. By documenting these cases, the study reinforces the importance of timely wound care, appropriate RIG administration, and completion of vaccination schedules in accordance with NRCP and WHO protocols.

A retrospective descriptive case series was conducted at a tertiary-care teaching institute in Western Maharashtra, catering to both urban and rural populations. Case records of paediatric patients aged ≤13 years who presented with WHO Category III animal-bite injuries between May and August 2025 were reviewed. Ten cases fulfilling the inclusion criteria were analysed. Inclusion criteria: Children (≤13 years) with Category III exposure under WHO guidelines⁽¹⁾ and complete treatment documentation. Exclusion criteria: Patients >13 years or with incomplete records. Data were extracted from hospital OPD registers, emergency department notes, and case sheets. Variables included age, sex, type of animal, site and nature of wound, timing of hospital presentation, first aid, PEP details (RIG and ARV), and outcome. All patients received PEP as per NRCP (2023) and WHO (2018) guidelines. Wounds were washed with soap and water, antiseptic applied, RIG infiltrated locally, and ARV (ARV 0.1 mL per site) administered by the intradermal two-site regimen on Days 0, 3, 7, and 28. Tetanus toxoid was given to all children. Ethical consideration: This case series is based on retrospective review of Anonymize hospital records. The privacy and the confidentiality were maintained. No patient identifiers are disclosed. Informed consent was obtained from the child’s parents or guardian. Institutional Ethics Committee approval was obtained Summary of findings Among ten paediatric patients (aged 2–13 years), eight (80%) had dog bites and two (20%) cat bites. The majority were Category III unprovoked exposures, with face (30%) and lower limbs (50%) being the most common sites. Seven children were male and three female. Eight patients reported within six hours, facilitating early wound management. All received local RIG infiltration and full ARV courses. No rabies, secondary infection, or serious adverse reactions occurred. Case 1 – Child A (4 years, Male) History: A 4-year-old male child was brought by his mother to the Anti-Rabies Clinic of a tertiary-care teaching institute in Western Maharashtra on 16th April 2025, with a history of dog-bite injury over the right side of the forehead and scalp. The incident occurred at approximately 7 a.m. near Chikhali when a stray, unprovoked dog attacked the child while he was playing outside. The animal was unvaccinated and later untraceable. There was active bleeding from the wound site. No prior animal bite exposure was reported. The child was immediately taken to a nearby private clinic where he received tetanus toxoid (TT) and was then referred for further management.

Case Age / Sex Type of Animal Nature of Bite WHO Category Site(s) of Injury Provoked / Unprovoked Time to Reporting RIG Given (Type / Dose) ARV Schedule (Days 0,3,7,28) 1 3 y / F Stray dog Multiple bites III Forehead above eye, parietal scalp Unprovoked Within 3 hrs ERIG – local infiltration ID (0,3,7,28) 2 4 y / M Stray dog Multiple deep lacerations III Occipital & parietal scalp, scapular & thigh Unprovoked < 2 hrs ERIG – local + IM ID (0,3,7,28) 3 5 y / M Stray dog Multiple CLWs III Post-auricular & nape of neck Unprovoked < 3 hrs ERIG local + IM ID (0,3,7,28) 4 4 y / F Stray dog Multiple CLWs III Neck, back, thigh, leg Unprovoked < 2 hrs ERIG (2.0 mL) local + IM ID (0,3,7,28) 5 2 y / F Pet cat (scratch) Nail scratch III R eye region (lid margin) Provoked Same day ERIG local + topical (eye) ID (0,3,7,28) 6 4 y / M Stray dog Single deep CLW III L calf region (8×3×1 cm) Unprovoked < 4 hrs ERIG 8 mL local + IM ID (0,3,7,28) 7 6 y / M Pet dog (unvaccinated) Multiple punctures III L face (mandible), R hand Unprovoked < 4 hrs ERIG 1.8 mL local + IM ID (0,3,7,28) 8 11 y / M Stray dog Multiple abrasions III R forearm, lumbar, leg Unprovoked < 3 hrs ERIG local + IM ID (0,3,7,28) 9 4 y / F Stray cat Abrasions III R ankle region Provoked < 6 hrs ERIG 1.0 mL local + IM ID (0,3,7,28) 10 10 y / M Pet dog (unvaccinated) Superficial punctures III B/L lower legs (R upper, L lower) Unprovoked Within 2 hrs ERIG 4.0 mL local + IM ID (0,3,7,28) Examination: On examination, the child was conscious, oriented, and haemodynamically stable. Local findings: Two clean lacerated wounds (CLWs) were present — one on the right frontal region (4 cm × 1 cm) and another on the parietal scalp (3 cm× 1.5 cm), both with mild oozing of blood. There was no evidence of neurovascular compromise. Ophthalmic evaluation revealed no corneal or periorbital injury and the right eyelid was intact. The case was classified as WHO Category III exposure owing to transdermal bites involving the head and face. The child weighed 13 kg. Management: Immediate wound washing was performed using soap and running water for 15 minutes, followed by povidone-iodine application. The patient received Inj. ARV (0.1 mL × 2 sites ID) on Days 0, 3, 7, 28, as per the updated ID regimen recommended under the National Rabies Control Programme (NRCP, 2024) ⁽²⁾. After a negative intradermal test dose, ARS (rabies immunoglobulin) was administered at a dose of 1.73 mL, infiltrated locally around both wounds and the remainder intramuscularly in the anterolateral thigh ⁽³⁾. The child was also given oral Amoxiclav suspension (25 mg/kg/day divided doses), paracetamol syrup, and povidone-iodine ointment for daily wound dressing. The Paediatrics and Ophthalmology departments were consulted for local wound management and ocular surveillance. Outcome: The wound healed well without evidence of infection, cellulitis, or neurological involvement. Sutures were not required. No signs of hydrophobia or aerophobia were observed on subsequent visits. The child completed the full ARV schedule uneventfully and was followed up for scar management and counselling on pet-bite prevention. Head and face injuries in paediatric dog bites require urgent and meticulous wound care because of the high viral load in facial tissues and short incubation period of rabies ⁽⁴⁾. Early infiltration of rabies immunoglobulin and completion of the intradermal vaccination schedule ensured full recovery in this case. The prompt referral from the private practitioner and inter-departmental coordination between Community Medicine, Paediatrics, and Ophthalmology played a key role in favourable outcome. Case 2 – Child B (4 years, Male) History: A 4-year-old male child was brought to the casualty department of a tertiary-care teaching hospital in Western Maharashtra on 20th May 2025, with extensive bite wounds inflicted by multiple strays, unprovoked dogs near his residence in the Chakan area. The child was attacked while playing outdoors. The dogs were unvaccinated and untraceable. There was profuse bleeding from the scalp and left-thigh regions. He was initially taken to a nearby rural hospital where Inj. TT 0.5 mL IM was administered; following which he was referred for definitive anti-rabies management. Examination: On arrival, the child was conscious but anxious; vital parameters were stable. Local findings: Multiple deep clean lacerated wounds (CLWs) were noted on the bilateral temporal, occipital and parietal scalp regions, the largest measuring approximately 8 cm × 2 cm, with exposed subcutaneous tissue but no bone involvement. Additional CLWs were present over the left thigh, and superficial puncture and abrasion marks over the left scapular and anterior chest wall. Systemic examination: Cardiovascular, respiratory and neurological systems were within normal limits. The exposure was classified as WHO Category III, given the transdermal, bleeding wounds over highly innervated areas (scalp and face). The child weighed approximately 14 kg. Management: All wounds were thoroughly irrigated for at least 15 minutes with running water and soap, followed by povidone-iodine application. After a negative intradermal sensitivity test, Inj. Anti-Rabies Serum (ARS) was infiltrated locally into all wound sites (total dose ≈ 4.0 mL, calculated per body weight) with the remainder administered intramuscularly in the anterolateral thigh ⁽¹⁾. Inj. ARV 0.1 mL × 2 sites ID was initiated on Days 0, 3, 7 and 28 according to the National Rabies Control Programme (NRCP, 2024) schedule ⁽²⁾. Prophylactic oral Amoxiclav (25 mg/kg/day in three divided doses) and Paracetamol syrup were prescribed along with daily wound dressing using povidone-iodine ointment. The child was jointly managed by the Paediatrics, Surgery, and Community Medicine departments, with close neurological and wound surveillance. Outcome: Progressive wound healing was noted over subsequent reviews with healthy granulation tissue and no evidence of secondary infection. There were no neurological deficits or symptoms suggestive of rabies. The child completed the full ARV schedule uneventfully and was discharged after counselling on avoidance of stray animals and completion of follow-up. Severe scalp bites in children represent a high-risk exposure due to the dense innervation and vascularity of the head region, which accelerates viral dissemination⁽³⁾. In this case, timely irrigation, prompt administration of RIG and early initiation of intradermal ARV ensured an uncomplicated recovery. Coordinated inter-departmental management and adherence to NRCP guidelines were critical in achieving a successful outcome. Case 3 – Child C (5 years, Male) History: A 5-year-old boy presented to the emergency department of a tertiary-care teaching hospital in Western Maharashtra on 7th July 2025 following multiple bites by a stray, unprovoked dog near his home in the Chakan area. The incident occurred while the child was playing outdoors in the early morning. The animal was unvaccinated and not traceable. There was active bleeding from wounds behind the right ear and over the neck. He was promptly brought to the hospital within one hour of exposure. Examination: On arrival, the child was alert, afebrile, and haemodynamically stable. Local examination: A deep clean lacerated wound (CLW) measuring approximately 2 cm × 1 cm was present in the right post-auricular region, with surrounding tissue oedema and active bleeding. Multiple puncture and abrasion marks were seen over the nape of neck, and a separate CLW (2 cm × 2 cm) over the left gluteal region with superficial tissue loss. Systemic examination: No neurovascular deficit; cardiovascular, respiratory and abdominal findings were normal. The exposure was classified as WHO Category III, owing to transdermal, bleeding wounds in a highly innervated head-and-neck region. The child’s weight was 13 kg. Management: All wounds were immediately and thoroughly washed with soap and running water for 15 minutes, followed by povidone-iodine application. After a negative test dose, Inj. Anti-Rabies Serum (ARS) was locally infiltrated (1.7 mL) around all bite wounds; the remaining quantity was administered intramuscularly in the anterolateral thigh ⁽¹⁾. Inj. ARV 0.1 mL × 2 sites ID was given on Days 0, 3, 7 and 28, as per NRCP (2024) protocol ⁽²⁾. Inj. TT 0.5 mL IM stat was administered. Supportive treatment included oral Amoxiclav (25 mg/kg/day), Syp. Paracetamol (15 mg/kg SOS) and daily povidone-iodine dressing. The case was jointly managed by the Community Medicine, Paediatrics and Surgery departments, ensuring wound care, prophylaxis, and follow-up. Outcome: Wound healing occurred satisfactorily within two weeks, leaving minimal scarring. No signs of secondary infection, neurological involvement, or rabies were observed during serial follow-up. The child completed the full ARV schedule and remained asymptomatic on subsequent review. Head-and-neck bites in children pose an especially high risk of rabies transmission due to the shorter incubation period and dense neural innervation ⁽³⁾. Early and thorough wound irrigation, timely local RIG infiltration and strict adherence to the intradermal ARV schedule remain the most effective life-saving interventions. Community-level prevention through stray-dog control and parental awareness is vital in reducing such paediatric exposures. Case 4 – Child D (4 years, Female) History: A 4-year-old girl was referred to the casualty department of a tertiary-care teaching hospital on 30th August 2025, following multiple dog bites inflicted by a stray, unprovoked dog in a residential locality near Bhosari. The animal was unvaccinated and untraceable. The child was initially managed at a nearby municipal hospital, where she received Inj. TT 0.5 mL IM, and was subsequently referred for rabies immunoglobulin (ARS) infiltration and further management. The bites occurred while the child was playing near her home premises, and the family brought her to the hospital within two hours of exposure. Examination: On admission, the child was conscious, cooperative, and haemodynamically stable. Local examination: Multiple bite wounds were observed — Clean lacerated wound (CLW), 4 cm × 1 cm, over the right thigh with exposed subcutaneous tissue. Multiple puncture wounds over the right lower back and scapular region with mild bleeding. Laceration over posterior neck and post-auricular region, ~6 cm × 0.5 cm, with surrounding abrasion. Superficial CLWs over scalp and forehead (~1 cm each). Systemic examination: Normal cardiovascular and respiratory findings; no neurological deficit. The exposure was categorized as WHO Category III, due to multiple transdermals, bleeding wounds in high-risk sites (head, neck, and thigh). Management: All wounds were meticulously washed with soap and water for a minimum of 15 minutes and then cleaned with povidone-iodine. After a negative test dose, Inj. Anti-Rabies Serum (ARS) was locally infiltrated (2.0 mL) into all accessible wounds; the remaining quantity was injected intramuscularly in the anterolateral thigh ⁽¹⁾. Inj. ARV 0.1 mL × 2 sites ID was administered on Days 0, 3, 7, and 28, as per NRCP (2024) guidelines ⁽²⁾. Prophylactic oral Amoxiclav (25 mg/kg/day in three divided doses) and Syp. Paracetamol were prescribed for pain and secondary infection prevention. Daily wound dressing with povidone-iodine ointment was done under sterile precautions. The child was jointly managed by the Paediatrics, Surgery, and Community Medicine departments. Outcome: Gradual epithelialization was observed over two weeks, with no evidence of wound infection or systemic complications. The child completed the full ARV schedule uneventfully, remained afebrile, and exhibited no neurological symptoms during follow-up. This case highlights a typical high-risk paediatric exposure, involving multiple anatomical sites including the head and neck — regions associated with shorter incubation periods and increased fatality if untreated ⁽³⁾. The child’s complete recovery underscores the efficacy of immediate wound cleansing, ARS infiltration, and adherence to the intradermal ARV schedule. Public education regarding early reporting and avoidance of stray animals remains critical to rabies prevention efforts. Case 5 – Child E (2 years, Female) History: A 2-year-old girl was brought by her mother to the casualty department on 12th September 2025 following a cat-scratch injury near the right eye. The incident occurred at home late at night when the family’s pet cat suddenly scratched the child while being handled. The animal was unvaccinated and later classified as unprovoked. The child was referred from a private clinic to the tertiary-care hospital within one hour of injury for category III prophylaxis. Examination: The child was conscious, irritable but consolable. Local findings: Superficial abrasion with oozing just below the right lower eyelid, measuring about 0.5 cm × 0.3 cm. Mild sub-conjunctival haemorrhage on the temporal side of the right eye. No corneal involvement or deep laceration. Ocular examination (by Ophthalmology): Cornea – clear; anterior chamber – normal; pupils – bilaterally equal and reactive; vision assessment limited due to age. Systemic findings: Stable vital parameters; no neurological or systemic abnormalities. The exposure was classified as WHO Category III, considering mucous-membrane involvement near the eye. The child’s weight was 10.7 kg. Management: The wound was immediately washed with soap and running water for 15 minutes and irrigated with normal saline. After a negative test dose, Inj. Anti-Rabies Serum (ARS) was locally infiltrated (1.3 mL) around the periorbital wound using a fine needle, avoiding ocular penetration; remaining volume was injected intramuscularly in the thigh ⁽¹⁾. Inj. ARV 0.1 mL × 2 sites intradermally was administered on Days 0, 3, 7 and 28, per NRCP (2024) guidelines ⁽²⁾. Inj. TT 0.5 mL IM stat was given. Supportive management included topical antibiotic eye drops, Syp. Amoxiclav (25 mg/kg/day) and Syp. Paracetamol as needed. Daily gentle eye dressing and observation were done jointly by the Community Medicine, Paediatrics and Ophthalmology departments. Outcome: Epithelial healing occurred within five days with no secondary infection. The child remained afebrile and completed the full ARV schedule. At three-week review, there was no visual impairment, scarring, or rabies-related complication. Facial and ocular scratches, though sometimes underestimated, represent critical Category III exposures because even minor breaks near mucous membranes permit viral entry ⁽³⁾. This case highlights the value of prompt wound irrigation, precise RIG infiltration, and strict ARV compliance, which together ensure full protection. The event also emphasizes the need for regular vaccination of pet animals and parental vigilance to prevent paediatric rabies exposures. Case 6 – Child F (8 years, Male) History: An 8-year-old boy presented to the casualty department on 13th September 2025 with a history of dog bite on the left calf sustained while playing near the Bhadasgaon dam area. The attack was unprovoked and caused by a stray, unvaccinated dog. The child was brought to the hospital within one hour of exposure by his parents. Examination: On arrival, the child was alert, conscious, and haemodynamically stable. Local examination: A clean lacerated wound (CLW) measuring approximately 3 × 2 cm × 1 cm was noted over the left calf with mild active bleeding and surrounding erythema. No tendon or bone exposure was seen. Systemic examination: Cardiovascular, respiratory, and neurological systems were normal. The exposure was classified as WHO Category III, due to transdermal laceration with bleeding in a lower limb site. The child’s weight was 23 kg. Management: Wound care included thorough washing with soap and running water for 15 minutes, followed by application of povidone-iodine. After a negative test dose, Inj. Anti-Rabies Serum (ARS) was locally infiltrated (0.7 mL) into and around the wound, and the remaining quantity was administered intramuscularly in the opposite thigh as per protocol ⁽¹⁾. Inj. ARV 0.1 mL × 2 sites ID was given on Days 0, 3, 7 and 28 according to NRCP (2024) intradermal schedule ⁽²⁾. Inj. TT 0.5 mL IM stat was administered. Oral Amoxiclav (25 mg/kg/day) and Syp. Paracetamol were prescribed for five days. The case was referred to and managed jointly by the Surgery, Paediatrics, and Community Medicine departments for wound care, ARS administration, and follow-up. Outcome: The wound healed completely by secondary intention within two weeks, with no evidence of infection or adverse reaction to vaccines. The child completed the full course of ARV and remained asymptomatic on follow-up visits. This case represents a typical lower-limb Category III bite, common in ambulatory children exposed to stray dogs. Early arrival, immediate washing, and infiltration of RIG ensured uneventful recovery. Reinforcement of community-based awareness on first-aid measures and the NRCP protocol remains essential in preventing rabies-related morbidity and mortality in paediatric populations. Case 7 – Child G (4 years, Male) History: A 4-year-old boy was brought by his father to the tertiary-care hospital on 13th September 2025 following a dog bite to the left side of the face and right hand. The incident occurred at home when the family’s pet dog, which was unvaccinated, suddenly bit the child during feeding. The event was classified as unprovoked. The child was brought to the hospital within 45 minutes of exposure for immediate wound care and post-exposure prophylaxis. Examination: On arrival, the child was alert and crying but consolable. Local examination: Irregular lacerated wound, approximately 2 cm × 1 cm, over the left mandibular region (cheek) with oozing of blood and crusting. Minor abrasions on the dorsal aspect of right hand. No evidence of deep tissue involvement or neurovascular injury. Systemic examination: Vitals stable; no other wounds on the body; neurological status normal. This was classified as a WHO Category III exposure, due to a bleeding facial bite and hand injury from an unvaccinated animal. The child weighed 14 kg. Management: Immediate washing of all wounds with soap and water for 15 minutes was performed, followed by cleansing with povidone-iodine. After a negative test dose, Inj. Anti-Rabies Serum (ARS) 1.8 mL was locally infiltrated around both wounds and the remaining volume given intramuscularly ⁽¹⁾. Inj. ARV 0.1 mL × 2 sites intradermally was administered on Days 0, 3, 7 and 28 per NRCP (2024) guidelines ⁽²⁾. Inj. TT 0.5 mL IM stat was given. Oral Amoxiclav suspension (25 mg/kg/day) and Paracetamol syrup were prescribed. The case was jointly handled by Community Medicine, Paediatrics, and Dental Surgery departments for wound evaluation and scar prevention advice. Outcome: At 2-week follow-up, scab formation and satisfactory epithelial healing were observed. The child completed the full ARV schedule and remained asymptomatic on observation. No secondary infection or cosmetic complication was noted. Facial bites in young children pose higher risks due to rich innervation and proximity to the CNS, leading to shorter incubation periods for rabies if untreated. Early wound irrigation, infiltration of ARS, and adherence to ARV protocol ensure complete protection ⁽³⁾. This case also highlights that domesticated pet, if unvaccinated, remain an important rabies threat in urban settings—underlining the importance of annual pet vaccination and parental supervision. Case 8 – Child H (11 years, Male) History: An 11-year-old boy presented to the casualty department on 26th September 2025 following a dog bite by a suspected rabid stray dog while returning from school near Manchar. The attack was unprovoked, and the animal displayed abnormal aggressive behaviour and hypersalivation. The child was initially treated at the Sub-District Hospital, Manchar, where Inj. TT and the first dose of Inj. ARV were administered. He was then referred to the tertiary-care centre for rabies immunoglobulin (ARS) infiltration and wound management. Examination: On admission, the patient was conscious and stable, with multiple lacerated and abrasion wounds: Right forearm: Multiple CLWs over anterior, lateral, and posterior aspects, with oozing of blood. Right lumbar region: Two deep lacerations extending into subcutaneous tissue (approx.3 cm × 2 cm each). Left elbow and left lower leg: Multiple abrasions and tooth marks. There was no tendon or bone involvement. Vital parameters were within normal limits, and no neurological deficit was noted. Systemic examination: Normal. The exposure was classified as WHO Category III. Management: All wounds were thoroughly washed with soap and running water for 15 minutes, followed by normal saline irrigation and povidone-iodine cleansing. After a negative test dose, Inj. Equine Rabies Immunoglobulin (ERIG) was locally infiltrated (4.0 mL) into and around all wounds, and the remainder was given intramuscularly in the anterolateral thigh as per protocol ⁽¹⁾. Inj. ARV (0.1 mL × 2 sites intradermally) was administered on Days 0, 3, 7, and 28 per NRCP (2024) guidelines ⁽²⁾. Inj. TT 0.5 mL IM stat was given. IV fluids, broad-spectrum antibiotics (Amoxiclav 50 mg/kg/day), and analgesics were prescribed. The Surgery department performed wound toilet and conservative debridement; secondary suturing was planned after infection control. Outcome: The wounds healed by secondary intention within 3 weeks. No evidence of local infection, allergic reaction, or systemic illness was observed. The child completed the ARV schedule uneventfully. This case illustrates a severe Category III multi-site exposure in an older child inflicted by a rabid stray dog. The presence of deep lacerations over the trunk and limbs required careful infiltration of ARS to ensure complete neutralization at all bite sites. The timely referral, appropriate ARS administration, and full ARV completion ensured a successful outcome. This underscores the need for community-level awareness and rapid referral systems for rural dog-bite victims to prevent fatal rabies. Case 9 – Child I (4 years, Female) History: A 4-year-old female child was brought to the tertiary-care hospital on 29th September 2025 with a complaint of cat bite over the right ankle region. The incident occurred while the child was playing and accidentally stepped on a stray cat, resulting in a provoked bite. The animal was stray and unvaccinated. The parents immediately washed the wound with water and soap and took the child to the Kharalwadi Dispensary, where she received Inj. ARV (IM route) and was referred for Inj. ARS administration. Examination: On presentation, the child was conscious and active. Local examination: Multiple abrasions and superficial tooth marks were observed over the right ankle. No active bleeding or deep tissue involvement was noted. Systemic examination: Normal. Exposure was classified as WHO Category III due to penetration of the skin by a potentially rabid animal. Management: Wound toilet was done with soap and running water for 15 minutes, followed by povidone-iodine cleansing. After a negative test dose, Inj. Equine Rabies Immunoglobulin (ERIG) was locally infiltrated (1.0 mL) around the bite site and the remainder given intramuscularly as per NRCP protocol ⁽¹⁾. Inj. ARV 0.1 mL × 2 sites intradermally was administered on Days 0, 3, 7, and 28 according to NRCP (2024) guidelines ⁽²⁾. Inj. TT 0.5 mL IM stat was given. Oral Amoxiclav suspension (25 mg/kg/day) and Syp. Paracetamol were prescribed for five days. The case was managed collaboratively by the Community Medicine and Paediatrics departments. Outcome: The wound healed completely within one week without secondary infection or hypersensitivity to ARS. The child completed the full ARV schedule uneventfully. This case represents a mild but significant Category III bite by a stray cat, emphasizing that cat exposures are often under-reported compared to dog bites. Although provoked, the child required full post-exposure prophylaxis due to the unvaccinated status of the animal. The case demonstrates the importance of immediate washing, infiltration of ARS, and complete ARV schedule, even for apparently minor cat scratches or bites in children. Case 10 – Child J (10 years, Male) History: A 10-year-old boy was brought to the emergency department on 12th October 2025 after sustaining a dog bite on both lower limbs. The incident occurred near Chandoli around 3 p.m. while the child was playing outside his house. The attacking animal was the family’s pet dog, which had not been vaccinated against rabies. The attack was unprovoked. The child was brought within two hours of exposure for immediate management. Examination: On examination, the child was alert and hemodynamically stable. Local findings: A 2 cm × 1 cm punctured bleeding wound on the right upper leg (distal aspect). Two superficial abrasions and a tooth-mark wound on the left lower leg. No tendon or neurovascular injury. Systemic examination: Normal. The exposure was classified as WHO Category III, due to bleeding wounds from an unvaccinated dog. Weight = 30.3 kg. Management: All wounds were irrigated thoroughly with soap and running water for 15 minutes and cleaned with povidone-iodine. After a negative test dose, Inj. Equine Rabies Immunoglobulin (ERIG) 4.0 mL was locally infiltrated into and around all bite sites, and the remaining dose was given intramuscularly in the opposite limb as per NRCP protocol ⁽¹⁾. Inj. ARV 0.1 mL × 2 sites intradermally was administered on Days 0, 3, 7 and 28 as per NRCP (2024) guidelines ⁽²⁾. Inj. TT 0.5 mL IM stat was given. Oral Amoxiclav (40 mg/kg/day) and Paracetamol syrup were prescribed. The case was managed under joint supervision of the Community Medicine and Paediatrics departments. Outcome: The child completed the full anti-rabies vaccine schedule and rabies immunoglobulin infiltration without any adverse reaction. On follow-up after 3 weeks, wounds had healed by epithelialization with no signs of infection or scarring. This case emphasizes the continuing risk from unvaccinated domestic pets, particularly in children. Even pet-dog exposures warrant full post-exposure prophylaxis (PEP) when vaccination status is uncertain. The prompt wound washing, appropriate ARS infiltration, and completion of the ARV schedule prevented complications and ensured recovery. Public education on mandatory pet vaccination remains critical to rabies-elimination goals.

This case series highlights the epidemiological pattern and clinical management of severe animal bites among children in Western Maharashtra. Dogs remain the predominant source of exposure, consistent with national reports⁽¹⁾⁽²⁾. Cat bites formed 20% of this series, echoing the emerging pattern of domestic exposures in peri-urban regions⁽³⁾. The face and lower limbs were the most frequently involved areas, aligning with findings by Sudarshan et al. and Kale et al., who reported similar anatomical patterns among Indian children⁽⁴⁾⁽⁵⁾. Younger children are more vulnerable due to proximity to animals and slower defensive response⁽⁶⁾. All ten cases received full post-exposure prophylaxis (PEP) under NRCP protocols, including wound cleaning, local ARS infiltration, and the intradermal ARV schedule⁽⁷⁾. Timely wound irrigation reduces viral load by up to 90%, emphasizing its critical role⁽⁸⁾. The intradermal two-site regimen proved safe, immunogenic, and economical for large public-sector clinics⁽⁹⁾. The absence of rabies or complications demonstrates effective programmatic adherence. However, recurring challenges include delayed reporting, lack of awareness, and poor vaccination of domestic animals⁽¹⁰⁾. Strengthening community education, municipal dog vaccination, and RIG availability in peripheral centers are essential. This study reinforces the need for an intersectoral One Health approach—integrating human, veterinary, and municipal services—to achieve India’s goal of zero human deaths due to dog-mediated rabies by 2030⁽¹¹⁾.

All ten paediatric Category III animal-bite cases were successfully managed following NRCP and WHO guidelines. Early wound care, local RIG infiltration, and completion of ARV were life-saving. None developed rabies or major infection. Strengthening public awareness, ensuring timely PEP access, and promoting responsible pet ownership are crucial to sustain progress toward rabies elimination in India by 2030. Ethical Statement This case series is based on retrospective review of anonymized hospital records. The privacy and the confidentiality were maintained. No patient identifiers are disclosed. Informed consent was obtained from the child’s parents or guardian. Institutional Ethics Committee approval was obtained.

1. WHO Expert Consultation on Rabies. Third Report. WHO TRS 1012. Geneva; 2018. 2. Sudarshan MK et al. Assessing the burden of human rabies in India. Indian J Public Health. 2022;66(3):239–44. 3. Menezes R. Rabies in India: Epidemiology, prevention, and control. Indian J Public Health. 2020;64(Suppl 1):S23–S27. 4. Kale RS et al. Profile of animal-bite cases attending a tertiary hospital in Maharashtra. Int J Community Med Public Health. 2021;8(9):4600–5. 5. Ghosh A et al. Epidemiological trends of rabies in children: A decade review. Indian J Pediatr. 2021;88(4):362–8. 6. Park K. Textbook of Preventive and Social Medicine. 27th ed. Jabalpur: Banarsidas Bhanot; 2023. 7. NRCP Guidelines. DGHS, MoHFW, Govt of India; 2023. 8. Gadekar RD et al. Implementation challenges in post-exposure prophylaxis of animal bite cases. J Family Med Prim Care. 2021;10(8):2857–61. 9. Wilde H et al. Rabies: still a neglected disease. PLoS Negl Trop Dis. 2021;15(7):e0009593. 10. Chhabra M et al. Post-exposure management of animal bites in children. J Pediatr Infect Dis. 2019;14(3):145–9. 11. WHO. Zero by 2030: Global Strategic Plan for Eliminating Dog-Mediated Human Rabies. Geneva; 2021.