Cost–benefit analysis of controlling rabies: prioritizing areas in rural setting of Maner: a cross sectional study

Nidhi Prasad, Binay Kumar, Sanjay Kumar Chaudhary, Sanjay Kumar


Background: Rabies being a preventable disease with no treatment available once onset starts but can be easily prevented by post-exposure among all animal bite victims. So it is essential to take the full course of vaccination for complete protection.

Methods: The present study was a hospital based cross sectional study and was carried out in rural health training centre in Maner, Patna.

Results: Our study included 340 patients who attended anti rabies clinic for post exposure prophylaxis. Among them 65% were children (<15 years) comprising mostly males (69%) and mostly of category III exposure. Direct cost of post exposure vaccination when compared with the cost of pre exposure prophylaxis is one-third (approx).

Conclusions: Compliance to anti-rabies vaccination for post-exposure prophylaxis is still low and they are still at risk of developing rabies. Reasons being irregular supply of vaccine and immunoglobulin in government hospitals, loss of wages, forgotten dates, cost incurred to buy from outside and distance from the hospital if referred to other centre. Seeing the current scenario, planning and prioritizing areas to achieve our goal and lessen economic burden is need of the hour. We infer that pre exposure prophylaxis may be a cost effective strategy which can aid in the control and elimination of rabies in endemic settings.


Post exposure prophylaxis, Equine rabies immunoglobulin, Intramuscular rabies vaccination, Anti-rabies vaccines, Pre exposure prophylaxis

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National Rabies Control Programme. Available at: Accessed on 5 July 2019.

WHO. Available at: Accessed on 4 July, 2019.

Sudarshan MK, Madhusudana SN, Mahendra BJ, Rao NS, Ashwath Narayana DH, Abdul Rahman S, et al. Assessing the burden of human rabies in India: results of a national multi-center epidemiological survey. Int J Infect Dis. 2007;11:29-35.

WHO. Available at: about/en/. Accessed on 22 July 2019.

WHO Technical Report Series No.1012 WHO Expert Consultation on Rabies. Third report. World Health Organization, Geneva; 2018.

Sudarshan MK, Madhusudana SN, Mahendra BJ, Rao NS, AshwathNarayana DH, Abdul Rahman S, et al. Assessing the burden of human rabies in India: results of a national multi-center epidemiological survey. Int J Infect Dis. 2007;11(1):29-35.

Menezes R. Rabies in India. CMAJ. 2008;178(5):564-6.

India’s ongoing war against rabies. Bull WHO. 2009;87(12):885-964.

Kole AK, Roy R, Kole DC. Human rabies in India: a problem needing more attention. Bulletin of the World Health Organization. 2014;92:230.

Summary measures of population health: concepts, ethics, measurement and applications. In: Murray CJ, ed. Geneva: World Health Organization; 2002.

National guidelines for prevention of rabies in India, 2013.

Shankaraiah RH, Rajashekar RA, Veena V, Hanumanthaiah AD. Compliance to anti-rabies vaccination in post-exposure prophylaxis. Indian J Public Health. 2015;59:58-60.

Singh J1, Jain DC, Bhatia R, Ichhpujani RL, Harit AK, Panda RC, et al. Epidemiological Characteristics of Rabies in Delhi and Surrounding Areas, 1998. Indian Pediatr. 2001;38:1354-60.

Indian academy of paediatricians committee on immunization (IAPCOI) consensus recommendations on immunization. Indian Pediatr. 2012;49:550-64.

Wilde H, Bhanganada K, Chutivongse S, Siakasem A, Boonchai W, Supich C. Is injection of contaminated animal bite wounds with rabies immune Globulin a safe practice?. Transactions Royal Society Trop Med Hygiene. 1992,86:86-8.

National guidelines for Rabies prophylaxis and Intradermal Administration of Cell Culture Rabies Vaccines, 2009.

Ravish HS, Sudarshan MK, Madhusudana SN, Annadani RR, Narayana DH, Belludi AY, et al. Assessing safety and immunogenicity of post-exposure prophylaxis following interchange ability of rabies vaccines in humans. 2014;10(5):24584134.

Malerczyk C, Vakil HB, Bender W. Rabies pre-exposure vaccination of children with purified chick embryo cell vaccine (PCECV). Human Vaccines Immunotherapeutics. 2013;9:1454-9.

Weekly epidemiological record, Rabies vaccines: WHO position paper- April 2018, No.16, 2018, 93, 201-220.

World Health Organization WHO guide to identifying the economic consequences of disease and injury. Geneva; 2009.

Sudarshan MK, Mahendra BJ, Ashwath Narayana DH. Introducing intra dermal rabies vaccination in India: Rationale and Action plan. J APCRI. 2005;7(1):20-5.

Zhang YZ, Xiong CL, Zou Y, Wang DM, Jiang RJ, Xiao QY, et al. Molecular characterization of rabies virus isolates in China during 2004. Virus Res. 2006;121:179-88.

Warner CK, Schurr TG, Fekadu M. Molecular characterization of carrier rabies isolates. Virus Res. 1996;41:133-40.