Comparison of Safety Profile of Equine and Human Rabies Immunoglobulin in Children below 15 Years, in a Tertiary Care Hospital of Odisha - an Observational Study

Abstract

Background: The incidence of rabies is equally more in children < 15 year of age i.e. 35.3% as found in the APCRI-WHO Survey in India. Out of the two alternatives (Equine Rabies Immunoglobulin: ERIG and Human Rabies Immunoglobulin: HRIG) for treatment for Category III animal bites, HRIG is invariably the preferred intervention mounting to exorbitantly high economic burden. There is paucity of studies comparing their safety profiles especially in children. Methods: A hospital-based observational study was conducted at the Antirabies Clinic of SCBMCH, Cuttack, Odisha from March to April 2019. The enrolment of patients was done in two months period from 1 st March to 30 th April 2019 and all these patients were followed up for a period of one month till 31st May 2019. New Category III animal bite cases in <15 years of age, taking ERIG and HRIG comprised of two groups A and B, respectively. They were followed up on their subsequent visits on 3 rd , 7 th and 28 th days of treatment to study any local and systemic reactions. Chi square test/ Fischer exact test/ Mann Whitney test were applied to compare the outcomes. Result: Mean age in ERIG (Group A) is 9.84 (±3.9) years and for HRIG (Group B) is 7.1 (±4.1) years and mean weight for ERIG group is 27.63 (±12.4) kg and HRIG group is 24.2 (±23.8) kg. The total amount of immunoglobulin administered was 3.6 (±1.6) ml in ERIG (Group A) and 2.5 (±1.34) ml in HRIG (Group B). Any type of local reaction was seen in 42% cases in Group A (ERIG) and in only 5% cases in Group B (HRIG). Pain, itching, local swelling, oedema, and tenderness were more marked in Group A (ERIG) but were not found to be statistically significant in all cases. These local reactions were managed symptomatically with medications like analgesics and antihistaminic. Similarly Systemic reactions in form of arthralgia, fever, malaise and generalized rash were also more observed in Group A (ERIG) which could be managed symptomatically with same medications. Conclusion: Safety profiles (in terms of local and systemic reactions) of ERIG and HRIG were comparable in children below 15 years of age. The minor side effects of ERIG can easily be managed by readily available drugs like analgesics and antihistaminics in the ARV OPD itself.