Human Rabies Immune Globulin (HRIG)

The CDC recommends that a total dose (20 IU/kg) always be administered. Dosing must remain consistent despite variations in strength or formulation. Any remaining volume following infiltration of the wound should be injected intramuscularly (IM) at a site distant from vaccine administration.1

Gloved hands of a medical professional filling syringe from a vial of HyperRab® (rabies immune globulin [human])

Infiltration Matters

When administering RIG, focus on neutralizing the virus:

  • The highest viral load occurs at the wound site(s)
  • The CDC recommends that, if anatomically feasible, the full dose of RIG should be thoroughly infiltrated in the area around and into the wound(s)1
  • The most commonly encountered causes of PEP management failures are when RIG is not used at all, it is injected only IM and not into wound(s), or not all bite wound(s) are injected2

HRIG Volume Matters

Weight-based dosing can create challenges with the volume required to be administered in a total dose:

  • Anatomical constraints of some wounds (eg, ear, nose, or finger) can limit the portion of the dose that can be injected3,4
  • Risk of compartment syndrome should be minimized when possible4

HyperRAB® (rabies immune globulin [human]) is designed to help alleviate the most common administration challenges

Calculate HyperRAB Dosage

Dosing and Administration Recommendations

HyperRAB, at 300 IU/mL, is a higher-potency product that allows you to deliver more of the total dose per mL at the wound site.5

General Guidelines (Previously Unvaccinated Adults and Children)1,5

  • HyperRAB (300 IU/mL), supplied in 1-mL, 3-mL, and 5-mL vials, for twice the potency of alternatively available HRIG options
  • The recommended dose for HyperRAB is 20 IU/kg< (0.0665mL/kg) of body weight, given preferably at the time of first vaccine
  • HyperRAB should be administered as promptly as possible after exposure, but can be administered within 7 days after the first dose of the rabies vaccine
  • HyperRAB and vaccine should never be administered in the gluteal area

Severe hypersensitivity reactions may occur with HyperRAB. Patients with a history of prior systemic allergic reactions to human immunoglobulin preparations are at a greater risk of developing severe hypersensitivity and anaphylactic reactions. Have epinephrine available for treatment of acute allergic symptoms should they occur.5

What You Need to Know About Effectively Administering Rabies Vaccines

Vaccine Administration

Important Safety Information for HyperRAB® (rabies immune globulin [human])

Indication and Usage
HYPERRAB® (rabies immune globulin [human]) is indicated for postexposure prophylaxis, along with rabies vaccine, for all persons suspected of exposure to rabies.

Limitations of Use
Persons who have been previously immunized with rabies vaccine and have a confirmed adequate rabies antibody titer should receive only vaccine. For unvaccinated persons, the combination of HYPERRAB and vaccine is recommended for both bite and nonbite exposures regardless of the time interval between exposure and initiation of postexposure prophylaxis. Beyond 7 days (after the first vaccine dose), HYPERRAB is not indicated since an antibody response to vaccine is presumed to have occurred.

Important Safety Information

For infiltration and intramuscular use only.

Severe hypersensitivity reactions may occur with HYPERRAB. Patients with a history of prior systemic allergic reactions to human immunoglobulin preparations are at a greater risk of developing severe hypersensitivity and anaphylactic reactions. Have epinephrine available for treatment of acute allergic symptoms, should they occur.

HYPERRAB is made from human blood and may carry a risk of transmitting infectious agents, eg, viruses, the variant Creutzfeldt-Jakob disease (vCJD) agent, and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent.

The most common adverse reactions in >5% of subjects during clinical trials were injection-site pain, headache, injection-site nodule, abdominal pain, diarrhea, flatulence, nasal congestion, and oropharyngeal pain.

Do not administer repeated doses of HYPERRAB once vaccine treatment has been initiated as this could prevent the full expression of active immunity expected from the rabies vaccine.

Other antibodies in the HYPERRAB preparation may interfere with the response to live vaccines such as measles, mumps, polio, or rubella. Defer immunization with live vaccines for 4 months after HYPERRAB administration.

Please see full Prescribing Information for HYPERRAB.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088

References

  1. Manning SE, Rupprecht CE, Fishbein D, et al. Human rabies prevention—United States, 2008: recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2008;57(RR-3):1-28.
  2. Wilde H. Failure of rabies post-exposure prophylaxis. Vaccine. 2007;25(44):7605-7609.
  3. Madhusudana SN, Ashwin BY, Sudarshan S. Feasibility of reducing rabies immunoglobulin dosage for passive immunization against rabies: results of in vitro and in vivo studies. Hum Vaccin Immunother. 2013;9(9):1914-1917.
  4. SAGE Working Group on Rabies vaccines and immunoglobulins and the World Health Organization (WHO) Secretariat. Background paper: proposed revision of the policy on rabies vaccines and rabies immunoglobulins. September 22, 2017. Accessed April 23, 2020. http://www.who.int/immunization/sage/meetings/2017/october/1_Background_paper_WG_RABIES_final.pdf.
  5. HyperRAB (rabies immune globulin [human]) Prescribing Information. Grifols.