Clinical Report: Adherence to Rabies Post-Exposure Prophylaxis in Bengaluru Urban Clinic

Overview

This prospective study assessed adherence to the full 5-dose intramuscular anti-rabies vaccination schedule among 735 animal bite patients at an urban anti-rabies clinic in Bengaluru. Despite counselling, suboptimal compliance was observed, with multiple socio-demographic and logistical factors influencing vaccination completion.

Background

Rabies is a nearly universally fatal viral zoonosis, causing approximately 60,000 deaths annually worldwide, predominantly in Africa and Asia. India bears nearly half of the global rabies mortality burden, with domestic dogs responsible for 99% of human cases. Post-exposure prophylaxis (PEP), including wound care and a full vaccination course, is highly effective but adherence remains suboptimal, influenced by factors such as socio-economic status, accessibility, and healthcare provider knowledge. This study aimed to quantify PEP adherence and identify determinants among animal bite victims in a southern Indian urban setting.

Data Highlights

Key Findings

• Out of 912 bite victims, 735 were eligible and consented for the study.
• Compliance was defined as completion of the full 5-dose Essen regimen.
• Non-compliance included discontinuation before completing the schedule, except when the biting animal remained healthy or tested negative.
• Factors affecting adherence included socio-demographic variables (age, sex, education, occupation, residence, socio-economic status), exposure details, and logistical barriers such as distance and timing conflicts.
• Telephone follow-up was used to ascertain reasons for non-compliance, including work or school timing conflicts and forgetting vaccination dates.

Clinical Implications

Healthcare providers should emphasize the importance of completing the full PEP vaccination schedule and address common barriers such as scheduling conflicts and accessibility. Strengthening patient counselling, improving vaccine availability, and implementing reminder systems may enhance adherence. Tailored interventions considering socio-demographic factors can improve PEP uptake and reduce rabies mortality.

Conclusion

This study highlights suboptimal adherence to rabies PEP in an urban Indian setting, influenced by multiple patient and system-level factors. Targeted strategies are needed to improve compliance and thereby enhance rabies prevention efforts.

References

1. World Health Organization/Global Rabies Control/2023 -- Rabies Fact Sheet
2. National Rabies Control Programme India/2012-2022 -- Rabies Surveillance Data
3. Kempegowda Institute of Medical Sciences/2021-2022 -- Study on PEP Adherence in Bengaluru