From the Guidelines
Yes, rabies immunoglobulin (RIG) should be infiltrated into and around the wound site as part of post-exposure prophylaxis for rabies. When administering RIG, the full dose should be thoroughly infiltrated into the wound area if anatomically possible, with any remaining volume injected intramuscularly at a site distant from the rabies vaccine injection. The standard dose is 20 IU/kg body weight of human rabies immunoglobulin (HRIG) as recommended by the most recent guidelines 1. This local administration is crucial because RIG provides immediate passive immunity by neutralizing the virus at the entry site before it can enter the nervous system. The rabies virus travels through peripheral nerves to the central nervous system, so infiltrating the wound with immunoglobulin helps intercept the virus before this occurs. This wound infiltration should be done in conjunction with rabies vaccine administration (given in the deltoid muscle) as soon as possible after exposure, ideally within 24 hours, though it should not be withheld even if delayed. Key considerations for RIG administration include:
- The dose should not exceed the recommended amount to avoid suppressing active antibody production 1.
- RIG should not be administered in the same syringe or at the same anatomical site as the first vaccine dose 1.
- For previously vaccinated individuals, HRIG is not indicated as part of post-exposure prophylaxis 1. Given the potential for rabies to be fatal if not promptly treated, adherence to these guidelines is critical for preventing the disease and ensuring the best outcomes in terms of morbidity, mortality, and quality of life.
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) is administered into the wound as part of post-exposure prophylaxis (PEP) against rabies 3, 4, 5, 6, 7
- The World Health Organization (WHO) recommends local wound infiltration of RIG as the primary mechanism of protection, without distal intramuscular injection 7
- Studies have shown that local infiltration of RIG can be an effective and cost-effective approach for passive immunization against rabies 3
- The dose of RIG administered into the wound can vary depending on the size and number of wounds, as well as the patient's body weight 3, 4, 6
Wound Infiltration Techniques
- Wound infiltration of RIG can be performed using a variety of techniques, including injection into and around the wound 4, 5, 6
- The use of small-volume doses of RIG for wound infiltration has been shown to be effective in preventing rabies 3, 6
- Large-volume doses of RIG may not be necessary for wound infiltration, and may even lead to suboptimal care 7