From the Guidelines
Rabies immunoglobulin (RIG) should be infiltrated directly into and around the wound as much as anatomically feasible, with any remaining volume administered intramuscularly at a site distant from the vaccine injection. This approach is based on the most recent and highest quality evidence available, which emphasizes the importance of immediate and thorough wound cleansing with soap and water, followed by the administration of RIG to provide immediate neutralization of the rabies virus at the site of potential entry before it can enter the nervous system 1. The recommended dose of human RIG is 20 IU/kg body weight, applicable to all age groups, including children, as stated in the guidelines from the Advisory Committee on Immunization Practices 1. Key points to consider in the administration of RIG for post-exposure prophylaxis include:
- The full dose of RIG should be thoroughly infiltrated in the area around and into the wounds if anatomically feasible.
- Any remaining volume should be injected intramuscularly at a site distant from vaccine administration.
- RIG should never be administered in the same syringe or in the same anatomical site as the vaccine.
- Proper wound cleansing before immunoglobulin administration is essential to reduce viral load at the exposure site. The complete post-exposure regimen includes both the immunoglobulin (given only on day 0) and a series of rabies vaccine doses (typically on days 0,3,7, and 14), providing both immediate passive immunity and long-term active immunity against rabies virus 1.
From the FDA Drug Label
If anatomically feasible, up to the full dose of HyperRAB S/D should be thoroughly infiltrated in the area around the wound and the rest should be administered intramuscularly in the deltoid muscle of the upper arm or lateral thigh muscle If anatomically feasible, the full dose should be infiltrated around the wound(s) and any remaining volume should be administered IM at an anatomical site distant from vaccine administration.
Rabies Immunoglobulin Administration:
- The answer is yes, rabies immunoglobulin injections can be administered into the wound, specifically by infiltrating the dose around the wound if anatomically feasible.
- The remaining volume should be administered intramuscularly at a distant site 2.
From the Research
Administration of Rabies Immunoglobulin
- Rabies immunoglobulin (RIG) injections are administered into the wound as part of post-exposure prophylaxis (PEP) against rabies 3, 4, 5.
- The World Health Organization (WHO) recommends local wound infiltration of RIG as the primary mechanism of protection, without distal intramuscular injection 4.
- Studies have shown that local infiltration of RIG can be an effective and cost-efficient approach for passive immunization against rabies, especially in cases where RIG is in short supply or unaffordable 3, 4.
- However, adherence to guideline recommendations for RIG administration, including wound infiltration, has been found to be lower than expected, with only 56% of eligible patients receiving RIG via infiltration into and around the wound in one study 5.
Dosage and Administration
- The dosage of RIG is typically calculated based on body weight, but studies have shown that local infiltration of RIG can be effective with smaller quantities, proportionate to the size and number of wounds 3, 4.
- The minimum dose of RIG given in one study was 0.25 ml, and the maximum dose was 8 ml, with an average of 1.26 ml per patient 3.
- RIG can be administered via infiltration into and around the wound, and this method has been shown to be effective in preventing rabies 3, 4, 5.