RIG provides passive immunization and is administered only once, as soon as possible after the initiation of PEP and not beyond day 7 after the first dose of vaccine. Equine Rabies Immunoglobulin(eRIG) is less costly than Human Immunoglobulin(hRIG) and both have shown similar clinical outcomes in preventing rabies. As eRIG products are now highly purified, skin testing before administration is unnecessary and should be abandoned. There is poor correlation between skin sensitivity test dose and allergic reaction.
However the place where RIG is given should have facility for management of anaphylaxis.
To confer the maximum public health benefit, WHO recommends the following:
- The maximum dose is 20 IU (hRIG) and 40 IU (eRIG) per kg body weight. There is no minimum dose.
- Infiltrate into the wound. It is critical to provide rabies immunoglobulin at the site of bite.
Vaccines should never be withheld, regardless of the availability of RIG.
IAP Advisory Committee on Vaccines & Immunization (ACVIP) endorses the use of Rabies Human Monoclonal Antibody(RHMAB) as an alternative to Rabies Immuno Globulin (RIG) – human or equine – along with rabies vaccines in all category-III bites.
Preparation available as 2.5 ml vial with 100U RHMAB per vial.
The recommended dose is 3.33 IU/kg body weight, preferably at the time of the first vaccine dose, There is no Maximum ceiling dose of RHMAB.