Death from rabies: The reason being poor compliance to vaccination or it's failure

Rabies is endemic in India and responsible for 20,000 human deaths every year. It is 100% preventable when the vaccine is taken along with proper wound care and rabies immunoglobulin administration though update continues regarding the requirement of the number of vaccine doses, the need for immunoglobulin, and if required their types. We study four cases of rabies having street dogs' bite category grade 3. Everyone took vaccines at least three doses but none of them took rabies immunoglobulin. They developed symptoms of rabies with a gap of 15-28 days after the bites and admitted to a tertiary care center. One patient was left against medical advice and three patients were treated according to the modified Milwaukee protocol. But, none of them could be saved. So, it may be proposed that the reason of deaths may be due to lack of administration of rabies immunoglobulin (passive vaccination) or failure of vaccines. Hence, the government may focus on the administration of complete and quality post-exposure prophylaxis in all cases of animal bites. Although Milwaukee protocol saves few lives, it may be further improved or other treatment modalities may be developed for rabies treatment.