Rabies Vaccine for Children: Who Needs PrEP Before a Dog Bite?
Experts differ on whether all children need rabies PrEP, with exposure risk, living conditions and access to emergency treatment influencing the decision. Doctors stress that PrEP never replaces timely treatment after a bite or scratch.
Rabies remains almost invariably fatal once symptoms appear, but timely prevention can stop the disease. This has raised a debate in India over whether children should receive rabies pre-exposure prophylaxis, or PrEP, before any dog bite.
The Indian Academy of Paediatrics recommended PrEP for children in 2022, while national guidelines allow it to be considered for people at higher risk of exposure. Doctors say children who frequently encounter dogs, live with pets or have limited access to emergency treatment may be considered for vaccination after individual assessment.
Experts, however, differ on whether every child needs PrEP. Community medicine specialist Dr Khan Amir Maroof has argued that exposure risk should guide the decision rather than routinely adding another vaccine to the childhood schedule. The World Health Organization similarly recommends PrEP primarily for people facing continuous or increased exposure risks.
Children can be particularly vulnerable because they may have closer contact with dogs, fail to recognise warning signs or hide minor scratches from adults. Dogs remain the main source of human rabies transmission globally.
Most importantly, PrEP does not eliminate the need for medical care after exposure. Following a suspicious bite or scratch, the wound should immediately be washed with soap and running water for at least 15 minutes, followed by prompt medical evaluation.
For unvaccinated people, post-exposure prophylaxis can include vaccination and, for severe exposures, rabies immunoglobulin or other recommended treatment. Properly administered PEP is highly effective, making rapid medical attention critical after any potentially risky exposure.
