Once the rabies virus infects the central nervous system, the disease is almost 100% fatal; on the other hand, the disease is 100% preventable if we can administer post-exposure prophylaxis immediately after an exposure and before symptoms develop. About 15 million animal bites occur in India annually, requiring millions of people to receive rabies post-exposure prophylaxis. Most animal bites in India (91.5%) are by dogs, of which about 60% are strays. Someone dies from rabies every 30 minutes. The annual cost of postbite treatment is about $25 million. [1] The multicentric rabies survey estimated an annual incidence of 20,565 human rabies deaths in India (about 2 per 100,000 population).[1] Still many rabies cases go undetected. While true cryptic rabies is virtually non-existent or statistically negligible in Indian medical literature, unreported or misdiagnosed cases are highly prevalent.[2] Because rabies is not a universally notifiable disease across all states and many deaths occur in remote rural areas, thousands of clinical rabies deaths go unrecorded by central authorities. There are cases of death in patients with encephalitis without known etiology. It will not be surprising if rabies is positive in a few of these cases, and hence testing for this virus is necessary when we have cases of life-threatening encephalitis without a known cause. The steady increase in the number of cases involving dog bites and an ever-increasing demand for postexposure vaccination indicate that India is amid an epidemic of rabies in dogs or a greater number of humans exposed to them. Monkeys are susceptible to rabies, and their bites are increasing in India. Other animals, such as jackals, horses, cattle, rodents, mongooses, foxes, wolves and many other carnivorous animals, may transmit rabies. These are more prevalent in rural areas and we know, India has a 62–64% rural population. Approximately 100 to 105 million rural households depend on livestock and cattle for their livelihood in India, (which we know is a potential source of rabies). There are also rare non-bite exposure routes for rabies that must not be forgotten. These include organ transplants, specifically for those receiving corneal or solid organ transplants from an undiagnosed infected donor, as well as aerosol transmission. The breathing air containing concentrated virus particles occurs rarely in laboratories handling the virus or in deep caves heavily populated by infected bats. Contamination may occur by consuming raw meat or unpasteurized milk from a rabid animal. Hence it is understandable the burden of this fatal disease in India.It is almost impossible to practically stop transmission and the only way to break the chain and try to eradicate the disease is by vaccination. Unfortunately, there is no vaccination for the disease in our national immunization schedule, as it is costly and is relatively rare “?” The other reasons are while the post-exposure prophylaxis is highly effective, the pre-exposure prophylaxis cannot ensure lifelong immunity. Now, the question lies in how many of the cases of infected individuals are getting post-exposure prophylaxis. Additionally, are we identifying all cases of rabies? The reasons why the rabies vaccine should be in the routine schedule for immunization: 1. Often children forget to mention a minor bite, underestimating the gravity of the situation. Sometimes, children may be apprehensive about getting scolded by their guardians if they confess to a bite, which makes this significant event less likely to be reported. 2. Animals like bats (an important source of rabies infection) have razor-thin teeth and claws, their bites or scratches can be completely microscopic and painless. Again, this significant exposure may go unreported. 3. Owing to variable and sometimes long incubation periods of rabies infection (three months after inoculation and even 18 months after transplantation) people forget about the source of infection. 4. A non-canine source of rabies (though rare) as reported persons may remain unaware of their exposure to rabies. 5. Many cases of “dumb rabies” may initially present with nonlife-threatening symptoms like brachial neuritis or GBS and later turn into a catastrophic course. Thus, by the time the disease is diagnosed, it is too late. 6. Many non-canine transmitters act as reservoirs of the disease only without getting themselves affected. Hence, we may mistakenly think that these animals, though came into close contact, were unaffected. While vaccines for other diseases can reduce suffering, the rabies-killed vaccine can prevent deaths with nearly 100% efficacy and minimal side effects. Hence, there is no doubt about the cost effectiveness of this vaccination. Keeping our threshold lowest and introducing the vaccine routinely (in the national immunization schedule) in susceptible groups of individuals (at least) we can prevent millions of deaths. We need to do more research to identify safer, cost-effective, patient-friendly (painless and fewer pricks) vaccines to eradicate this deadly disease (for example, the dead intradermal vaccine may be a beneficial alternative).[3]

1. Sudarshan MK, Madhusudana SN, Mahendra BJ, Rao NS, Ashwath Narayana DH, Abdul Rahman S et al. Assessing the burden of human rabies in India: results of a national multi-center epidemiological survey. Int J Infect Dis. 2007 ;11(1):29-35. 2. Varun CN, Chandel S, Kumar DK, Siddalingaiah N, Telang S, Bhalke PS et al. Comprehensive genomic analysis of rabies virus in India reveals distinct lineages and evolutionary stability. Virus Genes. 2026 Feb;62(1):92-105. 3. Wang Y, Sun H, Wu Y. Advances in Adjuvanted Rabies Vaccines. Vaccines. 2026; 14(2):132