Rabies and the missing deaths: Why do India’s official numbers differ so sharply from estimates? |Explained

The story so far: India is working towards eliminating dog-mediated human rabies by 2030. Yet the country does not have a single, comprehensive national count of human rabies deaths. While the Health Ministry’s disease surveillance system recorded 54 deaths in 2024, an ICMR-led study estimates that 5,726 people die of rabies in India every year.

Is rabies a notifiable disease in India?

Rabies is not a notifiable disease nationwide. Unlike diseases for which there is a clearly established national notification mechanism covering every State and Union Territory, rabies notification has historically depended on State-level notification requirements and the disease surveillance system.

The National Centre for Disease Control (NCDC) has been working to make human rabies a notifiable disease across the country. Communications have been sent to States to notify the disease under the relevant State legislation.

However, a disease being under surveillance does not necessarily mean that every case or death occurring in the country is automatically captured in one central database.

Rabies is a particularly difficult disease to count because a large proportion of deaths can occur outside the formal health system. Once clinical symptoms appear, rabies is almost invariably fatal, but patients may die at home or in facilities that do not routinely report the death through disease-surveillance channels.

How is a disease chosen for notification in India?

Disease notification is largely a public-health surveillance and State-level regulatory function, while the Union government maintains national surveillance systems such as the Integrated Disease Surveillance Programme (IDSP).

A disease is generally prioritised for notification or surveillance when it has significant public-health importance — for example, high mortality or morbidity, epidemic potential, rapid spread, risk of international transmission, emergence of a new pathogen, or where early detection can trigger effective control measures. India’s disease-prioritisation exercises have considered epidemiological, clinical, economic and public-health factors, with expert consultation.

Once a disease/condition is designated for surveillance, health facilities, laboratories and health workers report cases through the surveillance system. Under IDSP, reporting includes suspected (S), presumptive (P) and laboratory-confirmed (L) cases. Data move from reporting units to District and State Surveillance Units and ultimately to the Central Surveillance Unit at the National Centre for Disease Control (NCDC).

A rising or unusual cluster triggers investigation by Rapid Response Teams, which can lead to laboratory confirmation, containment measures and further reporting. 

The exact legal notification requirement can depend on the State/UT and the particular disease. Leprosy, for instance, was declared a notifiable disease nationally in 2025.

So, how many people die of rabies in India?

There are different answers, depending on what is being measured. The Integrated Disease Surveillance Programme/Integrated Health Information Platform (IDSP–IHIP) recorded 21 human rabies deaths in 2022, 50 in 2023 and 54 in 2024.

The Registrar General of India’s Medical Certification of Cause of Death (MCCD) system, meanwhile, recorded 66 medically certified rabies deaths in 2022 and 271 in 2023.