India: Counterfeit Rabies Vaccine Circulating

According to the Drug Controller General of India, Indian Immunologicals Limited (the vaccine manufacturer), the U.S. CDC, and UK Health Security Agency, a counterfeit rabies vaccine (Abhayrab; batch number KA24014) has been circulating through unauthorized sources in major Indian cities, including Delhi, Mumbai, Ahmedabad, and Lucknow; the extent of potential distribution is unknown. This falsified product poses a significant public health threat due to lack of efficacy, potentially harmful components, and risk of treatment failure in preventing rabies—a fatal disease. The counterfeit vaccine has notable differences in formulation, packaging, labeling, manufacturing details, and expiration date compared to the genuine registered vaccine.

Affected cities (confirmed):

Delhi
Mumbai
Ahmedabad
Lucknow
Extent of distribution to other areas unknown

Key concerns:

Counterfeit vaccine may contain ineffective substances (saline, distilled water) or harmful, unregulated ingredients
Vaccine circulated without maintaining required cold chain (2-8°C), further compromising any potential efficacy
Treatment failure could result in rabies deaths, as the disease is nearly always fatal once symptoms develop

Keep in Mind:

The actual extent of counterfeit vaccine distribution is unknown and may be more widespread than reported
India accounts for 36% of the world’s rabies deaths, with an estimated 18,000-20,000 deaths annually
About 30-60% of reported rabies cases and deaths occur in children under 15 years, as bites often go unrecognized and unreported
A human rabies case was reported in the U.S. in 2025 in a traveler from India who received a dog bite and subsequently died
Rabies is preventable with proper wound care and timely vaccination, but once symptoms develop, it is nearly always fatal
Travelers who received rabies vaccine in India between November 2023 and present should verify the vaccine source and consider revaccination if uncertain

Rabies Risk in India

India is endemic for rabies, with rabid dogs being the primary source of human infections. The true burden of rabies is not fully known due to underreporting, but available data indicates:

18,000-20,000 rabies deaths annually
Dog bites are common, especially to children
Stray dogs and puppies roaming freely on streets pose significant risk
Rabies affects the central nervous system (brain and spinal cord)

Transmission:

Through saliva of infected animals via bites, scratches, or fresh wounds licked by rabid animals
Dogs account for vast majority of human rabies cases in India
Other mammals (cats, monkeys, bats) can also transmit rabies

Symptoms:

First symptoms appear weeks or months after exposure and include weakness, discomfort, fever, headache, and itching/prickling at bite site. Severe disease symptoms follow, including anxiety, confusion, agitation, hallucinations, difficulty swallowing, excessive salivation, paralysis, and coma. Death typically occurs within days of symptom onset.

Recommendations for Travelers

Prevention is critical:

Avoid all contact with dogs (including puppies), cats (including kittens), and wild mammals while in India
Be especially cautious of animals roaming freely on streets
Do not attempt to pet, feed, or touch any animals
Supervise children closely around animals

Pre-exposure vaccination:

Travelers should be vaccinated prior to travel if they:

Might come in contact with dogs, cats, or wildlife
Plan to work with animals during travel
Will be in rural or remote areas where medical care may be delayed
Plan extended stays in India
Are children (at higher risk due to proximity to animals and potential to not report bites)

Pre-exposure vaccination consists of 2 doses given 7 days apart. This does NOT eliminate the need for post-exposure treatment if bitten, but it simplifies treatment and provides protection if treatment is delayed.

If bitten, scratched, or licked on broken skin:

Immediately wash the wound thoroughly with soap and running water for at least 15 minutes
Seek immediate medical care at an established, reputable healthcare facility
Request verification of the vaccine product name, batch number, and manufacturer
Take a photo of the vaccine vial/packaging if possible
Keep written records of all vaccines received, including:
- Vaccine name and manufacturer
- Batch/lot number
- Date administered
- Healthcare facility name and location
- Vaccinator’s name/credentials

For post-exposure prophylaxis in India:

Seek care at established, reputable healthcare facilities (major hospitals, international clinics)
Ask for verification that genuine vaccine is being used
Genuine Abhayrab will have proper cold chain documentation and packaging
If uncertain about vaccine authenticity, travel to another country (Nepal, Thailand, UAE) to access reliable rabies vaccine
Contact your embassy or consulate for recommendations on reliable medical facilities

Upon returning home:

Contact your healthcare provider immediately if you:
- Received rabies vaccine in India
- Are uncertain about the vaccine source or authenticity
- Did not complete full post-exposure prophylaxis series
- Had a potential rabies exposure but did not seek treatment
Healthcare provider will assess need for additional vaccination
If you have confirmation you received a different brand of rabies vaccine (not Abhayrab), you likely do not require additional vaccine

Identifying Genuine vs. Counterfeit Vaccine

Red flags for counterfeit vaccine:

Purchased from unauthorized sources (pharmacies without proper licensure, street vendors)
Significantly cheaper than market rate
Packaging differences from genuine product
No cold chain documentation
Unusual or suspicious labeling
Healthcare facility cannot provide detailed product information