The CDC's Advisory Committee on Immunization Practices recommends: "If anatomically feasible, the full dose of HRIG should be thoroughly infiltrated in the area around and into the wounds. Any remaining volume should be injected IM at a site from vaccine administration."1
Location: Westminster, Maryland
Incident: Margaret-Ellen, a college student, was on a walk with three friends in town. On a side street, they discovered a small, dirty, stray dog that they thought they might rescue and take to the dog shelter. When Margaret-Ellen leaned over to examine the dog, it snapped at her causing a wound on her nose and then ran away. The young woman immediately went to the local emergency room to have the bite taken care of.
Diagnosis: The doctor in the local emergency department confirmed that:
- Margaret-Ellen had not been previously vaccinated for rabies
- The dog could not be located
Treatment: The doctor thoroughly cleansed the small wound and infiltrated it with as much of the total dose of rabies immune globulin (HyperRAB® [rabies immune globulin (human)]) as possible . The total dose could not be infiltrated at the wound site, and the remainder of the total dose was given intramuscularly (IM) in the arm. The first dose of rabies vaccine was administered IM in the opposite arm.
Outcome: Thanks to the comprehensive treatment she received, Margaret-Ellen was able to return to her normal activities with friends at school.
Bats are the most common source of rabies exposures in the US; exposure to saliva from a bat, or other infected animal, through a mucous membrane can cause risk.1,2
The Hernandez Family*
Age: Rob and Tina and their 3 children
Location: Pine Forest, Texas
Incident: Rob and Tina were awakened in the night by their 5-year-old son saying there was a "bird" in the room that he shared with his 7-year-old brother. When they investigated, they discovered a bat flying around the room while their older son slept. They opened a window and allowed the bat to escape. Their 4-year-old daughter was asleep in the adjacent room. There were no evident wounds or scratches. Tina related the incident to a neighbor, who urged the family to seek emergency care.
Diagnosis: When the family arrived at the emergency department, the attending physician determined that:
- No family member had been previously vaccinated
- The animal could not be located
Treatment: Even though the rabies exposure may not have resulted in a wound, exposure to animal's (particularly a bat's) saliva through a mucus membrane or open skin carries high risk. Therefore, the doctor administered a rabies vaccine and a dose of rabies immune globulin (HyperRAB) to each family member. Because there were no evident wound sites, the total dose of rabies immune globulin was administered IM in the deltoid or IM in the arm.3
Outcome: Thanks to the comprehensive treatment the family received, they returned to home, confident that their family was protected.