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Injecting rabies immunoglobulin (RIG) into wounds only: A significant saving of lives and costly RIG.

Omesh Kumar Bharti1, Shampur Narayan Madhusudana2, Henry Wilde3

  • 1a State Intra-dermal Anti-rabies Clinic and Research Centre, DDU Zonal Hospital Shimla, Government of Himachal Pradesh , Shimla , India.

Human Vaccines & Immunotherapeutics
|March 10, 2017
PubMed
Summary

In 2014, Himachal Pradesh faced a shortage of rabies immunoglobulin (RIG). A limited supply of equine rabies immunoglobulin (eRIG) was used for severe dog bites, followed by vaccination, with all patients surviving.

Keywords:
RabiesRabies immunoglobulinanimal bitespost-exposure prophylaxiswound injection

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Area of Science:

  • Veterinary Medicine
  • Public Health
  • Infectious Diseases

Background:

  • Increasing dog bite cases in Himachal Pradesh in 2014 presented a critical public health challenge.
  • There was a severe shortage of rabies immunoglobulin (RIG), a crucial post-exposure prophylaxis for rabies.
  • A limited supply of equine rabies immunoglobulin (eRIG) was available from the Central Research Institute (CRI), Kasauli.

Purpose of the Study:

  • To evaluate the emergency use of available equine rabies immunoglobulin (eRIG) in severe dog bite victims.
  • To assess the efficacy of rabies vaccination schedules following eRIG administration.
  • To determine the outcomes for patients receiving eRIG and subsequent rabies vaccination.

Main Methods:

  • Equine rabies immunoglobulin (eRIG) was administered via local infiltration to 269 severe dog bite patients.
  • All patients received rabies vaccination according to the World Health Organization (WHO) approved intra-dermal Thai Red Cross Society schedule.
  • A subgroup of 26 patients with laboratory-confirmed rabid dog bites were specifically monitored for over one year.

Main Results:

  • The emergency use of eRIG and subsequent vaccination was implemented for 269 patients.
  • A subgroup of 26 patients, severely bitten by confirmed rabid dogs, received this treatment.
  • All 26 patients in the monitored subgroup survived the follow-up period of over one year.

Conclusions:

  • The emergency administration of equine rabies immunoglobulin (eRIG) combined with WHO-approved rabies vaccination proved effective in preventing rabies.
  • This approach demonstrated successful outcomes even with limited immunoglobulin availability.
  • The study highlights the importance of accessible rabies prophylaxis in managing dog bite incidents.