TN issues advisory on Rabies prevention after dog bite deaths in Kerala

The circular underscores the urgent need for proper training in identifying the category of dog bites and ensuring timely and correct administration of post-exposure prophylaxis (PEP), including rabies immunoglobulin (RIG) and anti-rabies vaccine (ARV).

Director of Public Health, Dr. T.S. Selvavinayagam, in a communication to district and city health officers, warned that rabies is a fatal viral disease that affects the brain and nervous system, and once symptoms appear, survival is rare.

“Rabies PEP is life-saving only if administered correctly and promptly,” he said.

The advisory follows the deaths of two boys in Kerala who were bitten by stray dogs and had received vaccination.

The fatalities are believed to have occurred due to delays in starting PEP, failure to administer RIG in category III exposures, improper wound cleaning, missed or delayed vaccine doses, or issues with vaccine storage and administration.

Healthcare providers have been reminded that RIG is crucial in neutralising the virus at the site of deep or bleeding wounds, especially within the initial days before the vaccine-induced immune response develops.

Without RIG, the virus can spread to the nervous system despite vaccination. The directorate also noted that wounds, especially on the face or head, require immediate and aggressive treatment, as any delay— even by a few days — can render vaccination ineffective.

Proper wound washing with soap and water for at least 15 minutes remains the most important first step in preventing rabies.

Children are at a greater risk due to their weaker immune responses and the possibility of not reporting bites accurately, the advisory stated.

The directorate reiterated the guidelines for assessing dog bite severity: Category I: In case of touching/feeding animals or licks on intact skin no PEP is required.

Category II: In case of minor scratches or abrasions without bleeding ARV is required.

Category III: In case of bites or scratches with bleeding, or licks on broken skin ARV with RIG is mandatory.

All health facilities have been asked to strictly adhere to these protocols to prevent avoidable rabies deaths.