Why are rabies victims in Kerala dying despite vaccination?

What’s disturbing is that the girl, who was bitten by a street dog on her elbow on April 8, was rushed to a family health centre and the anti-rabies vaccine was administered to her. However, after more than 10-12 days, the girl developed high fever and was taken to a hospital where it was confirmed that she has rabies.

Another rabies death

Just last week, another 6-year-old from Malappuram, Ziya Faris, succumbed to rabies despite having received the vaccine. Ziya passed away at the Kozhikode Medical college while undergoing treatment in the ICU.

Ziya had sustained heavy injuries on her head and leg after being mauled by a street dog, after she had stepped out to buy sweets. Reports said she was given the intradermal rabies vaccine, her wounds treated and she was discharged after the first dose. Her father told Malayala Manorama that they believed his daughter was recovering but she developed a fever weeks later and tested positive for rabies.

Rabies deaths in Kerala on the rise

Kerala has been in the spotlight for the rising number of rabies deaths in the state. According to the health department, there were just nine deaths in 2018, and eight in 2019. During the pandemic, in 2020, the figures dropped to five; in 2021, the number more than doubled to 11. Reports said quoting the health department that there were 15 deaths in 2022, 17 in 2023, and 22 in 2024.

Also read: Kerala: Girl bitten by stray dog dies in hospital

This year, there have been 12 deaths so far. After the death of the girl in Mallapuram due to rabies, the local administration panchayat swung into action and initiated a campaign to vaccinate all the animals in its jurisdiction and instructed officials to implement the Animal Birth Control programme.

Rabies vaccine not effective

Meanwhile, what is worrying is that the rabies deaths are seeing an upward trajectory despite post-exposure vaccination and the administration of immunoglobulin serum on the affected patients.

The rabies vaccines do not seem to be very effective and the victims are succumbing. In 2024 too, there were cases in Kerala where people died despite being given the vaccine shot on time. At that time, state health officials had argued that the nature of the wound and its management play a role in the patient’s recovery.

Latha Indira, secretary, People for Animals Trivandrum, an NGO, told The Federal, “It is not clear right now why these anti-rabies vaccinations are not working. This matter has to be investigated more deeply. These anti-rabies vaccines are being given free in government hospitals and there is no question of scarcity either.”

Also read: Rabies deaths in Kerala not due to ineffective vaccines: Central team

However, she pointed out that the quality of these vaccines has to be examined, as well as whether the people handling them are properly handling the cold chain system protocol.

Maintaining the cold chain system

Chennai-based Chinny Krishna, co-founder and co-chair of Blue Cross India, also concurred with this view. "I don’t think it has to do with the anti-rabies vaccine. If the cold chain is not maintained at the right temperature, then it's a problem. It has to be below 2 degrees C to 8 degrees C. If these vaccines are kept in a bag and taken around under the hot sun, it will not work on the dogs as well when they vaccinate them," he told The Federal.

Further, he criticised the Kerala government for not doing its job and implementing the Animal Birth Control (ABC) programme. "What the hell is the government doing?" he asked.

Krishna, who is one of the pioneers of ABC ((Animal Birth Programme) programme, having introduced it back in 1996 in Chennai, also pointed out that deaths due to rabies were as high as 30,000 in 1996 in India, and the number has come down to 2,000 a year now.

The problem should be seen in that light though India does account for nearly 60 to 70 per cent of global rabies deaths, he admitted.

ABC programme not widely implemented

According to Latha, ABC programme is not being held in rural areas in Kerala at all.

"Some of the councillors ask us even today, what is this ABC?”

In her view, the government is unable to implement the ABC because they lack the infrastructure to go ahead with it.

"Or, the government lacks the funds or it comes low in their priority though is a health issue. Take Tamil Nadu, they are planning to start 72 ABC units and 12 animal shelters for housing dogs with disease symptoms. Kerala should be more proactive on this front. The Trivandrum Chief Veterinary Officer has told us that they are planning mobile ABC units, which can help take it around to many places," Latha said.

Latha said Kerala government is currently involved in a drive to vaccinate stray and pet dogs on a large scale. This is being conducted by Mission Rabies, who are partnering with another NGO CAWA to vaccinate these dogs. It has been going on for the past one year, she said.

Two years ago too, a 17-year-old girl in Palakkad died of a dog bite despite taking the vaccine. There were lot of discussions around it at that time. Can we do deeper studies to find out why these deaths are happening? she asked.

Anti-street dog campaign

Sally Varma, who is a voice for animals in Kerala said, "Why is there no structured and mass ABC programme in place? When a rabies victim dies, a vaccination drive happens in that area and that's about it. The majority of the dogs on streets are abandoned breed dogs. There is no culture here of viewing the dog as a companion which is another problem."

Further, Varma said, the government has to take up this issue not as a street dog conflict or menace but they need to work towards a scientific and sustainable solution. "They should undertake sterilisation, vaccination campaigns and push for responsible ownership. These street dogs are so violent because they have not been treated with compassion by human beings at all, any interaction with humans has been an aggressive one," she added.