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Suggest Dosage For HRIG Vaccination

Posted on Thu, 5 Jan 2017

Question: Dear Doctor,

A few months ago I have received five shots of anti-Rabies vaccine.
I also received a shot of HRIG. However the dose of HRIG was 1) too low and 2) administer on the same site as the first vaccine.

What does this mean?
Does this mean the anti-Rabies schedule failed and should be start over? Or that it could have triggered an insufficient response at that specific time but the schedule itself was fine?

Am I fully immunized now? And in the case of a future bite, do I need to start post-exposure treatment again, or will a booster dose of two be sufficient?

Thanks in advance.

Best,

XXXX

Answered by Dr. Panagiotis Zografakis (4 hours later)

Brief Answer:
many questions, so please the complete answer...

Detailed Answer:
Hello,

HRIG should be injected around the injury and intramuscularly on a different site than the vaccine. Injecting them on the same site runs the risk of neutralizing the vaccine.

Current recommendations for vaccination include 4 (instead of 5) vaccinations so perhaps your immune status was OK after all.

In case of a future bite the recommendations for vaccinated individuals suggest two more shots of the vaccine for every subsequent exposure. Since your vaccination was not technically right, I would suggest repeating it all over again.

Keep in mind that there are not enough data to answer such questions with certainty because rabies is very difficult to study.

KInd Regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Panagiotis Zografakis (1 hour later)

Dear doctor,

Thank you for your answer.

I forgot to add that I already started over back then.
When I found out the HRIG had been administered at a wrong site, I ignored the first dose being given, and repeated it at a different site followed by the other shots of the 5 shots schedule in the weeks after.

So:
Day 0 -> Vaccine
Day 1 -> HRIG (had to find it)
Next day:
Day 0 -> Vaccine
Day 3 -> Vaccine
Day 7 -> Vaccine
etc.
etc.

Does this change the story?

Or should I have waited for a while longer?

Best,

XXXX

Answered by Dr. Panagiotis Zografakis (6 minutes later)

Brief Answer:
It does

Detailed Answer:
Thanks for the information. So you have completed vaccination... therefore after every new exposure two shots of the vaccine are required.

kind Regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Panagiotis Zografakis (7 hours later)

Dear Doctor,

Thanks. And My apologies again for leaving that part out first.
So it doesn't matter that I started over just a day later?

I am pretty sure that when I started over (which I have done indeed) it was at a different site. But maybe that also doesn't matter when starting over?

Best,

XXXX

Answered by Dr. Panagiotis Zografakis (11 hours later)

Brief Answer:
probably not

Detailed Answer:
You're welcome!

Regarding the delayed vaccination: it does matter but nobody can tell how much. Since the vaccine was administered one day before the immunoglobulin, it's possible that a big part of the vaccine was absorbed and became active but ... who can tell for sure?

I guess this answers your other question too.

Please let me know if you have more questions about it.

Kind Regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Panagiotis Zografakis (2 hours later)

I am not sure if I understand what you mean. What do you mean with the delayed vaccination?

What I actually mean was if I am considered to be fully immunized now? If it makes a difference that I started over the day after being given HRIG (and for ignoring the first dose being given the day before being given HRIG)

I indeed started a day before HRIG. This dose may or may not have failed. But for that reason I also started over with the vac. schedule the day after.

So:

Day 0 -> Vaccine (April 5)
Day 1 -> HRIG (had to find it) (April 6)
Next day:
Day 0 -> Vaccine (April 7)
Day 3 -> Vaccine (April 10)
Day 7 -> Vaccine (April 14)
etc.
etc.

Does it make a difference I started over the next day regardless of the site?

Answered by Dr. Panagiotis Zografakis (13 minutes later)

Brief Answer:
you're fully immunized

Detailed Answer:
I said 'delayed' vaccination because the first dose might have been less effective because it was injected on the same site as the immunoglobulin. In any case 4 doses are enough for your immunity (0,3,7,14) and the immunoglobulin can be given up to 7 days after the first vaccination. Obviously the sooner you get the immunoglobulin the better the protection...

There is no problem that you started over. You're considered immunized against rabies. For every subsequent suspicious exposure, two more injections should be done (vaccines only) on days 0 and 3.

I hope it's clear now!
Kind Regards!

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Panagiotis Zografakis (1 minute later)

Its completely clear, thanks a lot, for all your answers.

And you may close the discussion thats no problem the questions have been answered to my satisfaction.

Answered by Dr. Panagiotis Zografakis (5 minutes later)

Brief Answer:
you'welcome!

Detailed Answer:
Glad to help!
I can't close the discussion myself. You have to do it and also please rate the answers.

Kind Regards!

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar