Comparison of Safety Profile of Equine and Human Rabies Immunoglobulin in Children below 15 Years, in a Tertiary Care Hospital of Odisha - an Observational Study
Background: The incidence of rabies is equally more in children < 15 year of age i.e. 35.3% as found in the APCRI-WHO Survey in India. Out of the two alternatives (Equine Rabies Immunoglobulin: ERIG and Human Rabies Immunoglobulin: HRIG) for treatment for Category III animal bites, HRIG is invariably the preferred intervention mounting to exorbitantly high economic burden. There is paucity of studies comparing their safety profiles especially in children.
Methods: A hospital-based observational study was conducted at the Anti-rabies Clinic of SCBMCH, Cuttack, Odisha from March to April 2019. The enrolment of patients was done in two months period from 1st March to 30th April 2019 and all these patients were followed up for a period of one month till 31st May 2019. New Category III animal bite cases in <15 years of age, taking ERIG and HRIG comprised of two groups A and B, respectively. They were followed up on their subsequent visits on 3rd, 7th and 28th days of treatment to study any local and systemic reactions. Chi square test/ Fischer exact test/ Mann Whitney test were applied to compare the outcomes.
Result: Mean age in ERIG (Group A) is 9.84 (±3.9) years and for HRIG (Group B) is 7.1 (±4.1) years and mean weight for ERIG group is 27.63 (±12.4) kg and HRIG group is 24.2 (±23.8) kg. The total amount of immunoglobulin administered was 3.6 (±1.6) ml in ERIG (Group A) and 2.5 (±1.34) ml in HRIG (Group B). Any type of local reaction was seen in 42% cases in Group A (ERIG) and in only 5% cases in Group B (HRIG). Pain, itching, local swelling, oedema, and tenderness were more marked in Group A (ERIG) but were not found to be statistically significant in all cases. These local reactions were managed symptomatically with medications like analgesics and anti-histaminic. Similarly Systemic reactions in form of arthralgia, fever, malaise and generalized rash were also more observed in Group A (ERIG) which could be managed symptomatically with same medications.
Conclusion: Safety profiles (in terms of local and systemic reactions) of ERIG and HRIG were comparable in children below 15 years of age. The minor side effects of ERIG can easily be managed by readily available drugs like analgesics and antihistaminics in the ARV OPD itself.
How to cite this article:
Debta SP, Behera TR, Routray D. Comparison of Safety Profile of Equine and Human Rabies Immunoglobulin in Children below 15 Years, in a Tertiary Care Hospital of Odisha - an Observational Study. J Commun Dis 2020; 52(2): 7-12.
DK Taneja’s Health Policies Programmes in India, Jaypee Brothers Medical Publishers, New Delhi: 16th Edition,
WHO Weekly epidemiological record no. 16, 20April 2018,http://www.who.int/week.
World Health Organization .WHO Expert Consultation on Rabies. First report, Technical Report Series 931,
Geneva, Switzerland, 2005.
Sudarshan MK, Madhusudana SN, Mahendra BJ et al. Assessing burden of human rabies in India: Result
of a national multi-center epidemiological survey. International Journal of Infectious Diseases 2007; 11:
Wilde H, Chomchey P, Prakongsri S , Punyarata Bandhu P. Safety of equine rabies Immunoglobulins. Lancet
; 28(2): 1275.
Mohanty S, Behera TR, Patanaik N. Clinical Safety of an Equine Rabies Immunoglobulin, APCRI Journal 2018;
Maharana S, Behera TR, Pattanaik N. Serum Sickness in Patients Receiving Equine Rabies Immunoglobulin.
J Commun Dis 2018; 50(2): 30-33.
Behera TR, Satapathy DM, Pratap AK and Tripathy RM. Post exposure prophylaxis for rabies with ERIG and
IDRV in children. JCommun Dis 2011; 43(1): 31-37.
World Health Organization ‘s Positon Paper on Rabies. Weekly epidemiological record dated 7th Dec 2007 in
APCRI journal Vol. IX Issue II, January 2008.
Sikes RK. Human rabies immunoglobulin. Pub Health Report Sep 1969: 84(9): 797-800.
Wilde H, Bhangana K, Chutivongse S, Siakasem A, Boonchai W, Supich C. Is injection of contaminated
animal bite wounds with rabies immune globulin a safe practice? Trans R Soc Trop Med Hyg 1992; 86; 86-88.
Bhangada K , Wilde H, Sakolsataydron P, Oonsombat P. Dog-bite injuries at a Bangkok teaching hospital. Acta
Tropica 1993: 55; 249-55.
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