Local infiltration of rabies immunoglobulins without systemic intramuscular administration: An alternative cost effective approach for passive immunization against rabies

Figures & data

Figure 1. The woman and her daughter were bitten by a clinically confirmed rabid stray dog on face in Kullu district in April 2015. Both were given Local RIGs with IDRV and survived. But a similar patient from another area Rampur (2014), who was bitten on lower lip by a suspected rabid stray dog and given IM rabies vaccine without local RIGs, died of Rabies within 2 weeks of the bite. This demonstrates the life saving value of local RIGs with IDRV.

Table 1. Inclusion and Exclusion criteria for the subjects recruited in the study.

Inclusion Criteria	Exclusion criteria
All category III exposures	Immunompromised
Seeking PEP with in 72 hours after bite ( with one exception)	Severe malnourishment
Willing to give consent	Any associated disease
Available for follow up	Follow up not possible
Willing to provide blood sample if required

Table 2. Demographic data of the patients included in the study (n = 269) in relation to amount of ERIG administered locally and percentage reduction in dose of ERIG.

Parameter	Number of patients	Average quantity of ERIG consumed	% reduction in dose of ERIG
Age of the patient
<5 yrs	25	1.5 ML	80%
5-10 yrs	40	2.0 mL	60%
10-15 yrs	30	3.5 mL	75%
>15 yrs	174	3.5 mL	80%
Biting Animal
Dogs	140	2.5 mL	80%
Monkeys	116	2.0 mL	75%
Cats	8	2.5 mL	80%
Mongoose	2	2.0 mL	80%
Pigs	3	2.5 mL	80%
Bite on face, head and neck with severe risk	25	3.5 mL	70%
Bites on upper limbs	35	2.5 mL	70%
Bites on lower limbs	55	2.0 Ml	60%
Bites on chest	15	2.0 ML	70%
Bites on abdomen	10	1.5 mL	80%

Table 3. Location of wound site and associated risk among those exposed to suspected rabid animal bites. The results clearly show that there was no immunosuppression with local RIGs and we did not exceed the total RIGs volume as prescribed by WHO.

Pt. ID	Delay in seeking treatment	Wound site	Animal	RIGs given locally in the wound	Day of blood sample	RFFIT titers (IU/ml)	Animal follow-up	Pt follow up at 9 months or more
DDU 3	1 DAY	Rt. Calf	Dog	4 ml	D 15	7.5	Healthy	Healthy
DDU 6	1 Day	Leg	Suspected Rabid Dog	2 ml	D 8	6.5	Rabid Killed by People	Still Healthy after 1 year
DDU 7	0	Arm	Monkey bite	1 ml	D 12	5.6	Could not be followed	Healthy
DDU 8	2 Days	Arm	Dog	0.25 ml	D 14	7.5	Healthy	Healthy
DDU 14	3 Days	Rt. Elbow	Monkey	2 ml	D 12	7.8	Could not be followed	Healthy
DDU 27	3 Days	Fingers Dot wound	Monkey	0.25 ml	D 14	14.5	Could not be followed	Healthy
DDU 28	1 Day	Lt. Gluteus	Stray Dog	0.5 ml	D 14	6.9	Could not be followed	Healthy
DDU 30	3 Days	Hands	Stray Dog	0.5 ml	D 14	7.9	Could not be followed	Healthy
DDU 46	1 Day	Dot wound on Rt Calf	Stray pup	0.25 ml	D 14	10.5	Could not be followed	Healthy
DDU 50	0	Scratch in the back	Monkey	0.5 ml	D 14	4.5	Could not be followed	Healthy
DDU 54	3 Days	Dot wound fingers	Stray Dog	1 ml	D 14	7.5	Could not be followed	Healthy
DDU 69	0	Below Rt knee	Stray Dog	2 ml	D 14	30	Could not be followed	Healthy
DDU 75	2 Days	Below Rt knee	Stray Dog	1 ml	D 14	14.5	Could not be followed	Healthy
DDU 77	3 days	Lt leg	Dog	0.5 ml	D 14	15.6	Healthy	Healthy
DDU 78	0	Lt. gluteus	Stray Dog	1 ml	D 14	7.5	Could not be followed	Healthy
DDU 79	1 Day	Rt. Knee	Dog	1 ml	D 14	15.6	Healthy	Healthy
DDU 81	2 Days	Hands	Monkey	0.5 ml	D 14	7.5	Could not be followed	Healthy
DDU 119	0	Rt Foot	Dog	0.25 ml	D 14	7.5	Healthy	Healthy
DDU 133	0	Lt. Thigh and Lt. Arm 6x3x3	Wild Pig	8 ml diluted in 20 ml as pt. wt was 60 kg	D 10	8.5	Could not be followed	Healthy
DDU 152	1 Day	Hand	Stray Dog	0.25 ml	D 14	13.5	Could not be followed	Healthy
DDU 154	2 Days	Rt thigh	dog	0.25 ml	D 14	4.5	Healthy	Healthy
DDU 160	2 Days	Rt Arm	Monkey	3 ml	D 14	14.5	Could not be followed	Healthy
DDU 161	2 Days	Lt Arm	Monkey	0.25 ml	D 14	7.5	Could not be followed	Healthy
DDU 172	2 Days	Rt. Arm	dog	0.5 ml	D 14	12.8	Healthy	Healthy
DDU 180	0	On back	Stray Dog	0.5 ml	D 14	12.5	Could not be followed	Healthy
DDU 211	0	Lt. leg	Monkey	0.1 ml	D 14	13.4	Could not be followed	Healthy
DDU 248	2 Days	Lt. Hand	Dog	0.3 ml	D 14	12.5	Healthy	Healthy
DDU 319	0	Leg	Stray Dog	0.25 ml	D 14	12.5	Could not be followed	Healthy
DDU 384	73 Days	Rt. Hand Dorsum	Rabid pup of 2 months old	2 ml given in the scar due to pup bite	D 8	12.5	Pup rabid and died soon after	Healthy
DDU 324	0	Leg	Monkey	7 ml	D 14	14.5	Could not be followed	Healthy