The following are scenarios where patients may have been exposed to rabies. Each situation is distinct, and an appropriate treatment approach requires a clear understanding of post-exposure prophylaxis (PEP) guidelines and options available.
Select from the options below to guide you to each individual profile.
While playing at a park with friends, Spencer went into a wooded area to retrieve a lost ball and encountered an aggressive raccoon. The animal attacked and Spencer fended it off by repeatedly kicking at it. Spencer, who had been wearing shorts, was left with multiple scratches on his right leg. A friend’s father brought Spencer to the ER.
Rabies PEP was administered based on the patient’s age and weight. The full dose of HRIG (5.4 mL) was administered carefully around all detectable wounds. A rabies vaccine was then injected intramuscularly into the deltoid muscle.
Weight: 89 lb/40.4 kg
Animal exposure: Raccoon
Wounds location: Right leg
A grandmother was babysitting her 11-month old grandson. While playing in the front yard, an unleashed dog came running over. Playful at first, it then aggressively pushed over the boy and bit him on both hands. Shocked, the grandmother called for an ambulance and they went to the ER.
Rabies PEP was administered (1.2 mL HRIG dose) based on the patient’s age and weight. Since the patient was young with low body weight – extra caution was taken to identify an appropriate HRIG product, its concentration, and any instructions for dilution, if needed.
Weight: 20 lb/9.1 kg
Animal exposure: Dog
Wounds location: Hands
Cassie was staying at a friend’s family vacation home and slept in a converted attic bedroom space. She woke early in the morning to the sound of something fluttering near the ceiling, but couldn’t see what it was. She then noticed 4-5 very small bite marks on her hand. After speaking to her friend’s family at breakfast, they decided to go to the ER to be safe.
Rabies PEP was administered (8.5 mL HRIG dose) based on the patient’s weight. HRIG was infiltrated thoroughly into and around all visible wounds and the remaining was given by the intramuscular route at a site distant from the site of the rabies vaccination.
Weight: 140 lb/63.5 kg
Animal exposure: Bat
Wounds location: Hand
Because HRIG can partially suppress active production of rabies virus antibodies, no more than the recommended dose should be administered.1,2
In a prospective study involving 100 high-risk injections (fingers and toes), no case of compartment syndrome was found. The study authors never encountered any cases of compartment syndrome during the past 2 decades.4
References: 1. KEDRAB [package insert]. Fort Lee, NJ: Kedrion Biopharma Inc.; 2021. 2. Centers for Disease Control and Prevention. Postexposure prophylaxis. Human Rabies Immune Globulin. https://www.cdc.gov/rabies/medical_care/hrig.html. Reviewed: April 22, 2011. Accessed October 19, 2020. 3. Billstein-Leber M, Carrillo CJD, Cassano AT, Moline K, Robertson JJ. ASHP Guidelines on Preventing Medication Errors in Hospitals. Am J Health Syst Pharm. 2018;75:1493-1517. doi:10.2146/ajhp170811. 4. Shantavasinkul P, Wilde H. Postexposure prophylaxis for rabies in resource-limited/poor countries. Adv Virus Res. 2011;79:291-307.