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Human rabies immune globulin, also known as HRIG, is often recommended after an animal bite or scratch when there is a concern for rabies exposure. Receiving HRIG helps prevent the spread of the rabies virus by using antibodies (immune cells) already “programmed” to recognize and eliminate the virus.
Rabies infections can be life-threatening because once the rabies virus reaches the central nervous system, nearly 100% of cases are fatal. That’s why quick action to receive human rabies immune globulin and human rabies vaccine can be lifesaving.
I Was Bitten by an Animal, What Should I Do?
Not every person bitten or scratched by an animal needs HRIG and rabies vaccinations; it’s best to first contact your state or county public health department. Most public health offices will ask the person bitten a series of questions like these;
- type of animal (domestic or wild)
- if the animal can be sent for rabies testing
- where the bite occurred
- how long ago the bite occurred
- if animal was a pet and vaccinated against rabies
- if the person has previously received the rabies vaccine
In Massachusetts, when an animal bite occurs and there is concern for rabies exposure, contact the State Epidemiologist within the Department of Public Health at (617) 983-6800.
Keep in mind, it’s important to contact public health right away for an opinion. In general, if the bite or scratch was from a wild animal, especially a bat, coyote, fox, racoon, or skunk, there is more urgency to receiving treatment. If you find a bat in your home, it’s a good idea to trap the animal for rabies testing later.
Where Can I Find Rabies Immune Globulin?
HRIG is typically only available at the Emergency Room (ER). Most Urgent Care and physician offices do not have rabies immune globulin available because the cost of purchase is very high and it is not a commonly requested service. Contacting the ER before arriving may be helpful to avoid long wait times.
How is HRIG Given?
The rabies immune globulin is given as a single or multiple injections depending on location of the wound. If there is not enough tissue surrounding the wound, such as a finger, or when a bite location is not obvious or unknown (bats), rabies immune globulin is typically administered in the deltoid muscle of the arm. The amount of HRIG needed depends on the person’s weight.
How Much Does HRIG Cost?
Unfortunately, human rabies immune globulin can be very costly, so it’s important to contact your health insurance to discuss your coverage benefits. Most health insurance plans consider HRIG medically necessary but you may still be responsible for the ER co-payment or cost to reach an out-of-pocket maximum. Discuss with your health insurance representative that you have been recommended to receive HRIG because of a possible rabies exposure and need to be seen at the ER.
Do I Need a Rabies Vaccine at the Same Time as Immune Globulin?
Yes, in addition to HRIG, you will receive the 1st dose of human rabies vaccine. Rabies vaccination is needed to provide a longer-lasting immune response against the rabies virus to ensure you do not develop a rabies infection. Rabies immune globulin provides immediate but only short-term protection against infection, so it’s important to receive both HRIG and rabies vaccination at the same time.
CDC sets the guidelines for all US healthcare providers to follow after a known or suspected rabies virus exposure. Rabies Post-exposure Prophylaxis (PEP) includes cleansing of wound, receipt of HRIG, and rabies vaccinations.
I Was Vaccinated Against Rabies for Work, Do I Still Need HRIG After an Animal Bite?
Receiving the human rabies vaccines before an animal bite occurs is called pre-exposure prophylaxis (PrEV). Many people who work in veterinary medicine or travel internationally have already received a series of rabies immunizations. For these individuals, rabies immune globulin is not recommended after a possible rabies exposure. Instead, you should receive two rabies vaccines separated by three days.
How Many Doses of Rabies Vaccines Do I Need After an Animal Bite?
A total of four rabies vaccinations are needed over a two week period. The 1st rabies vaccination (given at the same time as HRIG) is called “Day 0”. Additional doses are given on day 3, 7, and 14. It’s important to stick to the recommended schedule as close as possible.
Do I Return to the ER for All Four Rabies Vaccines?
Many people choose not to return for the rabies vaccinations at the ER to avoid long wait times and high co-payments. Instead, consider contacting a travel vaccination clinic like Destination Health to complete your post-exposure rabies vaccinations; each of our three Massachusetts locations keeps the rabies vaccines in-stock at all times. Some physician offices can order rabies immunizations, but keep in mind it may take several days for the shipment to arrive.
Where Can I Find More Information About Human Rabies Immune Globulin (HRIG)
Please feel welcome to contact Destination Health Clinic with additional questions or read more about HRIG and rabies post-exposure best practices from the CDC.