Compliance to post-exposure prophylaxis among dog bite victims attending anti-rabies vaccination clinic in a community health centre in District Ambala, Haryana

Abstract

Background: Rabies, primarily a zoonotic disease transmitted through bites or licks from infected animals, is responsible for tens of thousands of deaths globally, with 95% of fatalities occurring in Asia and Africa. In Southeast Asia, India accounts for 36% of global rabies-related deaths, approximately 18,000 to 20,000 annually. The high mortality rate is linked to factors such as lack of awareness, inadequate dog vaccination, and non-compliance with post-exposure prophylaxis (PEP). Rabies can be prevented through prompt PEP, which includes wound cleansing, anti-rabies immunoglobulin (RIG), and vaccination. India provides free anti-rabies vaccines (ARVs), with the intradermal route being preferred for its safety, efficacy, and cost-effectiveness. However, patient compliance with the four-dose intradermal regimen is essential for successful treatment. This study aims to assess compliance with the intradermal ARV regimen and find factors influencing non-compliance among animal bite victims attending the Anti-Rabies Clinic in CHC in district Ambala, Haryana. Methods: A longitudinal study was conducted from January to December 2023 at the Anti-Rabies Clinic (ARC) to assess compliance with the intradermal anti-rabies vaccination (ARV) regimen among dog bite victims. All dog bite victims, regardless of age, who had access to communication (mobile/landline phones), were included. Exclusion criteria included individuals seeking pre-exposure prophylaxis or critically injured patients unable to respond or consent. A random Community Health Centre (CHC) in Ambala, India, was selected, and 300 eligible cases were interviewed. Data were collected via a self-designed proforma, including socio-demographic information and PEP compliance details. Patients were classified according to WHO categories of exposure, and those in Categories II and III received ARV, with rabies immunoglobulin for Category III. Follow-up was conducted to assess adherence to the Updated Thai Red Cross Regimen (2-2-2-0-2). Non-compliance reasons were explored via phone interviews 30 days post-vaccination. Data were analyzed using SPSS, and Chi-square tests were applied to assess associations. Results were presented as proportions and percentages. Results: A total of 307 dog bite victims attended the Anti-Rabies Vaccination Clinic during the study period. Of these, 261 (85%) were eligible for post-exposure prophylaxis (PEP) and received the first dose of the anti-rabies vaccine (ARV). The study found that 71.6% of patients completed the full ARV regimen, with a marked decline in compliance across successive doses (Chi-square for trends: p