Rabies is a malignant viral infection that spreads to people through the saliva of infected animals. It attacks the central nervous system and 99% of cases are caused by infected dogs.

A recent Lancet study has shown that despite the overall decrease in deaths in recent decades, there are about 5,726 human rabies deaths.

This makes immediate medical intervention required after dog bites or scratches. While many people believe that rabies vaccine alone is enough, experts have been emphasized that in some cases, rabies immunoglobulin (rig) is also necessary to prevent the virus from spreading.

Immediate medical aid is important

Dr. Mohammad Hussain, known as a cancer doctor, highlighted the severity of rabies in an X (East Twitter) post: “There is 100% mortality of rabies. So do not hesitate to see your doctor after a dog bites. Do not take possibility.”

Even a minor scratch from a potentially crazy animal requires immediate medical attention. Dr. According to Neha Rastogi Panda, the Fortis Memorial Research Institute, Advisory-Tacural Disease at Gurugram, alone rabies vaccine is not enough in serious cases, and rabies immunoglobulin (RIG) is important to provide immediate protection.

How rabies vaccine works

Anti-rabies vaccine (ARV) stimulates the immune system to produce antibodies against rabies virus. It contains an inactive (killed) form of the virus that helps identify the body and helps fight it when it is exposed.

Types of rabies vaccination:

East-exposure Profilaxis (PREP): High risk individuals are given, such as vet, animal handlers, and passengers in rabies-endemic areas, help them develop immunity in advance.

Post-exposure Profilaxis (PEP): A cut or scratch was given after a bite or scratch to prevent the virus from reaching the nervous system. The PEP consists of a series of vaccine doses and, in some cases, rig.

Why rabies immunoglobulin (rig) is required

Rabies immunoglobulin (rig) is an injection that immediately saves a person against rabies after a person’s bite. This includes prepared antibodies that neutralize the rabies virus at the wound site.

This prevents the infection from spreading in the nervous system. Dr. Sankate Mankad, Infectious Disease Advisor, Shalby Hospitals, Ahmedabad, said that immunoglobulin “provides immediate protection for those who have not been vaccinated against rabies” in the past while the body’s immune system responds.

Many people believe that rabies vaccine after dog bites is sufficient, but in severe cases, rabies immunoglobulin (RIG) is important as it provides immediate antibodies to neutralize the virus on the exposure site.

Dr. Neha Rastogi Panda said that the vaccine takes about 7–14 days to encourage the body’s immune response, if the rig is not administered, leaves a window to spread the virus.

Without rigs, a high risk of virus reaches the central nervous system before the vaccine becomes effective, causing malignant rabies.

What is standard treatment protocol after dog bites?

The World Health Organization (WHO) guidelines underline the steps that should be raised immediately after the dog bite:

Immediate wound care

Wash the wound thoroughly with soap and flowing water for at least 15 minutes. Apply antiseptics such as iodine or alcohol (70%) to reduce viral load.

Look for medical care immediately

Visit a health facility to assess vaccination and rig requirement.

Classes exposure

Category I: Touching or feeding animals, licks on the intact skin – no treatment is required.

Category II: Minor scratches or nibbing on minor skin – requirement of vaccine.

Category III: Contamination of deep bite, wound, or mucous membrane – the vaccine and immunoglobulin are required.

Rabies vaccination schedule

For post-exposure Profilaxis (PEP), which recommends 4-khurak intramuscular regimen: day 0, 3, 7, and 14 (with 5th dose on 28 days for individuals).

If the person has already received the exposure Profilaxis (PREP), only 2 doses (day 0 and day 3) are required, and not required rigs.

Rabies immunoglobulin (rig) administration

The rig should be injected around and around the wound for maximum effectiveness.

Time limit for rig administration

The rig is the most effective within 7 days of the first rabies vaccine dose. After this period, the vaccine itself produces enough antibodies, making the rig unnecessary.

If the rig is delayed:

• Within 7 days: Still effective and should be administered as soon as possible.
• After 7 days: Usually not needed because the vaccine has started working.
• Beyond 7 days without rig: The risk of virus reaching the nervous system increases, causing rabies to become fatal.

Are there challenges in reaching rabies immunoglobulin in India?

Access to rabies immunoglobulin (rig) in India is a challenge, especially in rural areas. Dr. Panda said, “Despite the availability of rabies vaccination, the rig is expensive and is often in low supply. Human rabies immunoglobulin (HRIG) is particularly expensive, while the equine rabies immunoglobulin (eryg) is a cheap option, but still difficult to receive.”

While a specific rabies vaccine costs between Rs 300 to Rs 400, an immunoglobulin injection cost ranges from Rs 4,000 to Rs 6,000.

Dr. Panda said, “Many healthcare workers are not fully trained, which are challenging in post-exposure Profilaxis (PEP) protocol, and cold chain logistics for proper storage and cold chain logistics for the transportation of rigs,” Dr. Panda said.

To improve the awareness and availability of rigs, public education campaign is important on the need for wound care, vaccination and rigs.