Rabies immunoglobuan(RIG)

🦠 Rabies Immunoglobulin (RIG) - Essential for Post Exposure Prophylaxis (PEP)

**Rabies immunoglobulin (RIG)** is equally important as **vaccination** in **Category 3 exposures**, which include:

  • Transdermal **scratches/bites**.
  • Contamination of **mucous membranes**.
  • Animal **licks on broken skin**.

Previously, we had **equine RIG** and **human RIG**, both of which had limitations:

  • 🐎 **Equine RIG** - Risk of **significant hypersensitivity**.
  • 🧬 **Human RIG** - **Limited availability & high cost**.

However, **monoclonal antibodies (mAbs)** have proven to be a **game changer** in **post-exposure prophylaxis (PEP)**.

In India, **Rabishield** and **Twinrab** are the two brands available for **mAb-based RIG**.

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💉 How & When to Administer Rabies Immunoglobulin (RIG)?

**RIG should be administered immediately** along with the **rabies vaccine** but using a **separate syringe**.

  • **Majority of RIG** must be **infiltrated at the wound site**.
  • If **excess remains**, administer **intramuscularly (IM)** at a **distant site**.

⏳ Why is Passive Immunization Needed?

Since **active immunity** takes time after vaccination, **passive immunization with RIG neutralizes the virus** in the early phase.

🕒 When Should RIG Be Given?

  • **Preferably with the first dose of the vaccine (Day 0).**
  • Can be **given later**, but **not after 1 week** (as it may suppress immune response development).

📅 Rabies Vaccine Schedule

**Regular vaccination schedule for immunocompetent individuals**:

  • 💉 **4 doses on** Day **0, 3, 7, 14**.

**For immunosuppressed individuals**:

  • 💉 An **additional dose** on **Day 28** is required.

**For those who previously had PEP**:

  • 🚫 **RIG is NOT indicated.**
  • 💉 **Only 2 doses** on **Day 0 and Day 3** are sufficient.

📢 Key Takeaways

  • ✔ **RIG is essential for Category 3 exposures**.
  • ✔ **Administer with the first vaccine dose** (Day 0) when possible.
  • ✔ **Use monoclonal antibodies (mAbs) like Rabishield & Twinrab**.
  • ✔ **Follow proper vaccine schedules based on immunocompetence.**

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