Rabies in India: A curable virus with 100% fatality after symptoms, still spreading through stray dog bites, poor awareness, and blocked action

In the end of June this year, a state-level Kabaddi player, identified as Brijesh, died of rabies. He was bitten by a puppy while rescuing it from a drain on 28th May. Brijesh ignored the bite as a minor scratch. A month later, he started displaying symptoms of rabies and within days he succumbed to the disease.

In May 2025, a 7-year-old girl identified as Niya Faisal died of rabies despite the vaccine in Kerala. Her death came days after 6-year-old Ziya Faris’s death from rabies in Kerala despite having received vaccination. Niya’s mother told media that stray dogs were attracted to a pile of garbage being thrown near her house by the locals. Despite her repeated requests, people did not stop throwing garbage and as a result a pack of stray dogs kept coming near her house. Niya was mauled by the dogs in front of her mother.

Before Niya and Ziya, another 13-year-old child died due to rabies despite getting the vaccine, raising serious concerns over the presence of rabies-infected stray dogs and the quality of vaccine in the state hospitals.

In March 2025, a woman died of rabies allegedly after drinking unboiled milk from an infected cow. The cow had contracted the infection after getting bitten by a stray dog. After the cow started showing symptoms, several people sought the rabies vaccine in the area but the woman who was selling the milk did not take precaution and a few days after consuming the milk, she developed symptoms.

All you need to know about rabies

Rabies is a viral zoonosis spread most often by dogs. It is transmitted through the saliva of an infected animal, typically via a bite or a scratch. There is no cure for rabies once the patient starts exhibiting clinical symptoms, and death is 100% certain within a few days. Even minor exposure can be deadly.

Experts suggest that many people don’t know that even a lick on broken skin or a scratch from an infected dog or any other animal that can transmit the disease is fatal. Initially, flu-like symptoms appear. As time passes, the rabies virus causes confusion, agitation and hydrophobia. Once neurological signs appear, the only thing left is to wait for the patient’s death. There is no cure for the disease once symptoms develop.

The only hope is that rabies is preventable with prompt and appropriate medical care. In practice, this means immediate wound washing and post-exposure prophylaxis, which is a course of vaccines, can prevent the disease from developing. In severe cases, immediate administration of rabies immunoglobulin plays a crucial role in saving the patient. However, if PEP is delayed or omitted, the virus is fatal. In short, rabies is arguably the deadliest disease many Indians neglect. It is a treatable infection. However, without swift action, it becomes an almost certain killer. Rabies is ruthless and does not care about the age or social status of the person. If you are bitten by a dog, get the vaccine immediately, otherwise it will become your death sentence.

How symptoms progress

Rabies typically begins with non-specific early symptoms such as fever, headache and unusual sensations such as tingling, pricking or burning around the site of exposure. As the infection progresses, patients may develop one of two clinical forms.

The first is furious rabies, which is characterised by hyperactivity, excitability, hydrophobia (fear of water) and sometimes aerophobia (fear of air drafts). In a few days, the patient dies due to cardio-respiratory arrest.

The second type is paralytic rabies, which accounts for around 20% of human cases. The progress of infection is slower, with muscle weakness starting around the wound and eventually leading to coma and death. This form is misdiagnosed, contributing to significant under-reporting.

Prevention and precaution

According to the Government of India, mass vaccination of dogs, responsible dog ownership and community awareness is the key to prevention of the disease. According to the World Health Organisation, at least 70% vaccination coverage of the dog population is necessary to break the transmission chain. Ensuring pet dogs are vaccinated on schedule and recognising that any bite, scratch or lick, especially on broken skin, poses a risk are fundamental messages promoted in public education campaigns.

Post-exposure care

In case a person is bitten, licked or scratched by a dog, post-exposure care begins immediately. First, the wound must be thoroughly washed for at least 15 minutes with soap and water. This process physically removes the virus and inactivates it through soap’s lipolytic action. The National Guidelines for Rabies Prophylaxis (2019) confirm that prompt and appropriate wound care, grouped together with PEP, is completely effective in preventing the disease from progressing.

Once the wound is washed properly, post-exposure prophylaxis (PEP) requires a full course of rabies vaccines. It should be administered either intramuscularly or intradermally. The latter is endorsed by the Drug Controller General of India as a cost-effective alternative.

The exposure to the rabies virus is divided into three categories.

Category I

This refers to no exposure, such as when the animal simply licks intact skin or touches it without breaking the surface. For these situations, no rabies vaccine or immunoglobulin is required; only general wound cleaning, if necessary, is advised.

Category II

This includes nibbling of uncovered skin (not through clothing), minor scratches or abrasions without bleeding. In these cases, the guidelines call for administration of the rabies vaccine (anti-rabies vaccine, ARV) under either the intramuscular or intradermal schedule. Rabies immunoglobulin is not necessary for Category II exposures.

Category III

This encompasses more serious exposures, transdermal bites or scratches, contamination of mucous membranes or broken skin with saliva, or contact with wild animals such as bats. The Government of India guidelines mandate both rabies vaccine and rabies immunoglobulin (RIG) for all Category III exposures. Notably, according to the guidelines, exposure to all wild animals should be treated as Category III exposure.

WHO emphasises that timely access to standardised, quality-assured PEP can achieve almost 100% protection against rabies. The effective management of rabies relies heavily on a “One Health” approach, integrating community education, dog vaccination and immediate medical response. Government of India and WHO materials highlight that educating communities and engaging health workers and veterinarians is a proven strategy to save lives.

India is also working on the global goal of zero human rabies deaths by 2030. To achieve the goal, according to the experts, awareness, wound washing, PEP and canine vaccination are the key factors.

India’s rabies burden

India bears an outsized share of the global rabies toll. While the government data show only dozens of confirmed deaths each year, for example, 21 deaths in 2022 and 54 in 2024, WHO and independent studies estimate roughly 18,000 to 20,000 deaths in India by rabies. Notably, WHO’s numbers match a 2006 press release of the Ministry of Environment, Forest and Climate Change. In that press release, the ministry categorically stated that there is no exact statistical data available for rabies deaths in India.

WHO suggests that India bears the burden of 36% of rabies deaths worldwide. The huge gap exists because many cases never enter the system. Rabies is not yet a nationally notifiable disease, and deaths in remote areas are often blamed on other causes. Mild exposures are often ignored due to lack of awareness. Studies suggest under-reporting is rampant, meaning the real toll is orders of magnitude higher than official figures.

High-risk groups are particularly affected. Children are the worst hit. Around 30% to 60% of dog-bite victims in endemic regions are under 15. In India, impoverished rural kids, who often play with dogs unsupervised, make up a large slice of deaths. Dogs cause around 96% of human rabies cases, and children account for around 40% of dog-bite exposures.

Other vulnerable groups include the elderly, disabled and urban poor, who may lack swift access to care. In sum, India’s epidemic has stubbornly refused to drop because the underlying conditions, large stray dog populations and low awareness, persist, masking the full scale of the problem.

Preventable, yet unstoppable – What’s going wrong?

Rabies should have been eliminated from the world a long time ago. Modern PEP is highly effective if administered immediately, and it will prevent 100% of rabies. In India, many clinics offer free anti-rabies vaccine and immunoglobulin. However, in practice, these lifesaving therapies often fail to reach the patient.

Reports suggest that many districts lack reliable vaccine and immunoglobulin supplies. Lack of qualified staff is another problem. A Tribune investigation noted that while many government hospitals offer free vaccines, timely access remains a hurdle, especially in rural areas. Furthermore, supply chain gaps, cold chain problems, and long distances mean victims often leave clinics empty-handed. Restocking vaccines timely is another issue. There have been reports even from PGI Chandigarh and medical colleges in Kerala where vaccines were not available for weeks and even months.

Delay and ignorance also add up to the fatal exposure. Families often do not realise the danger. Some patients seek herbal remedies, which are not effective. Seeking traditional healers or doing nothing instead of immediate PEP is tragically common. There is a lack of awareness, especially in rural areas, which leads to such cases and under-reporting.

In short, the medical tools exist, but implementation fails. Victims often present too late. Untreated, the disease becomes “unstoppable”, just as avoidable as it is deadly.

The real driver – India’s growing stray dog population

The scale of India’s stray dog problem is staggering. It drives rabies. Dogs are by far the main reservoir. Around 99% of transmission comes from dog bites. India has millions of free-ranging dogs on its streets. Officially, the number stands at around 6.8 million. However, according to experts, the real number is far higher. Unmanaged garbage, lack of sterilisation, haphazard urban planning and intervention of “dog lovers” is what is causing a rampant increase in the dog population on Indian streets.

Where there are more strays, there are more bites. 37 lakh reported cases of dog bites in 2024 is not a small number and must not be ignored. 4.8 lakh dog bite cases in Maharashtra and Tamil Nadu, 3.9 lakh in Gujarat, 3.6 lakh in Karnataka, and 2.6 lakh in Bihar, as per data made available by GoI, is not a small number. Sadly, the numbers mismatch with previous data reported by media houses. According to a report in the New Indian Express, in 2022, Andhra Pradesh reported over 7 lakh dog bite cases, but GoI data says it was 1.9 lakh. There is a huge gap between the two numbers. If the numbers mismatch at such a massive scale, how can the Central Government and State Government work together in controlling the menace?

In short, the ballooning stray dog population, fed by open garbage and patchy spay/neuter programmes, is the primary engine behind India’s rabies problem.

The ABC Rules dilemma – How 2001 changed India’s ability to act

In 2001, India shifted policy dramatically. The Animal Birth Control (Dogs) Rules were introduced under the Prevention of Cruelty to Animals Act, banning the killing of stray dogs. Henceforth, local authorities were to curb dog numbers only via humane capture-sterilisation-vaccination-release (ABC/CNR) programmes.

Culling was declared illegal. These rules were reinforced in 2023’s updated ABC guidelines. The Supreme Court and high courts have repeatedly held that local laws cannot override the ABC Rules, effectively barring municipalities from killing or permanently removing dogs.

The blanket no-kill policy may look well-intended, but it has hamstrung authorities in practice. They must now sterilise and vaccinate every captured dog and return it to its original area within days. A recent Punjab and Haryana High Court ruling emphasised that dogs “cannot be kept in shelters indefinitely”; they must go back to the streets after treatment.

For residents, facing aggressive dog packs feels maddening. Citizens injured or killed by strays find no legal recourse to have the animal removed or euthanised.

Meanwhile, the ABC programme itself struggles. Sterilisation campaigns have so far failed to reach the scale needed. For example, Bengaluru authorities report only a 10% drop in street dog numbers from 2019–23, despite increasing sterilisation output by 20%. In effect, the strict ABC framework has often been honoured only on paper. Many dogs remain unsterilised, and any attempt at aggressive control is blocked by legal constraints. The outcome is “an ecosystem of chaos” where the law says one thing but ground reality delivers little, and people remain unprotected.

Dog lovers and the ecosystem of chaos

The management of stray dogs in India has become a polarising battle between frustrated residents and “dog lovers”. On one hand, there are feeders and activists who have no respect for human lives and try to intervene in the process of removal of stray dogs from areas where they do not even live.

These dog lovers and feeders often turn public spaces such as parks and sidewalks into dog-feeding zones. If RWAs try to establish feeding zones as mandated by the law, they oppose. If someone tries to stop them from feeding dogs at random places, these dog lovers and activists become hostile and file complaints at police stations or call the Animal Welfare Board of India (AWBI) or NGOs with reach to “higher powers”, which is another issue in itself.

There have been reports where dog feeders leave a mess behind. Garbage piles up and dog dung makes its way to the unauthorised feeding areas, attracting more diseases while further fuelling resentment among non-feeders and the general public.

More ominously, a vocal animal-rights fringe actively impedes any removal of dogs. They have challenged municipal catch teams, using law and social media to demand instant release of captured animals. This has left civic agencies cowed. For instance, even after attacks, courts have sided with the no-kill ethic. The judiciary and lawmakers have made it next to impossible to kill even rabid dogs, making the lives of people impossible.

Meanwhile, other human actions worsen the situation. Illegal puppy mills and pet shops add to the crisis. Abandonment of pedigree dogs by illegal dog breeders is one of the reasons for the growing dog attacks. They tend to get violent as they have lived their entire lifetime in closed surroundings and are released into the open. In the end, misplaced compassion is costing lives.

Conclusion

Rabies and the growing dog population is not a “problem”. It is a human survival crisis. Dogs kill children, the poor and other vulnerable communities. People should not have died of rabies, not even one. There must be a balance between compassion and accountability. No one wants cruelty against animals, but at the same time, the no-kill policy is a menace. There is an urgent need to control the dog population and impose strict regulations when it comes to vaccination, sterilisation, dog population control, feeding and caring. No one should have a free hand to stop the authorities from putting human lives as the priority.

In the end, India must treat rabies as seriously as polio or malaria. Political will and resources should match the scale of the problem. While India must work on eliminating the disease, there is also an immediate need to curb the population of stray dogs. Remember, people do not just die of rabies when it comes to dogs, they die because of the injuries they have sustained during the attack as well.

In the upcoming articles of this series, we will take a closer look at the ABC Rules and their far-reaching implications.

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