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 against rabies), 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

Dosage 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(s), which has been 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 the 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, it is not necessary to administer rabies immunoglobulin as 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 (pain, inflammation); 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 (risk of shock).
• 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

Remarks

• 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.

Storage