Bangalore: Less than one victim of every 10 bitten by dogs "elect to receive" post exposure treatment (PET), according to a report of 2004 by the Association for Prevention and Control of Rabies in India.

The number of dog bites that occur annually in India is approximately 17.4 million, says the report. This endangers the victim to rabies, a disease which has a 100 per cent mortality rate when contracted.

Principal among the reason for this huge gap between the numbers of dog bites and the cases treated is the prohibitive cost of anti-rabies vaccinations. An average anti-rabies course consists of five vaccinations, which cost between 1,500 and Rs. 2,000. Of the seven brands of anti-rabies serum produced, only one is produced by a public sector institute, and is approximately half the price.

To supplement this, according to WHO recommendations, is an anti-rabies immune globulin (RIG) treatment that is essential for "Category III" dog bites (that is, severe bites to "ennervated" regions such as the hand or face). These are injected directly to the wound to prevent the virus from establishing itself, to tide through the 10-day window before the vaccinations begin to work. This costs an additional Rs. 500 to Rs. 1,000.

Preventive shots are also being recommended by the WHO to "vulnerable populations" that cost Rs. 900 that give protection for only two years.

However, it is the urban poor and rural and semi-rural communities, who can ill-afford the regime. Of the recorded 20,000 cases of rabies three years ago, 19,000 occurred in rural and semi-rural areas, where PET is both difficult to come by, or beyond paying power.

"Even big government hospitals in Bangalore do not have the vaccine half the year, leave alone taluk hospitals and primary care centres," M.K. Sudarshan, Principal and Professor of Community Medicine, Kempegowda Institute of Medical sciences (KIMS), told The Hindu . "The victim is generally turned away because vaccines arrive intermittently, and the only recourse is to buy the vaccines at the market price."

Government hospitals that are supposed to provide rabies treatments free of cost rarely have stock. "This is because there is neither a government policy, nor guidelines on rabies control, not to speak of a budget," says Dr. Sudarshan. "Rabies is a low priority disease. It is a disease of the poor," he said.

The intra-dermal vaccines, which will reduce the cost and volume of vaccination by 60 per cent to 80 per cent was recommended to the Government in 1992. It was only approved last year in the teeth of opposition from private manufacturers of the anti-rabies vaccine who feared that it would cut into their sales. While it may take some time for the intra-dermal vaccine to replace the conventional system, it will make treatment affordable for dog bite victims, says Dr. Sudarshan.

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