DETERMINATION OF OPTIMAL RABIES IMMUNOGLOBULIN (RIG) VOLUME FOR LOCAL WOUND MANAGEMENT OF ANIMAL BITES IN CHILDREN AND ADOLESCENTS

Rabies is a viral zoonotic disease.It transmits through infected saliva via bites or scratches

from rabid animals (in particular dogs).Rabies is an invariably fatal disease. An unknown number of humans die of rabies every year

worldwide. News media often estimate 40,000 to 60,000 annual human cases worldwide.

India alone reports approximately 20,000 deaths annually.Rabies immune globulin (RIG) is an essential part of postexposure rabies treatment.It

provides protection against the virus during the first 10–14 days after exposure, and before

endogenous neutralizing antibodies are formed in response to vaccination.RIG, that is

injected into and around the virus inoculation sites,which saves lives. One-half of the RIG

should be injected into the bite wounds and the rest intramuscularly,at a different site than

vaccine.This injection is often performed into the gluteal region; a site which except in the

very lean, contains a thick fat layer.RIG,injected at sites other than the wounds,has any

value in neutralizing virus.HRIG is manufactured from non-UK human blood products. The final formulation is a liquid

and the potency of the material is assessed in international units (IU/ml). The maximum dose

is 20IU/kg, adults and children (all ages), and should not be exceeded as it may inhibit the

immune response to rabies vaccine.

WHO Expert Committee’s recommendation was changed from intramuscular administration

to one where ‘as much as possible’ of the calculated dose of RIG was to be injected into and

around the wound.The dose was, and remains, calculated on the basis of body weight,

suggesting that these recommendations have been trapped in their own irrational history.

Recognising that dog bites vary in number, size and location, these recommendations allow

RIG to be diluted in saline to ensure there is sufficient volume to inject into all wounds.

Curiously, where the wound is too small to take the whole dose, it is still stated that the

residue is to be inoculated into a distal site, even though it is accepted that this will not result

in a significant circulation antibody level.

so we are conducting this study to find out the optimal dose of rabies immunoglobulin (RIG) volume for local wound management of animal bites in children and adolescents.