Should Rabies Vaccination in the Gluteus Muscle be Treated as Unimmunized? - A Case Report

  • Vrinda Lath Senior Resident, Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
  • Freston Marc Sirur Associate Professor, Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
  • Ramya Emergency Medical Technology, Second Semester MSc EMT Student, Medical Technology, Manipal College of Health Professions, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
  • Omesh Kumar Bharti State Institute of Health & Family Welfare, Shimla, Himachal Pradesh, India.
Keywords: Rabies, Partial Vaccination, Gluteal Route

Abstract

Rabies is a fatal disease with almost 100% mortality, with the recommended mainstay of management being preventive, postexposure prophylaxis, and mass dog vaccination. In India, there have been many reports of failure of post-exposure prophylaxis, often due to administration, vaccine quality, and storage. One of the contributing factors is the gluteal administration of rabies vaccine. Here we discuss a case of a partially vaccinated child presenting on day 3 following a category 3 bite, with the first two doses administered intramuscularly in the gluteal region. This case highlights a conundrum faced by clinicians who often encounter partially vaccinated patients, which in this case was treated similarly to an unvaccinated case as the route of previous doses was gluteal.

How to cite this article:
Lath V, Sirur FM, Ramya, Bharati OK. Should
Rabies Vaccination in the Gluteus Muscle be
Treated as Unimmunized? - A Case Report. APCRI
J. 2024; 26(1): 1-3.

DOI: https://doi.org/10.24321/0973.5038.202401

References

World Health Organization. Zero by 30: the global strategic plan to end human deaths from dog-mediated rabies by 2030. Geneva: WHO; 2018. [Google Scholar]

National Rabies Control Programme. National guidelines on rabies prophylaxis. National Centre for Disease Control. Ministry of Health & Family Welfare, Govt of India; 2015.

Thiagarajan K. Why did rabies control fail in India? BMJ. 2022;378:o2284. [PubMed] [Google Scholar]

World Health Organization. Rabies vaccines: WHO position paper, April 2018–Recommendations. Vaccine. 2018.

Soentjens P, Croughs M, Burm C, Declerq S, Clerinx J, Maniewski U, Broucke SV, Theunissen C, Huits R, Brosius I, Florence E, Kenyon C, Griensven JV, Ierssel SV, Lynen L, Balliauw K, Gucht SV, Esbroeck MV, Vlieghe E, Bottieau E, Herrewege YV. Time of administration of rabies immunoglobulins and adequacy of antibody response upon post-exposure prophylaxis: a descriptive retrospective study in Belgium. Acta Clin Belg. 2021;76(2):91-7. [PubMed] [Google Scholar]

Fishbein DB, Sawyer LA, Reid-Sanden FL, Weir EH. Administration of human diploid-cell rabies vaccine in the gluteal area. N Engl J Med. 1988;318(2):124-5. [PubMed] [Google Scholar]

Chomchay P, Khawplod P, Wilde H. Neutralizing antibodies to rabies following injection of rabies immune globulin into gluteal fat or deltoid muscle. J Travel Med. 2000;7(4):187-8. [PubMed] [Google Scholar]

Reid-Sanden FL, Fishbein DB, Stevens CA, Briggs DJ. Administration of rabies vaccine in the gluteal area: a continuing problem. Arch Intern Med. 1991;151(4):821. [PubMed] [Google Scholar]

Bharti OK, Sharma V. Failure of postexposure prophylaxis in a patient given rabies vaccine intramuscularly in the gluteus muscle, Himachal Pradesh, India. Indian J Crit Care Med. 2018;22(3):189-90. [PubMed] [Google Scholar]

Bharti OK, Anderson DC, Kishore J, Katoch P, Sharma P. Small volume of Rabies Immunoglobulin (RIG) is effective for local wound infiltration in rabies postexposure prophylaxis whereas intramuscular RIG is just a wastage. J Adv Res Med. 2021;8(3):8-12. [Google Scholar]

Bharti OK, Madhusudana SN, Gaunta PL, Belludi AY. Local infiltration of rabies immunoglobulins without systemic intramuscular administration: an alternative cost effective approach for passive immunization against rabies. Hum Vaccin Immunother. 2016;12(3):837-42. [PubMed] [Google Scholar]

Bharti OK, Ramachandran V, Kumar SR, Phull A. Pup vaccination practices in India leave people to the risk of rabies — lessons from investigation of rabies deaths due to scratch/bite by pups in remote hilly villages of Himachal Pradesh, India. World J Vaccines. 2014;4(1):7-10. [Google Scholar]

Published
2024-06-10
Section
Case Report