WHAT IS AN ACCEPTABLE DELAY IN RABIES IMMUNE GLOBULIN ADMINISTRATION WHEN VACCINE ALONE HAD BEEN GIVEN PREVIOUSLY

Rabies immune globulins (RIG) are not always available. Rabies-exposed patients often present to medical centers, particularly in canine rab ies infested regions, after a vaccine series has been started without immune globulin administration. It is known that rabies immune globuli n can result in suppression of the neutralizing antibody response whic h usually yields detectable antibodies by day 7. We have shown that it can be administered with a delay of up to 5 days after the start of v accine treatment without significant antibody suppression within the f irst month, This study utilized the WHO approved multisite Thai Red Cr oss intradermal postexposure regimen. Effective use of rabies immune g lobulin in severe and multiple wounds, particularly in small children, may require dilution of the RIG in normal saline to provide a volume adequate for infiltration of all wounds. Copyright (C) 1996 Elsevier S cience Ltd.