Rabies is a major public health challenge in India with the highest burden globally. Anti rabies vaccine (ARV) and anti rabies serum (ARS) provide safe and effective post exposure prophylaxis (PEP) in animal bite cases. However, providing universal PEP to incident animal bite cases is a major challenge in resource constrained settings especially due to the high cost of vaccine and serum. Hence, prevention of vaccine wastage is indispensable for rabies control in the developing world. Guidelines for rabies prophylaxis in incident animal bite cases with previous history of exposure and associated PEP recommend a two dose booster regimen on day 0 and 3. Nevertheless, evidence from some socioepidemiological studies on rabies reported from India suggest that there exist several patient and provider related factors which promote an unwarranted universal repetition of complete course of rabies PEP in re- exposure to animal bite cases. This potentially results in an avoidable wastage of 2 doses of ARV and/or ARS per animal bite case who have previously received full course of rabies PEP. Animal bite victims with low socioeconomic and educational status have greater likelihood of being subject to excess rabies PEP vaccination. This is often due to their inability to produce related medical records and lack of awareness of the treatment received during past animal bite exposure. Lack of knowledge relating to postexposure schedule in previous vaccinated cases among residents and medical graduates may also contribute to rabies vaccine wastage.

Keywords: Rabies; India; PEP; Vaccine Wastage; Vaccination.