When is rabies immune globulin contraindicated

A separate, sterile syringe and needle MUST be used for each patient. Administer rabies immune globulin, human RIG at same time as first dose of rabies vaccine or up to 7 days after first dose of rabies vaccine. Do not administer rabies immune globulin, human RIG in the same syringe or with the same needle as the rabies vaccine.

Never administer rabies immune globulin, human RIG at the same anatomical site as the rabies vaccine. Infiltrate as much of the dose as possible in and around any detectable bite wounds. If using HyperRAB solution i. DO NOT dilute with normal saline. Inject any remaining volume intramuscularly. Administer any excess dose not able to be injected in and around the bite wounds IM, using a separate needle, at a site distant from the rabies vaccine administration site.

When the bite site is unknown or indeterminate undetectable , administer the full dose IM at a site distance from the rabies vaccine administration site. The preferred injection sites are the upper arm deltoid region, or in small children, the anterolateral aspect of the thigh. Unless the exposure site is the gluteal region, avoid administration into the gluteal region, where absorbance is unpredictable. If a large IM volume is required i.

Although there are no clinical efficacy data supporting subcutaneous administration of rabies immune globulin, human RIG, Kedrab may be administered subcutaneously in patients for whom IM injections are contraindicated e. Rabies immune globulin, human RIG is indicated for intramuscular IM administration and, thus, should be given cautiously to persons receiving anticoagulant therapy.

Also, patients with thrombocytopenia, coagulopathy e. All steps to avoid hematoma formation are recommended. In patients for whom intramuscular administration is contraindicated, KedRAB may be administered subcutaneously; however, it should be noted that there are no clinical efficacy data supporting subcutaneous administration of rabies immune globulin, human RIG.

Use rabies immune globulin, human RIG with caution and monitor patients with a history of prior systemic allergic reactions for hypersensitivity after administration. Do not administer rabies immune globulin, human RIG intravenously. Intravenous administration of rabies immune globulin, human RIG increases the risk for severe allergic or hypersensitivity reactions, including anaphylactic shock. Rabies immune globulin, human RIG can precipitate a drop in blood pressure associated with an anaphylactic reaction, even in patients who tolerated previous immune globulin therapy.

Immediately discontinue rabies immune globulin, human RIG if an allergic or anaphylactic reaction develops. In case of shock, implement standard medical treatment. The patient or responsible adult should report any adverse reaction after rabies immune globulin, human RIG administration to the health care provider.

This includes, but is not limited to, the reporting of events required by the National Childhood Vaccine Injury Act of Weigh the benefits of rabies immune globulin, human RIG administration against the potential risks of hypersensitivity reactions in patients with IgA deficiency. Patients who are deficient in IgA have the potential to develop IgA antibodies and may have anaphylactic reactions after administration of blood products containing IgA, such as RIG.

Rabies immune globulin, human RIG is a derivative of human blood. As with other products derived from or purified with human blood components, the remote possibility of contamination with hepatitis, Creutzfeldt-Jakob disease CJD , and other bacterial or viral infections exists in patients receiving rabies immune globulin, human RIG.

Screening plasma donors for prior exposure to certain viruses, testing for the presence of viruses, and inactivating or reducing viruses has reduced the risk of transmission of infectious agents.

The manufacturing processes are designed to reduce the risk of transmitting viral infection; however, none of the processes are completely effective. Some viruses, such as parvovirus B19, are particularly difficult to remove or inactivate.

Parvovirus B19 most seriously affects pregnant women and immune compromised individuals and symptoms include fever, drowsiness, chills, and rhinitis followed in about 2 weeks with rash and joint pain.

There is also the possibility that unknown infectious agents may be present in this product. Discuss the risks and benefits of rabies immune globulin, human RIG therapy prior to administration. Patients and caregivers should be encouraged to notify their health care provider if they develop infectious symptoms. All infections thought to have been transmitted by rabies immune globulin, human RIG should be reported to the manufacturer. After rabies immune globulin, human RIG administration, a transient increase of the concentrations of the passively transferred serum antibodies may result in misleading positive serologic tests.

Passive transmission of antibodies to erythrocyte antigens may result in laboratory test interference for red cell antibodies such as the antiglobulin test Coombs' test. Hemolysis may occur in patients receiving immune globulins. Patients at increased risk include those with non-O blood group types, those with underlying inflammatory conditions, and those receiving high cumulative doses of immune globulins over several days.

Clinical signs and symptoms of hemolysis include fever, chills, and dark urine. If any of these occur, perform appropriate laboratory testing, and administer medical therapy as indicated.

Monitor patients at increased risk for thrombosis or thrombotic complications for at least 24 hours after receiving rabies immune globulin, human RIG. Patients at increased risk for thrombosis include patients with acquired or hereditary hypercoagulable states, prolonged immobilization, in-dwelling vascular catheters, advanced age geriatric , estrogen use, history of venous or arterial thrombosis, cardiovascular risk factors e.

Before administering rabies immune globulin, human RIG to patients at risk for hyperviscosity, consider measuring baseline blood viscosity. It is not known if rabies immune globulin, human RIG can cause fetal harm when administered during pregnancy or affect reproductive capacity. Rabies immune globulin, human RIG has not been studied in pregnant women, and animal developmental or reproduction toxicity studies with rabies immune globulin, human RIG have not been conducted.

Use rabies immune globulin, human RIG during pregnancy only if clearly needed. Because of the potential consequences of inadequately treated rabies exposure, pregnancy is not considered a contraindication to use of postexposure prophylaxis regimens. Immunoglobulins, such as the rabies immune globulin, are excreted in human milk. Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for rabies immune globulin, human RIG and any potential adverse effects on the breast-fed child from rabies immune globulin, human RIG or from the mother's underlying condition.

In general, given the potential severity of the illness, postexposure regimens using rabies immune globulin, human RIG in an exposed mother should be pursued, regardless of lactation status. Antibodies in RIG may interfere with the immune response to the live virus vaccine.

According to the Advisory Committee on Immunization Practices, if the measles virus vaccine, live attenuated is administered less than 4 months after receipt of RIG, the vaccine dose should be repeated unless serologic testing is feasible and indicates a response to the vaccine.

The repeat dose and serologic tests must be performed 4 months or more after RIG administration. Major Defer immunization with mumps virus vaccine, live for 4 months after rabies immune globulin, human RIG administration. According to the Advisory Committee on Immunization Practices, if the mumps virus vaccine, live is administered less than 4 months after receipt of RIG, the vaccine dose should be repeated unless serologic testing is feasible and indicates a response to the vaccine.

Patients who are immunosuppressed by disease or medications should postpone preexposure vaccinations and consider avoiding activities for which rabies preexposure prophylaxis is indicated. When this course is not possible, immunosuppressed persons who are at risk for rabies should be vaccinated by the IM route and their antibody titers checked. Failure to seroconvert after the third dose should be managed in consultation with their physician and appropriate public health officials.

Because of the potential consequences of inadequately treated rabies exposure, pregnancy is not considered a contraindication to postexposure prophylaxis. Several studies have shown no indication of increased incidence of abortion, premature births, or fetal abnormalities associated with rabies vaccination. If the risk of exposure to rabies is substantial, preexposure prophylaxis might also be indicated during pregnancy. Rabies exposure or diagnosis of rabies in the mother is not an indication for pregnancy termination.

People who have a history of serious hypersensitivity to components of rabies vaccine should be revaccinated with caution. However, if severe allergic reactions occur it may be advisable to switch to the alternate vaccine to complete the series.

For assistance with problems or questions about rabies prophylaxis, contact your local or state health department. If local or state health department personnel are unavailable, call CDC at during working hours or during nights, weekends, and holidays.

Skip directly to site content Skip directly to page options Skip directly to A-Z link. Section Navigation. Facebook Twitter LinkedIn Syndicate. Immunosuppression Immunosuppressive agents should not be administered during postexposure therapy unless essential for the treatment of other conditions.