Clinical Scorecard: Adherence to Post-Exposure Prophylaxis for Rabies Among Animal Bite Patients at an Urban Anti-Rabies Clinic in Bengaluru
At a Glance
Category
Detail
Condition
Rabies, a fatal viral zoonotic disease transmitted primarily by domestic dogs
Key Mechanisms
Post-exposure prophylaxis (PEP) involving wound cleansing, full anti-rabies vaccination course, and rabies immunoglobulin or monoclonal antibody for category III exposures
Target Population
Animal bite victims, especially in urban and rural populations in rabies-endemic regions like India
Care Setting
Anti-rabies clinics providing PEP services in hospital or community medicine units
Key Highlights
Rabies causes nearly 60,000 deaths annually worldwide, with over 95% in Africa and Asia; India accounts for nearly half of global mortality.
PEP adherence is critical but suboptimal, with completion rates as low as 41.36% reported; factors influencing compliance include socio-demographics, logistical barriers, and provider knowledge.
This prospective study in Bengaluru assessed compliance with the 5-dose intramuscular Essen regimen and identified determinants of non-compliance to inform programmatic improvements.
Guideline-Based Recommendations
Diagnosis
Classify exposure according to WHO categories; category III exposures require immediate PEP including RIG or RmAb.
Do not delay PEP initiation while awaiting observation or laboratory confirmation in endemic areas.
Management
Administer full 5-dose intramuscular Essen regimen on days 0, 3, 7, 14, and 28.
Provide rabies immunoglobulin or monoclonal antibody for category III exposures.
Counsel patients on importance of completing full vaccination schedule.
Monitoring & Follow-up
Follow up patients on scheduled vaccination days to assess compliance.
Use telephone follow-up to identify reasons for missed doses and address barriers.
Risks
Incomplete PEP significantly increases risk of fatal rabies.
Delays or interruptions in vaccination schedule reduce effectiveness of prophylaxis.
Patient & Prescribing Data
735 animal bite victims attending an urban anti-rabies clinic in Bengaluru, India
Compliance assessed with full 5-dose Essen regimen; non-compliance reasons include work or school timing conflicts, distance to clinic, and forgetfulness.
Clinical Best Practices
Ensure prompt initiation of PEP immediately after exposure without waiting for animal observation or test results in endemic areas.
Provide thorough patient counselling on the critical importance of completing the full vaccination schedule.
Address logistical barriers such as clinic accessibility and scheduling conflicts to improve adherence.
Train healthcare providers on updated PEP guidelines to ensure appropriate administration and patient education.
Implement follow-up mechanisms including telephone reminders to reduce missed doses.
