- Multiple transdermal bites or scratches
- Contamination of mucous membrane with saliva
- Severe bites located on the face, head, neck and hands
- When the domestic or wild animal responsible cannot be examined or is infected or suspected to be infected by the rabies virus
- Bites to young children
Rabies immunoglobulin provides passive immunization against rabies for prevention of rabies in patients after contact with a rabid animal or an animal presumed to be rabid. Anti rabies serum itself does not constitute an anti rabies treatment and should always be used in conjunction with rabies vaccine.
Dosage & Administration
The recommended dose for both adults and children is 40 lU/kg of body weight. If anatomically feasible, as much as possible of the dose should be infiltrated around and into the wound(s). The remainder should be administered intramuscularly (into the gluteal region) in a single injection.
However, for children, particularly in the case of multiple wounds, it has been proposed to dilute the dose 2-3 times in a 0.9% sodium chloride solution to obtain a sufficient quantity of equine Rabies Immunoglobulin to infiltrate the wound(s) correctly. Wounds in certain anatomical sites (fingertips) should be infiltrated with care so as to prevent a local increase in pressure in the tissue.
For prevention of rabies, combined immunoglobulin-vaccine treatment is recommended. The 1st dose of the rabies vaccine should be given at the same time as the Rabies Immunoglobulin, but in different parts of the body. If Rabies Immunoglobulin is not available when the rabies vaccine is administered, it can be administered up to the 7th or 8th day after the first dose of rabies vaccine. When indicated, begin anti-tetanus treatment and administer anti-microbial drugs to control infections other than rabies.
The WHO expert committee on rabies has issued the following therapeutic recommendations:
Touching or feeding of animal, licks on intact skin:
- Recommended treatment: None, if reliable case history is available.
Nibbling of uncovered skin, minor scratches superficial bites (except on head, neck, shoulder girdle,arms or hands) or abrasions without bleeding, licks on broken skin.
- Recommended treatment: Administer vaccine immediately on Day 0, D3, D7, D14 and D28.Stop treatment if animal remains healthy throughout the observation period of 10 days or if animal is killed humanely and found to be negative by appropriate laboratory techniques.
Single or multiple transdermal bites or scratches specially on head, neck, shoulder girdle,arms or hands. Contamination of mucus membrane with saliva (i.e. licks on broken skin).
- Recommended treatment: Administer rabies vaccine immediately on Day 0, D3, D7, D14 and D28 or D90 (optional) and Rabies Immunoglobulin on DO immediately. Stop treatment if animal remains healthy throughout the observation period of 10 days or if animal is killed humanely and found to be negative by appropriate laboratory techniques.