Intensifying vaccination of dogs and ensuring that people bitten by dogs receive timely and complete rabies post-exposure prophylaxis (PEP) could save far more lives in Keralam than routine pre-exposure prophylaxis (PrEP) vaccination of children, according to a new modelling study on the cost-effectiveness of rabies interventions.
The research was led by the University of Glasgow in collaboration with researchers from the Directorate of Medical Education, Kerala University of Health Sciences, the School of Public Health, the Directorates of Health and Animal Husbandry in Keralam, and the London School of Economics and Political Science. The findings add a new dimension to the ongoing debate over whether Keralam should introduce routine PrEP for children as a rabies prevention strategy. “The study is a comparison of the cost effectiveness of PrEP against other interventions as a population-level strategy to reduce rabies. Nujum of the School of Public Health, KUHS, who led the research in Kerala. The study’s sensitivity analysis underlines the importance of improving access to PEP. The researchers also found that increasing vaccination coverage among domestic dogs alone could produce substantial health gains. Mandatory licensing and vaccination of domestic dogs, can help improve coverage. Nujum.
Because children are particularly vulnerable to severe bites, including injuries to the face and hands, which could become fatal, despite post-exposure treatment, paediatricians and several public health experts have advocated childhood PrEP. Because it stops virus transmission in the community, and takes us closer to rabies elimination,” said Zinia T, it points out that, as a public health strategy, investing in dog vaccination is more cost effective. “About 70-80% of dog-bite cases in the State are due to domestic dogs.
In contrast, comprehensive vaccination of dogs, combined with improved post-bite treatment and efforts to close gaps in PEP, could reduce rabies deaths by 83% compared to the current strategy, the study says. Scaling up vaccination of both owned and free-roaming dogs to 70% coverage could potentially bring human rabies deaths down to zero in Keralam within three years, according to the model. Rabies prevention is already one of Keralam’s most intensive public health interventions, with more than 9,00,000 people receiving free treatment every year following animal bites. The State also has a PEP completion rate of over 90%. Yet human rabies deaths continue to occur, with 33 deaths reported in 2025, including among children. The researchers modelled 12 different combinations of dog vaccination, post-bite treatment and PrEP over a 10-year period from 2026-2035. Raising the proportion of bite victims who seek medical care from 70% to 95% could prevent more than 1,100 additional deaths—over 20 times the mortality reduction achievable even with maximum PrEP coverage in the model.
Researcher at the University of Glasgow’s School of Biodiversity, One Health & Veterinary Medicine and lead author, PrEP for children is unlikely to be the best use of public health resources in Keralam, where access to post-bite vaccination and completion of the regimen are already high, according to Martha Luka. We could focus on completing domestic dog vaccination and then move on to vaccinating strays,” said Dr.
