IMAGINE a child happily heading to the park to play ball with friends. A stray dog prowls nearby, foaming at the mouth and ferociously gnawing on a bramble. The canine spots the children and lunges at them. Some run away screaming in terror, while one unlucky child is knocked down and assaulted by the aggressive dog. Park guards throw sticks and stones at the snarling, vicious creature until it is killed, leaving the boy with bleeding arms, legs, and face. Depending on the family’s awareness and resources, their options are: to take the child to the nearest private clinic, to the emergency department of a public hospital, or to apply salt and chili to the wounds. The clinic doctor has nothing to offer; the ED doctor administers an injection in the arm, but has no rabies immunoglobulin (RIG). The grandmother suggests applying spices.
Over time, the gashes heal, and the boy returns to school, with everything seemingly normal. Six weeks later, he comes home with a headache, fever, and unusual sensations in his arms and legs where he was bitten. Two days later, he complains of something ‘stuck in his throat’, he cannot drink water, and avoids the breeze from the fan. The frightened parents recognise the unmistakable signs of rabies. There is no going back; he is doomed to die within the next day or two.
This is not an unusual story. Unbeknownst to the public and the uncaring civic authorities, such incidents occur in Karachi at least 200 times daily, whether on the streets, in playgrounds, or near garbage dumps. The Sindh Health Department recorded 200,000 bites across Sindh from January to October 2023. There is no record of how many of these bites resulted in rabies. Public hospitals report at least one or two rabies deaths each week, mostly among children. Since there is no official reporting system or registry, these ‘incidents’ are reported randomly in the press, mourned, and quickly forgotten.
The Electronic Medical Report at the Indus Hospital’s Rabies Prevention Centre documents 50-70 new dog bites almost daily, mostly in children, along with 70-80 follow-up visits. It strictly follows WHO guidelines: soothe the frightened victim, scrub each wound with soap and water, determine the circumstances of the attack, assess the wound severity — whether a superficial scratch or laceration — and decide the next steps. If necessary, the vaccine is administered by a trained nurse into the skin of both upper arms. If the wound is a laceration, then a calculated amount of RIG is infiltrated intoeach wound. The patient is instructed to return on the third and seventh days to complete the series and ensure protection against rabies.
Today is World Rabies Day.
For ED doctors who are not up-to-date on the current methods of Post-Exposure Prophylaxis (PEP), the centre conducts three-day hands-on workshops to teach the proper techniques of individual care. At least 20 centres in Sindh and lower Punjab have been trained and are now operational.
Unfortunately, preventing rabies remains a neglected issue, but experts at the Indus Hospital addressed this challenge by implementing the ‘One Health’ programme in a nearby fishing village. The community was engaged through discussions, and it was explained that vaccinating dogs would stop the transmission of the rabies virus from dogs to humans, ultimately eliminating the disease.
The WHO provided animal rabies vaccines and a professional trainer. Unemployed young men were trained to catch and vaccinate stray dogs, while veterinarians learned to perform surgical sterilisations. Nearly 37,000 dogs were vaccinated, and 12,000 male and female dogs were sterilised. After two years, the village was evaluated for the impact: no rabies cases were reported, and there were noticeably fewer puppies. Older dogs would live out their normal life spans, and in a few years, the dog population would dwindle to acceptable numbers. The project was handed over to the city authorities to adopt this approach for controlling rabies and managing the growing population of stray dogs.
Citizens cry out daily that dogs have overrun their cities. They are afraid to walk on the streets or let their children play outside. They plead for safety. In many low-income countries, local governments have taken control by rapidly culling as many dogs as possible, then vaccinating and sterilising the remaining ones to balance the ecosystem.
A critical study conducted at the hospital in collaboration with Erasmus University in the Netherlands found that 64 per cent of severe bites in Karachi tested positive for the rabies virus. Any accidental dog bite could potentially transmit rabies. A grave concern is that EDs nationwide lack sufficient vaccine supplies, and almost none have RIG.
All levels of government must stay alert and act quickly. The situation is dire.
The writer is faculty, Indus Hospital, and a member of the WHO Expert Panel for Rabies.
Published in Dawn, September 28th, 2025
