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. 2025 Jun 13:38:100608.
doi: 10.1016/j.lansea.2025.100608. eCollection 2025 Jul.

Availability of anti-rabies vaccine and rabies immunoglobulin in Indian health facilities: a nationwide cross-sectional health facility survey

Navaneeth S Krishna  1 , Jeromie Wesley Vivian Thangaraj  1 , Shanmugasundaram Devika  1 , Aruna Sasi  1 , Suganya Egambaram  1 , D Sudha Rani  1 , Siraj Ahmed Khan  2 , Anitha Delli  1 , Ashok Kumar Srivastava  3 , Ayush Mishra  4 , Basavaraj Shrinivasa  5 , Chandhini Pandiyan  1 , Devendra Gour  6 , Debjani Ram Purakayastha  7 , Nirmal Verma  8 , Parul Sharma  9 , Ravinder Kumar Soni  10 , Sabarinatha Ramasamy  1 , Sreelakshmi Mohandas K  11 , Subrata Baidya  12 , Tanveer Rehman  13 , Vijay V Yeldandi  14 , Akashdeep Singh  10 , Aswathy Sreedevi  11 , Babasaheb V Tandale  5 , Chokkalingam Durairajan  1 , Hemant Mahajan  7 , Kamlesh Jain  8 , Mahendra M Reddy  4 , Manju Toppo  6 , Nitinkumar Valjibhai Solanki  9 , Pramit Ghosh  2 , Shaili Vyas  3 , Shampa Das  12 , Subrata Kumar Palo  13 , Venela Prasanth  14 , Atefh Ali  13 , Viswanath Guru Bathin  14 , Dinesh Kumar Sahu  8 , G P Sabitha Rani  14 , Major Madhukar  7 , Kamran Zaman  4 , Krishna Pandey  7 , M Punnam Chander  12 , Rajni Kant  4 , Reshmi Ann Varkey  11 , Sanghamitra Pati  13 , Shailendra Agarwal  8 , Srashti Panwar  3 , Vishnu B Menon  11 , Raman Swathy Vaman  15 , Anoop Velayudhan  16 , Sam Joy  16 , Manju Rahi  17 , Manoj V Murhekar  1
Affiliations

Availability of anti-rabies vaccine and rabies immunoglobulin in Indian health facilities: a nationwide cross-sectional health facility survey

Navaneeth S Krishna et al. Lancet Reg Health Southeast Asia. .

Abstract

Background: Ensuring the uninterrupted availability of the anti-rabies vaccine (ARV) and rabies immunoglobulin (RIG) in health facilities is crucial to achieve the global target of zero dog-mediated human rabies deaths by 2030. This study aimed to estimate the availability of ARV and RIG across health facilities in India.

Methods: We conducted a nationwide health facility-based, cross-sectional study across 60 districts selected by multistage probability sampling from 15 Indian states. In each district, we selected nine health facilities. We interviewed staff involved in the rabies control program in each of the selected health facilities, and abstracted and physically validated information on the availability of ARV and RIG.

Findings: Of the 534 health facilities surveyed, 467 (87.5%) were public sector health facilities. ARV was available in 372 (79.7%, 95% CI: 75.7%-83.2%) public sector health facilities, ranging from 60.0% to 93.2% in different geographic regions. Availability of ARV was lowest in Urban Primary Healthcare Centres (UPHCs) (58.9%, 95% CI: 45.0%-71.9%). RIG was available in 95 (20.3%, 95% CI: 16.8%-24.3%) public sector health facilities, with the highest availability in southern states (27/88, 30.7%). The availability of RIG ranged from 1.8% (95% CI: 16.8%-24.3%) in UPHCs to 69.2% (95% CI: 48.2%-85.7%) in medical college hospitals.

Interpretation: Considerable geographic and facility-level variations exist in the availability of ARV and RIG across India. Bridging the gap in the availability of ARV and RIG should be prioritised to achieve the goal of zero-dog-mediated human rabies deaths by 2030.

Funding: Indian Council of Medical Research.

Keywords: Bites and stings; Health facility; Immunoglobulin; Monoclonal antibody; Rabies; Vaccine.

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Conflict of interest statement

We declare no competing interests.

Figures

Fig. 1
Fig. 1
Availability (%) of anti-rabies vaccine (ARV) and rabies immunoglobulin (RIG) across public and private sector health facilities in India. Error bars represent 95% confidence intervals.
Fig. 2
Fig. 2
Availability (%) of anti-rabies vaccine (ARV) and rabies immunoglobulin (RIG) across different types of health facilities. Error bars represent 95% confidence intervals.
Fig. 3
Fig. 3
Availability (%) of Anti-Rabies Vaccine (ARV) and Rabies Immunoglobulin (RIG) across government health facilities by level of care and geographic zone in India. Error bars represent 95% confidence intervals.
See this image and copyright information in PMC

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