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Small Volume of Rabies Immunoglobulin (RIG) is Effective for Local Wound Infiltration in Rabies Post-Exposure Prophylaxis whereas Intramuscular RIG is just a Wastage

Rabies is a zoonosis that is 100% fatal once symptoms of the disease appear. However, it is almost 100% preventable if the prophylactic measures with proper wound wash, vaccines and immunoglobulins are taken soon after exposure to the animal bite. A general tendency has been noticed among clinicians all over the world to inject Rabies Immunoglobulins (RIG) intramuscularly, mostly in the gluteal muscle, despite the guidelines that suggest infiltrating it into the wounds. This has resulted in failures of Post Exposure Prophylaxis in many countries leading to the death of patients due to rabies. Here we discuss how giving any amount or even large amount of RIG intramuscularly (IM) is not going to neutralise rabies virus at the wound site especially during the window period, exposing the patients to the risk of rabies, whereas a small volume of RIG injected into the wound(s) is a lifesaving intervention as it neutralises the virus there and then in the wound(s) especially during the initial window period when the exposed person is unprotected, as the response to concurrent vaccination may take 10-14 days after exposure/ bite.