Small Volume of Rabies Immunoglobulin (RIG) is Effective for Local Wound Infiltration in Rabies Post-Exposure Prophylaxis whereas Intramuscular RIG is just a Wastage

Abstract

Rabies is a zoonosis that is 100% fatal once symptoms of the disease appear. However, it is almost 100% preventable if the prophylactic measures with proper wound wash, vaccines and immunoglobulins are taken soon after exposure to the animal bite. A general tendency has been noticed among clinicians all over the world to inject Rabies Immunoglobulins (RIG) intramuscularly, mostly in the gluteal muscle, despite the guidelines that suggest infiltrating it into the wounds. This has resulted in failures of Post Exposure Prophylaxis in many countries leading to the death of patients due to rabies. Here we discuss how giving any amount or even large amount of RIG intramuscularly (IM) is not going to neutralise rabies virus at the wound site especially during the window period, exposing the patients to the risk of rabies, whereas a small volume of RIG injected into the wound(s) is a lifesaving intervention as it neutralises the virus there and then in the wound(s) especially during the initial window period when the exposed person is unprotected, as the response to concurrent vaccination may take 10-14 days after exposure/ bite.

WHO Needs to Re-look at Animal Bite Wound Classification for Rabies Post Exposure Prophylaxis to Save People from Deadly Rabies!

“…18 We have also used diluted eRIG in many cases having wounds on the head and neck without failure and have advocated that even a small volume of RIG covering the surface of the wound till depth is effective for rabies PEP. 19 A 4-yearold girl who was seriously bitten by a confirmed rabid dog in rural China survived with only wounds infiltration of hRIG diluted 15 times to a concentration of 33.33 IU/ml. 20 Therefore, there is no need of using concentrated RIG for wounds on highly innervated areas like the head and neck and expanding the categories to category IV, however, all wounds/ scratches should be carefully assessed, washed with soap and water, and RIG infiltration should be done to cover the surface of the wound(s) till depth along with rabies vaccination for effective rabies PEP.…”

Survival of 21 Dogs after Post-exposure Prophylaxis using Intra-dermal Rabies Vaccine in the Pre-scapular Region and Emergency Use of Expired Equine Rabies Immunoglobulin for Local Wound Infiltration in Victims of a Rabid Dog Bite using One Health Approach

“…Moreover, we need more than 0.5 IU/ml titers of eRIG for only wound infiltration, which was supposed to be there even if eRIG was expired. 7 One human being was given due vaccine and eRIG that was not expired.…”