Human rabies immunoglobulin (HRIG)

Therapeutic action

Neutralisation of rabies virus at wound sites.

Indications

• Prevention of rabies after category III exposure, except in patients who have received a full course of pre-exposure prophylaxis against rabies, in combination with rabies vaccine.
• Prevention of rabies after category II and III exposures in immunocompromised patients, even in patients who have received a full course of pre-exposure prophylaxis, in combination with rabies vaccine.

Forms and strengths, route of administration

• Solution for injection, 300 IU in 1 ml ampoule (300 IU/ml) and 1500 IU in 5 ml ampoule (300 IU/ml).
• For infiltration into and around the wound.

Dose and duration

• Child and adult: 20 IU/kg single dose on D0, along with the first dose of rabies vaccine.
• Infiltrate as much of the dose as possible into and around the wound or wounds, which should be cleaned beforehand.
• In the event of multiple wounds, dilute the dose 2- to 3-fold with sterile 0.9% sodium chloride to obtain a sufficient quantity to infiltrate all sites.
• If HRIG is not available on D0, administer the first dose of rabies vaccine alone. Administer HRIG as soon as possible between D0 and D7. From D8 onward, rabies immunoglobulin is no longer necessary because vaccine-induced antibodies begin to appear.

Contra-indications, adverse effects, precautions

• May cause fever, headache, gastrointestinal disturbances, joint pain, local reactions at the injection site such as pain or inflammation, and rarely anaphylactic reactions.
• Aspirate prior to injection to confirm that the needle is not in a vein and ensure that the HRIG does not enter a blood vessel.
• For finger wounds, infiltrate with caution to avoid increased pressure in the tissue compartment.
• If administered simultaneously with rabies immunoglobulin and other vaccines, use different syringes and injection sites.
• Pregnancy and breast-feeding: no contra-indication.
• Purified equine rabies immunoglobulin F(ab')2 fragments may replace HRIG if unavailable. The method of administration is the same but the dose is 40 IU/kg.