Audit of Effectiveness of Rabies Post-Exposure Prophylaxis

John Anjum 

Assistant Professor, Department of Community Medicine, Pushpagiri Medical College, and Research Centre, Tiruvalla, Pathanamthitta, Kerala

Correspondence: Anjum John, Department of Community Medicine, Pushpagiri Institute of Medical Sciences and Research Center, Tiruvalla, Kerala, India.

Received: December 23, 2026                                             Published: March 07, 2026

Citation: John Anjum. Audit of Effectiveness of Rabies Post-Exposure Prophylaxis. AOJ Pub Health. 2026;1(1):01–09.

Copyright: ©2026 John Anjum. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially.

Abstract 

Background: The state of Kerala in India reports rising dog bite rates and an increase in human rabies deaths. 

Objective: To quantify the real-world effectiveness of PEP (post exposure prophylaxis) in preventing rabies deaths, using population-level data. 

Methods: Dog-bite and rabies-mortality data from Kerala (2014–July 2025) were analysed, with detailed case-level information from 2021–2025. PEP effectiveness was defined as the difference between observed number of rabies deaths among PEP recipients and the expected rabies deaths without PEP. 

Results: Between 2021 and 2025, approximately 1.29 million persons received PEP for dog bites in Kerala. Among these PEP recipients, an estimated 9,494 rabid stray-dog bites would have caused 1,567 deaths (had PEP not been given). PEP effectiveness analysis was restricted to bites and rabies deaths of stray dog origin. An estimated 14 PEP-failure deaths were from stray dog bites. This corresponds to 1,553 deaths prevented by PEP (1,567 expected deaths minus 14 observed deaths), consistent with a PEP effectiveness of 99.1% [(1,553/1,567)×100]. 86% of PEP-failure cases involved high-risk bites to the head, face, neck or fingers. During this period, 88 rabies deaths occurred among those who did not receive PEP. 

Conclusion: Even under conservative assumptions, Kerala’s PEP programme remains highly effective. Most deaths occurred either in individuals who did not initiate PEP or in those with high-risk bites that left insufficient time for immunity to develop. Rather than indicating PEP failure, the steady rise in rabies cases reflects increasing dog-bite incidence, growth of the stray dog population, and an expanding human–wildlife interface that increases contact with non-canine rabies reservoirs.

Keywords: Rabies, Rabies virus, Rabies Vaccines, dog bite, PEP, post-exposure prophylaxis

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