Compliance with anti-rabies post-exposure prophylaxis among animal bite victims attending anti-rabies clinic of a tertiary care centre in urban Bengaluru

Rabies is a preventable zoonotic disease, yet timely and complete post-exposure prophylaxis (PEP) remains a major operational challenge in endemic countries. Compliance to the full vaccination schedule is critical for ensuring protection against rabies virus following category II and III exposures. A prospective observational study was conducted at the Anti-Rabies Clinic, Kempegowda Institute of Medical Sciences Hospital, Bengaluru, India, among all animal bite victims attending for PEP between October 2021 to December 2022. Data on socio-demographics, exposure characteristics, health-seeking behavior, vaccination compliance, and reasons for drop-out were collected using a structured case record form. Compliance was defined as completing all five doses of intramuscular anti-rabies vaccine according to the Essen regimen. A total of 735 animal bite victims were enrolled; 80.4% completed the full vaccination course. Compliance declined progressively from 100% for the first dose to 93.7% for the second, 86.4% for the third, 82.3% for the fourth, and 80.4% for the fifth dose. The main reasons for drop-out were negligence (27.7%), work-related timing conflicts (26.3%), forgotten dates (22.9%), long travel distance (13.2%), and school timing conflicts (9.7%). Compliance with the 5-dose intramuscular anti-rabies vaccination schedule was suboptimal, with early-dose attrition as the main gap. Addressing behavioral barriers such as negligence and forgetfulness, alongside structural challenges like work-timing conflicts, is critical. Strengthening reminder systems and improving service accessibility within national programs could markedly enhance adherence and contribute to achieving zero human rabies deaths. Rabies is almost always fatal once symptoms appear, but it is preventable with prompt, complete post-exposure prophylaxis (PEP). In India, ensuring bite victims finish vaccination is a public-health priority. We followed 735 animal-bite victims at a tertiary-care anti-rabies clinic to assess completion. Among those who presented, nearly all started PEP on the day of presentation; however, 19.6% did not complete the full 5-dose schedule. The main reasons for drop-out were negligence, work or school conflicts, and travel distance. We also examined which groups were more likely to miss doses and found higher non-completion among rural residents and people from lower socio-economic backgrounds. Targeted reminders, brief counselling, and easier clinic access could improve completion and help India meet its rabies-elimination goals by 2030.