HRIG Eligibility After 7 Days Post-Exposure
No, a patient who presents more than 7 days after animal bite exposure should NOT receive HRIG, but must still receive the full rabies vaccine series immediately. 1
Critical Timing Window for HRIG
HRIG can be administered up to and including day 7 of the postexposure prophylaxis series. 1
Beyond the seventh day, HRIG is NOT indicated because an antibody response to the cell culture vaccine is presumed to have occurred by that time. 1
The rationale for this cutoff is that active antibody production from the vaccine series typically begins within 7 days, making passive immunization with HRIG unnecessary and potentially counterproductive. 1
What TO Do for Patients Presenting After Day 7
Initiate or continue the full rabies vaccine series immediately, regardless of delay—even if months have passed since exposure. 2, 3, 4
For previously unvaccinated persons presenting late, administer a 4-dose vaccine regimen on days 0,3,7, and 14 (using the day of presentation as day 0). 2, 4
Do NOT administer HRIG if more than 7 days have elapsed since the first vaccine dose was given. 1, 4
Critical Pitfall to Avoid
Never delay vaccine administration while debating HRIG eligibility. The vaccine series is the cornerstone of protection and should begin immediately upon presentation, regardless of timing. 3, 4
HRIG can partially suppress active antibody production, which is why exceeding the recommended dose or administering it beyond day 7 is contraindicated. 1
Why Treatment Should Still Proceed
Rabies incubation periods can range from days to over 1 year in humans, making delayed treatment potentially life-saving even after significant time has passed. 2, 3, 5
PEP should be initiated regardless of the interval from exposure, as long as clinical rabies symptoms have not yet appeared. 2, 3, 4
Modern postexposure prophylaxis has proven nearly 100% successful when administered properly, even with delays in initiation. 4