A 47-year-old man from Royapettah, Chennai, has died from rabies encephalitis on September 13, 2025, even after completing the full course of post-exposure rabies vaccination.
This case marks the 22nd rabies-related death in Tamil Nadu this year, highlighting the continued challenges in controlling this fatal disease.
On July 28, A. Mohammed Nasarudeen, an autorickshaw driver, was bitten on his right leg by a stray dog. He immediately sought treatment at Royapettah Government Hospital, where doctors administered the first dose of the anti-rabies vaccine along with rabies immunoglobulin. He followed up with the remaining three doses as recommended.
Despite completing the vaccination series, he began experiencing severe back pain, difficulty swallowing, and agitation. He was admitted to Rajiv Gandhi Government General Hospital, where he later succumbed to the disease.
“We are investigating the case to understand what led to the death in spite of completion of the four-dose vaccination schedule. The findings will be known only after the inquiry,” Dr A Somasundaram, Director of Public Health and Preventive Medicine, told TNIE on Sunday.
Rabies is a viral disease caused by the rabies virus, primarily transmitted through bites or scratches from infected animals. Once clinical symptoms develop, rabies is almost always fatal. [1]
Post-exposure prophylaxis (PEP), which includes rabies vaccination and, when indicated, rabies immunoglobulin, is highly effective at preventing disease if administered promptly. In India the commonly used intramuscular regimen is the five-dose Essen schedule (days 0, 3, 7, 14 and 28); the WHO also endorses validated intradermal and simplified schedules in certain programmatic settings. RIG provides immediate passive immunity and must be infiltrated appropriately around the wound; errors or delays in RIG administration, delays in seeking care, vaccine storage/handling problems, or host factors can rarely contribute to fatal “breakthrough” infections despite vaccination. Completing the recommended schedule and ensuring correct RIG use for category-III wounds remain critical. [1]
Health authorities are investigating why Mr. Nasarudeen developed rabies despite vaccination. Factors could include:
Delays in receiving treatment after the bite.
Improper storage or handling of the vaccine.
Improper or delayed administration of rabies immunoglobulin (RIG), especially failure to infiltrate around the wound.
Improper storage or handling of the vaccine.
Host-related factors such as weakened immunity, or very severe/high-risk bites (for example, on the face or head).
The dog involved was not isolated or observed, which may have increased community risk.
Authorities continue to urge the public to report stray animals, follow the full post-exposure prophylaxis schedule, and seek medical care promptly after potential rabies exposure. Ensuring correct vaccine handling and proper use of RIG for category-III exposures remain critical steps in preventing breakthrough infections.
References
World Health Organization. 2023b. WHO Recommendations on Post-Exposure Prophylaxis (PEP) for Rabies. Geneva: WHO. https://www.who.int/teams/control-of-neglected-tropical-diseases/rabies/pep-recommendations?
Centers for Disease Control and Prevention. 2024. Rabies: Epidemiology & Prevention. Atlanta: CDC. https://www.cdc.gov/rabies/index.html
(Rh/Eth/SS/MSM)