(2) Human rabies immune globulin (HRIG). HRIG is human anti-rabies
gammaglobulin concentrated by cold ethanol fractionation from plasma of
hyperimmunized human donors. The rabies neutralizing antibody content is
standardized to contain 150 international units (IU) per ml. HRIG is an immunizing
agent given after an individual has been exposed to rabies.
(a) Post-exposure regimen. Begin by an immediate, thorough
cleansing and flushing with soap or detergent and water of all wounds caused by a bite
or scratch of an animal. Do not suture the wound unless it is unavoidable for cosmetic
or tissue support reasons. If sutures have been necessary, however, replace them after
antiserum has been administered locally. Be sure the new sutures are loose and
noninterfering so that the wound is still able to drain and bleed.
(b) For persons previously immunized by the recommended regimen
with Human Diploid Cell Rabies Vaccine (HDCV) or who have previously demonstrated
rabies antibodies, administer a dose of 1.0 ml of HDCV on day zero and day three. Do
not give Rabies Immune Globulin (RIG).
(c) If the immune status is not known, the full post-exposure regimen
may be necessary. If sufficient antibody can be demonstrated from a serum sample,
treatment can be discontinued after at least two doses of HDCV has been administered.
(d) Persons not previously immunized will receive rabies immune
globulin (RIG), 20 IU per kilogram or body weight, one half infiltrated at the site of the
bite (if possible) and the remainder administered intramuscularly.
(e) Anti-rabies serum (ARS) derived from horses was replaced by
human RIG, and ARS is now obsolete. In the event that ARS is the only passive
immunization agent available (in a third world country, for example), administer or test
the dose as for any equine serum product.
(f) NOTE: Human Diploid Cell Rabies Vaccine (HDCV). HDCV is an
inactivated virus vaccine, prepared from fixed rabies virus grown in human diploid
culture. Fewer doses are required to establish protection, and reactions at the site of
vaccination are minor. This vaccine can be used as a preventive measure against
rabies and can be offered to people in high risk groups--veterinarians, animal handlers,
certain lab workers, and persons spending more than thirty days in foreign countries
where rabies is a constant threat. (In the last instance, immunization should be given to
young children since they might not want to identify a potentially rabid animal.) Also,
(dogs, cats, foxes, skunks, bats, or any other species at a risk of having rabies) should
be considered for pre-exposure immunization. Presently, the United States Army
regards special forces soldiers in this category and requires them to receive and
complete the pre-exposure series. Additionally, HDCV is readily available to anyone
considered at risk. The pre-exposure dosage regimen of HDCV is 1.0 ml given
intramuscularly on days 0, 7, and 21 or 28. If the quantity of antibodies (titer) falls below
1:5, booster vaccine may be needed.