Adherence to guideline recommendations for human rabies immune globulin patient selection, dosing, timing, and anatomical site of administration in rabies postexposure prophylaxis

Hwang, Grace S.; Rizk, Elsie; Bui, Lan N.; Iso, Tomona; Sartain, Emily I.; Tran, Anh; Swan, Joshua T.

doi:10.1080/21645515.2019.1632680

Cited by 19 publications

(23 citation statements)

References 25 publications

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“…Accordingly, a significant proportion of PEP in the United States is administered in response to dog encounters: estimates range from 48% to 81%. [30][31][32] Children are at an increased risk for dog bites, and incur wounds predominantly in the head and neck, rather than the limbs as is seen in adults. 24,33,34 Rabies virus inoculation in highly innervated regions is associated with shorter incubation times, potentially as short as 10 days, due to greater risk for deposition of the initial inoculum in proximity to the central nervous system.…”

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of rabies immunoglobulin in pediatric patients with suspected exposure

Hobart-Porter

Stein

Toh

et al. 2021

Human Vaccines & Immunotherapeutics

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Rabies is a deadly viral zoonosis with global disease burden. Following exposure to a rabid animal, postexposure prophylaxis (PEP) is the standard of care for unvaccinated persons. Despite the large proportion of pediatric cases, limited safety and efficacy data exist for use in pediatric patients. We report the safety, efficacy, and immunogenicity of a phase 4, prospective, 2-center, open-label, single-arm clinical trial evaluating human rabies immunoglobulin (HRIG150; KEDRAB 150 IU/mL) as part of PEP in patients (aged <17) with suspected or confirmed rabies exposure, where PEP was indicated. Thirty participants received 20 IU/kg HRIG150 infiltrated into the detectable wound site(s), with any remainder injected intramuscularly, concomitantly with the first of a 4-dose series (days 0, 3, 7, and 14) of rabies vaccine. Rabies virus neutralizing antibody (RVNA) titers and tolerability were assessed on day 14 following administration. Participant safety was monitored for 84 days. No serious adverse events, rabies infections, or deaths were recorded. Twenty-one participants (70.0%) experienced a total of 57 treatment-emergent adverse events (TEAEs) within 14 days following administration. Twelve participants (40.0%) experienced a total of 13 adverse events deemed treatment related. All TEAEs were mild in severity. On day 14, 28 participants (93.3%) had RVNA levels of ≥0.5 IU/mL (mean±standard deviation: 18.89 ± 31.61). These results demonstrate that HRIG150 is well tolerated and effective in pediatric patients as a component of PEP. To the authors' knowledge, this study is the first to establish pediatric safety and efficacy of HRIG in the US.

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Section: Discussionmentioning

confidence: 99%

“…Incorrect treatment in the form of insufficient or non-administration of RIG has been reported in 42% to 48% of cases. 31 , 32 , 40 These gaps in knowledge and practice create unnecessary risks of preventable death from treatment failure, as documented in literature, and emphasize the need for improved education and awareness.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of rabies immunoglobulin in pediatric patients with suspected exposure

Hobart-Porter

Stein

Toh

et al. 2021

Human Vaccines & Immunotherapeutics

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“…Additionally, the ED quality infrastructure has not developed extensive clinical decision support and referral systems for rabies PEP like they have for other diseases (stroke, acute coronary syndrome, trauma, etc.). Rates of correct and appropriate delivery of PEP (particularly HRIG) remain low, and many patients with anatomically feasible wounds may not receive HRIG wound infiltration in the ED [6,7]. Thus, an opportunity may exist to optimize implementation of care delivery and coordination.…”

Section: When Given Delivery Of Rabies Pep Is Not Optimalmentioning

confidence: 99%

Rabies postexposure prophylaxis in the United States: Opportunities to improve access, coordination, and delivery

Howington

Nguyen²,

Bookstaver

et al. 2021

PLoS Negl Trop Dis

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Rabies remains a global public health concern that is responsible for more than 59,000 human deaths per year [1]. Postexposure prophylaxis (PEP) for humans exposed to rabies virus should include wound cleansing followed by 1 dose of human rabies immunoglobulin (HRIG) and a series of cell culture rabies vaccine doses [2]. Symptomatic rabies is nearly always fatal but universally preventable with appropriate PEP. An estimated 30,000 to 60,000 Americans receive rabies PEP each year [3]. The stakeholders involved in PEP implementation in the United States are diverse, creating systematic complexity that creates barriers to accessing care, lacks coordination, and delivers suboptimal care. Here, we elaborate on 3 issues of (i) access to, (ii) coordination of, and (iii) delivery of care for suspected rabies exposures; share examples of contemporary quality initiatives from large health systems; and propose novel solutions.

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“…The virus is most often acquired by the infected animal's bite when the wound is exposed to the animal's saliva. In addition, being scratched by the animal and contamination of the mucosae with infected fluids carry a risk (2). More than 90% of the cases in developing countries are caused by dogs.…”

Section: Introductionmentioning

confidence: 99%

Animal Contact and Rabies Prophylaxis Experience: Evaluation of 625 Pediatric Cases

Kara¹

2020

J Pediatr Inf

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Öz Giriş: Kuduz, memelileri enfekte eden ve ölümcül olabilen zoonotik bir hastalıktır. Tüm dünyada çok sayıda insan kuduz riskine sahip hayvanlar tarafından ısırılmaktadır. Ancak hayvanların aşılanması, temas öncesi ve temas sonrası profilaksi önlemleri ile hastalıktan korunmak mümkün olmaktadır. Bu çalışmada, kuduz şüpheli teması nedeniyle hastanemize başvurmuş çocuk hastaların klinik ve demografik özelliklerinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya, 1 Ocak 2018-31 Aralık 2018 tarihleri arasında kuduz riski olan hayvanlarla yalanma, tırmalanma veya ısırılma gibi temasları nedeniyle hastanemize başvurmuş 0-18 yaş arası çocuk hastalar dahil edildi. Hastalara ait demografik ve klinik bilgiler geriye dönük olarak elde edildi. Verilerin istatistiksel analizinde SPSS 22.0 programı kullanıldı. Bulgular: Çalışmaya dahil edilen toplam 625 çocuk hastanın %64.5'i erkekti. Hastaların yaş ortalaması 8.9 ± 5.1 (9; 0-18) yıldı. Hastalar yaş gruplarına göre sınıflandırıldığında en çok 12-18 yaş grubu (%34.1) çocuklar bulunmaktaydı. Hastaların çoğunluğu (%60.2) kentsel bölgede yaşamaktaydı. En sık kedilerle (%57.4) temas olmuştur. Çoğunlukla tek bölgeden ısırılma/tırmalanma gerçekleşmiştir. Bunların içinde en çok el bölgesinden (%26.7) temas olmuştur. Başvurudan önce %71.4 hastaya yara bakımı yapılmıştır. Uygun zamanda hastaneye başvuran 113 (%18.1) hastaya intramusküler kuduz immünglobulini (40 IU/kg) uygulanmıştır. Temas sonrası dönemde 145 (%23.2) hayvan en az 10 gün süreyle gözlenebilmiştir. Kuduz aşısı uygulaması sonrası ilk 24 saat içinde %1.1 hastada ateş gelişmiştir. Bunun dışında aşıya bağlı herhangi bir lokal ya da sistemik komplikasyon görülmemiştir. Hastaların %8.3'üne oral

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Adherence to guideline recommendations for human rabies immune globulin patient selection, dosing, timing, and anatomical site of administration in rabies postexposure prophylaxis

Abstract: T. Swan (2020) Adherence to guideline recommendations for human rabies immune globulin patient selection, dosing, timing, and anatomical site of administration in rabies postexposure prophylaxis,

Cited by 19 publications

References 25 publications

Safety and efficacy of rabies immunoglobulin in pediatric patients with suspected exposure

Safety and efficacy of rabies immunoglobulin in pediatric patients with suspected exposure

Rabies postexposure prophylaxis in the United States: Opportunities to improve access, coordination, and delivery

Animal Contact and Rabies Prophylaxis Experience: Evaluation of 625 Pediatric Cases

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