Public awareness and knowledge on rabies: a survey-based analysis

INTRODUCTION

Rabies is a deadly zoonotic illness causing infection to humans and animals, with symptoms typically leading to death if they emerge. It is caused by rabies virus (RABV), a neurotropic, bullet-shaped RNA virus belonging to the genus Lyssavirus and family Rhabdoviridae. Rabies is transmitted mainly through the saliva of infected animals via bites or contact with broken skin or mucous membranes. Dogs are the major reservoir and account for about 99% of human rabies cases worldwide.¹ Rabies is transmitted to humans mainly through bites from infected dogs and cats. In India, dogs cause over 90% of human rabies cases. The incubation period ranges from 5 days to 7 years, commonly 4–8 weeks. Rabies presents in two forms: encephalitic (furious), characterized by hydrophobia and rapid death within a week of symptoms and paralytic (dumb), resembling Guillain-Barré syndrome.² Rabies exists on all continents, except Antarctica, with over 95% of human deaths occurring in the Asia and Africa regions. Rabies predominantly affects poor and vulnerable populations who live in remote rural locations, with around 80% of human cases occur in rural areas. Internationally, rabies fatalities are seldom noticed and children of the age group of 5–14 years are most common sufferers. Rabies virus is transmitted through bites and scratches of dogs generally through saliva. When clinical symptoms appear, rabies is virtually 100% fatal.³ Human rabies is rare in resource-rich countries but remains a significant public health concern in resource-limited regions, causing tens of thousands of deaths annually. The burden is highest in Asia and Africa, primarily affecting children in areas without large-scale preventive measures.⁴ Rabies causes viral encephalitis and killing up to 70,000 people/year worldwide but preventable through vaccines. Researchers estimate that 30,000 to 70,000 deaths are attributable to rabies each year.⁵ Rabies deaths are concentrated in Asia (59.6%) and Africa (36.4%), with India accounting for about 35% of global human rabies deaths. Although India has the highest number of deaths, the highest mortality rates occur in the poorest countries of sub-Saharan Africa. Rabies disproportionately affects males and children, particularly in low-income settings, due to greater exposure to rabid animals. Children are at higher risk because bites often occur on the head and neck, leading to a higher likelihood of infection and a shorter incubation period.⁶ Rabies causes over 55,000 deaths annually worldwide, primarily in Asia and Africa, largely due to delayed or absent post-bite healthcare seeking. India accounts for approximately 36% of global rabies deaths, with an estimated 18,000–20,000 deaths each year. Children under 15 years constitute 30–60% of reported cases and deaths, as bites in this age group often go unnoticed or unreported.⁷ According to IDSP/IHIP (2025) by PIB Ministry of Health and Family Welfare, Government of India, total 66018 cases in 2022, 113499 cases in 2023, 142948 cases in 2024 and 16710 cases till January 2025, reported from dog bite cases in Madhya Pradesh. And at national level, total 2189909 cases in 2022, 3052521 cases in 2023, 3715713 cases in 2024 and 429664 cases till January 2025 reported from dog bite cases.

Fatality reported as 1 in 2022, 2 in 2023, 6 in 2024 from human rabies cases in Madhya Pradesh. Overall, 21 in 2022, 50 in 2023, 54 in 2024 fatality reported from Human Rabies cases at national level.⁸ According to a systematic review by John et al the annual crude dog bite incidence was reported between 0.26% and 2.5% with stray dogs as main biting animal. The bites were mainly reported in males, between age group 10–40 years, individuals belonging to low socio-economic status and people working in fields. The annual economic and humanistic burden is estimated to be 2.85 million USD and 1.3 million DALYs respectively.⁹ India has one of the world's largest dog populations, estimated at 25–35 million, with the majority being free-roaming or partially owned. In urban and peri-urban areas, free-roaming dogs are estimated to comprise more than 60–70% of the total dog population, although proportions vary across regions.¹⁰ According to Thangaraj et al India experiences an estimated 9.1 million animal bites annually, with dogs responsible for 76.8% of cases. The annual incidence of dog bites was 5.6 per 1,000 population. Among dog-bite victims, 20.5% did not receive anti-rabies vaccination (ARV), while many failed to complete the recommended vaccination schedule. The study estimated approximately 5,726 human rabies deaths annually in India, highlighting significant gaps in post-exposure prophylaxis and rabies prevention.¹¹ Magar et al found that only 14.4% of respondents had a high level of rabies awareness, while 45.2% had low awareness. Although most participants had heard about rabies, only 32.7% correctly identified it as a highly fatal viral disease. Books were the main source of information (46.2%). The most commonly recognized symptom was fear of water, air and light (68.3%) and 87.5% knew that rabies is preventable.

A significant association was observed between rabies awareness and a previous history of animal bite.¹² Rathod et al found that only 48.18 % participant aware about rabies disease. 18.51% participant were not able to give correct response regarding causative agent of rabies however majority of respondents knew which animal harbor rabies. 71% participant was aware about fatality of rabies at the same time 64% respondent aware about rabies can be prevented by vaccination.¹³ Sanjay et al revealed that only 0.2% had extensive knowledge of rabies. Majority (440, 72.0%) of the participants considered rabies as a fatal disease 77.3% opined that risk of rabies from dogs was high compared to 41.6% who believed that there was little or no risk of rabies from cats. Only 37 (3.7%) participants were aware about pre-exposure prophylaxis.¹⁴ Therefore, present study planned to assess the awareness and knowledge about rabies among general population across India.

METHODS

A quantitative research approach with a descriptive cross-sectional survey design was adopted to assess rabies awareness among the general population across India. The study was conducted through social media platforms from January to April 2026. A total of 567 participants aged 18 years and above were selected using a random sampling technique. The data collection tool comprised two sections: Section I included socio-demographic variables (age, gender and educational qualification), while Section II consisted of an awareness questionnaire on rabies symptoms, transmission and preventive measures.

Tool validity was established through expert review and literature review and reliability was confirmed with a split-half reliability coefficient of 0.936. Informed consent was obtained from all participants and confidentiality was maintained by assigning codes. Data were collected online after explaining the study purpose, with an average completion time of 10 minutes. The collected data were analyzed using frequency, percentage and Chi-square tests to assess awareness levels and associations with selected demographic variables.

RESULTS

The demographic profile of the participants revealed that the majority (82.02%) were in the 18–24 years age group, followed by 8.46% in the 25–35 years age group, 2.64% in the 36–46 years age group and 6.88% were aged 46 years and above. Regarding gender, 87.83% of the participants were female and 12.17% were male. In terms of educational qualification, 78.31% were graduates, 10.58% had completed schooling, 8.82% were postgraduates and 2.29% held a diploma qualification (Table 1). According to awareness questions regarding transmission of rabies, 292 (51.5%) participants or their family members received a rabies vaccination for prevention, 462 (81.48%) affirmed that they will keep “stay away from stray dog”, only 206 (36.33%) confirmed first step about “Clean the wound and observe the animal” if bitten by an animal suspected of having rabies, 556 (98.06%) participants assured that “Dog” is the most commonly associated with rabies transmission to humans, 424 (74.78%) participants were agree that best way to keep pets safe from rabies is “vaccination”. Overall, 388 (68.43%) participants were aware about transmission of rabies (Table 2).

According to knowledge questionnaire about symptoms, 542 (95.59%) participants confirmed that rabies is typically transmitted to humans “Through a bite or scratch from an infected animal”, only 154 (27.16%) informed that exposure to rabies and the appearance of signs and symptoms of rabies in humans duration is “1-3 months”, only 91 (16.05%) were knowing correctly that cure for rabies once symptoms appear was “Only if caught within the first 24 hours”, 316 (55.73%) participants were knowing correctly that “Paralysis and hydrophobia (fear of water)” were key symptom of rabies in humans. Overall, 276 (48.68%) participants were knowledgeable about symptoms of rabies (Table 3). According to knowledge on preventive measures, 385 (67.90%) participants confirmed that Person should seek ‘immediate’ medical attention after a potential rabies exposure, 531 (93.65%) participants were knowing correctly about vaccines used to prevent rabies, Around Half 295 (52.03%) participants were correctly knowing total requirement of complete pre-exposure rabies vaccination series that is ‘3, 380 (67.02%) participants picked out “office workers” ‘NOT typically recommended for pre-exposure rabies vaccination among Veterinarians, Animal control workers and Wildlife researchers’. 487 (85.89% participants were knowing about sign of animal might be sick with rabies, around half 286 (50.44%) participants have knowledge about ‘Skin biopsy and virus detection’ as diagnosis of rabies before symptoms appear. Overall, 394 (69.49%) participants had knowledge about preventive measures about rabies (Table 4).

On the basis of Table 5, study revealed that there was no significant association found between Awareness regarding transmission of rabies with demographic variables of the participants like age gender and educational level. On the basis of Table 6, study revealed that there was no significant association found between knowledge regarding symptoms of rabies with demographic variables of the participants like age gender and educational level. On the basis of Table 7, study revealed that there was no significant association found between awareness regarding preventive measures of rabies with demographic variables of the participants like age gender and educational level.

DISCUSSION

Rabies is endemic in India, which accounts for nearly 36% of rabies deaths worldwide. Despite uncertainties regarding its true burden, current estimates indicate that 18,000–20,000 people die from rabies each year.¹⁵

Present study discovered that only 51.5% participants or their family members received a rabies vaccination for prevention, 81.48% told that they will keep stay away from stray dog, 36.33% were assured about first step of “Clean the wound and observe the animal”, 98.06% told that “Dog” is the most commonly associated with rabies transmission to humans, 74.78% told that “vaccination” is safe practice for saving pets from rabies. Overall, 68.43% participants were aware about transmission of rabies. Our study result was consistent with the study findings of Yanal et al in which 96.4% participants identified the dog as the main source of human rabies.¹⁶ Jain et al also found similar results to the findings, in which 71.9% participants knew about transmission via dog bites, only 48.1% were aware of wound washing. (62.4%) had knowledge that timely vaccination can avoid the disease.¹⁷ The study findings supported by findings of Bharani et al in which 68% had sufficient knowledge about rabies.¹⁸ Rathod et al also revealed that only 48.18% participant aware about rabies disease.¹³ Subedi et al revealed that 86.70% participants knew dog as recognized the signs and symptoms of rabies in animals and humans.¹⁹ Overall, 42.06% of the respondents demonstrated satisfactory knowledge. The current study revealed that 95.59% participants told that rabies is typically transmitted to humans “Through a bite or scratch from an infected animal”, 27.16% knew that exposure to rabies and the appearance of signs and symptoms of rabies in humans duration is “1-3 months”, 16.05% knowing correctly about rabies is curable if caught within the first 24 hours, 55.73% knew that “Paralysis and hydrophobia (fear of water)” were key symptom of rabies in humans. Overall, 276 (48.68%) participants were knowledgeable about symptoms of rabies. The study findings were aligned with Yanal et al findings in which, 41.8% participants knew hydrophobia as a clinical feature of rabies.¹⁶ Kishore et al also found about 95.7% of the participants knew about hydrophobia as a clinical feature of rabies.²⁰

Present study found that 67.90% participants knew to seek ‘immediate’ medical attention after a potential rabies exposure, 93.65% participants knew about vaccines used to prevent rabies, 52.03% participants knew about total requirement of complete pre-exposure rabies vaccination series, 85.89% participants were knowing about sign of animal might be sick with rabies, around half 50.44% participants knew about ‘Skin biopsy and virus detection’ as diagnosis of rabies before symptoms appear. Overall, 394 (69.49%) participants had knowledge about preventive measures about rabies. Kapoor et al found similar result aligned with the study, as 79.44% participants were having knowledge about Rabies can be prevented by vaccination, Verma et al revealed that 64.5% participants had correct knowledge about Anti-rabies vaccine doses.^21,22

Rathod et al revealed that 64% participants were sure in their study that rabies can be prevented by vaccination.¹³ Yanal et al revealed a contradictory findings revealed by a study in which only 10.9% of the participants had an adequate level of knowledge.¹⁶ Kishore et al found that most of the study participants (59.9%) obtained a medium score (10-17) in knowledge regarding disease and its prevention.²⁰ Overall 55.5% participants scored adequate knowledge regarding rabies in a study conducted by Verma et al.²² Kpoor et al also revealed that only 22.5% respondents had good knowledge, 56% had fair about rabies.²¹ Thomas et al found that overall 53% of them had good knowledge in rabies.²⁴

On the basis of chi square analysis, study revealed that there was no significant association found between awareness regarding transmission of rabies, symptoms of rabies and preventive measures of rabies with any of demographic variables of the participants like age gender and educational level. Similar results by revealed by Pandey et al in which no personal variable was found to be in association with level of knowledge regarding rabies prevention among general population.²⁴ A contradictory finding revealed by Bharani et al in which significant association between knowledge regarding rabies with demographic variables such as gender, age, education and occupation.¹⁸ Thomas et al found that an association between educational status, place of residence of study participants and their knowledge regarding rabies.²³ Several studies also found regarding non association of knowledge level with demographic characteristics of the participants.^25-27 Standard tool was not used and no open-ended questions were asked.

CONCLUSION

With 567 participants surveyed, this study provides a snapshot of current rabies awareness among the general population. The findings reinforce the necessity for consistent public education, accessible vaccination programs and clear guidelines for exposure response. Reducing the global burden of rabies depends not only on medical advances but also on informed and proactive communities.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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