Kerala reported 102 rabies deaths in five years of which 20 victims were either fully or partially vaccinated while the rest of the deceased did not take any vaccine. Data obtained by Onmanorama through RTI from the Directorate of Health Services shows that 19 per cent of total rabies fatalities in Kerala between 2021 and 2025 (April) received both anti-rabies serum (ARS) and intradermal rabies vaccine (IDRV). Majority of the people who died even after receiving vaccination sustained serious wounds to head and face while others were bitten on arms, limbs and hands. Out of the 20 victims, 10 were found to have sustained grievous wounds to head and face.

Ziya Faris, the six-year-old girl who died of rabies in Kerala sustained bite wounds over the head, chest, left shoulder, left middle finger, and left lower limb. Health officials who investigated the case said that there were deep, lacerated wounds on her scalp. She was administered with the ARS and the IDRV, however she contracted infection and died. ARS is injected at the site of injury and it works faster than the vaccine. ARS contains antibodies which neutralize the virus quickly. ARS is administered to give immunity from the virus until the vaccine takes effect which usually takes 1-2 weeks.

While Ziya's death has triggered a debate on the efficacy of the rabies vaccine, health officials associated with the rabies control programme point out that wounds causing direct nerve injury are often fatal. "Lacerated wounds result in direct nerve injury. Hand, face, and palm are some of the areas which are innervated. This high density of nerves in these body parts poses high risk of nerve injury in case of bite wounds. The probability of direct entry into the nerve is high when a patient suffers lacerated wounds," a health official said.

The crucial aspect of wound management due to an animal bite is thorough washing. "90 per cent of viral load gets washed off when cleaned with soap. In many cases, this step is ignored," an official said.

In 2022, the state government constituted an expert committee for rabies deaths after a debate was triggered on the use of the vaccine following a series of fatalities. The committee analysed deaths which happened despite being vaccinated and one of the major findings was that the wounds of these deaths were in the highly innervated areas of head, face, neck and interdigital areas of arms. The shorter incubation period pointed towards the direct inoculation of rabies virus into the wounds, the committee noted in the report.

The committee also concluded that all the tested batches of vaccine and immunoglobulin were conforming to quality standards of potency, sterility, physical, biochemical and identity parameters. In addition, adequate antibody responses were observed in those who had received PEP (Post-Exposure Prophylaxis) from the same batches of the vaccine. "Among those who had received PEP and had later died, the virus must have entered the nerves by direct inoculation after sustaining bite in highly innervated areas," the committee noted.

As per the data, stray dogs accounted for the majority of fatalities, while wild cats, domestic dogs and foxes also resulted in rabies deaths in certain cases.