28th September 2021

Estimating the Volume of Equine Rabies Immunoglobulin (eRIG)

Required for Local Infiltration in Soft Tissue Animal Bites in Children
Using a Wound Size-Based Approach.
Anurag Agarwal, P Kumar, Surendra Bahadur Mathur, Amir Maroof Khan
J Trop Pediatr, 2021, 67 (4), 1 - 6
Background : Post-exposure prophylaxis using rabies immunoglobulin (RIG) is universal
recommendation for category III exposures.
This study was conducted to determine

quantity of RIG used to infiltrate animal bite wounds in relation to longest dimension and
area of wound.
Objective : To estimate the volume of RIG used in animal bite wounds in relation to the
longest dimension and area of the wound, when using the WHO recommended technique
of wound infiltration.
Methods : Children aged 2–18 years reporting within 7 days of category III animal bite
were included. eRIG (300 IU/ml) was used in all subjects. A predesigned proforma was
filled for clinical and epidemiological details of subjects. Maximum length and width of
wounds was measured by using non-stretchable measuring tape. RIG was infiltrated in
wounds as per WHO recommendations and volume infiltrated was noted.

ACADEMIC P.E.A.R.L.S
Pediatric Evidence And Research Learning Snippet

World Rabies Day 2021

World Rabies Day theme is: “Rabies: Facts, not Fear”.

Results: A total of 100 subjects were enrolled. The mean (+SD) volume of RIG infiltrated in
wounds per unit length was 0.75 (+ 0.21) ml/cm and per unit area was 3.18 (+ 1.75) ml/cm2. The
volume of RIG infiltrated had a linear correlation with the length of the wound (r = 0.84, p < 0.001).
The regression equation y = 0.6x + 0.3, where y is the volume of RIG (ml) and x is the length of
the wound (cm) was calculated. The volume of RIG infiltrated also had a linear correlation with the
area of the wound (r = 0.61, p < 0.001). The regression equation y = 0.9x + 1.1, where y is the
volume of RIG (ml) and x is the area of the wound (cm2) was also calculated.

Conclusions: The length and area of the wound are important determinants of the volume of RIG
that can be infiltrated in a wound. We propose that an average of 0.75 ml/cm and 3.18 ml/cm2 RIG
can be infiltrated in the animal bite wounds. The above proposed equations can prove to be a
useful tool for the primary health care provider to determine the volume of RIG needed to be
infiltrated in soft tissue animal bites.

Key Messages:
•The volume of RIG that can be infiltrated in a wound is dependent on the length and area of the
wound.
•By infiltrating RIG only in the wound, we save ~44% volume of RIG as compared to that calculated
by the weight in children.
•The proposed equations can be used by health workers for easily calculating the approximate
volume of RIG needed for infiltrating the wounds.
•This shall save cost, prevent wastage, promote availability and more equitable use of RIG.

EXPERT COMMENT
“A major limitation in administration of RIG to animal bite wounds
is the decreased availability of RIG. Judicious use of RIG will
greatly promote its availability. This is the first time that any
equations have been provided to calculate the volume of RIG
needed for infiltration based on the size of the wounds. The
equations provided in this pioneering study can help in easy
calculation of the volume of RIG needed based on the size of the
wound and thus prevent wastage of RIG. ”

Dr Anurag Agarwal
Professor, Dept. of Pediatrics,
Maulana Azad Medical College, New Delhi
Founder Secretary: Consortium Against Rabies
Executive Board Member: CIAP 2021

With warm regards, Reference

Agarwal A, Kumar P, Mathur SB, Khan AM.
DR. PIYUSH GUPTA DR REMESH KUMAR R. Estimating the volume of equine rabies
DR MANINDER S
IAP NATIONAL IAP PRESIDENT

PRESIDENT 2021 2022

immunoglobulin (eRIG) required for local
DHALIWAL infiltration in soft tissue animal bites in children
DR BAKUL JAYANT DR G.V. using a wound size-based approach. J Trop
PAREKH BASAVARAJA
IAP PRESIDENT HON. SECRETARY
Pediatr. 2021; 67 (4): 1 – 6.
Editor – Academic Pearls 2020 GEN. 2021 - 22 DOI:10.1093/tropej/fmab082. PMID:
pedpearls@gmail.com
34549787.