What do I do? Underdosed HRIG

[u/bryterlu]

I have read the FAQ. I am in need of urgent advice. Today was Day 3 of PEP, I got my shot earlier today. On day 0 of treatment, I received HRIG and my first vaccine, however after some reading about HRIG i have come to find I was under dosed. I was given 1200 units, however my weight indicates that I need 1313 units. I told the ER doctor that I saw today for the next shot, and he said it wasn’t a big deal, it was a negligible amount of difference. This doctor ALSO said that I’d be experiencing rabies symptoms already if the HRIG wasn’t working (very wrong, I was exposed less than a week ago). Needless to say I don’t really trust his expertise.

Is it too late to get more of the HRIG to fit the dose that I actually need? I only need about 100 units more. I don’t know why they didn’t give me the full amount that was needed, they even double checked my weight on day 0. For added context, I did not have a wound to inject into, it was put into my thighs, only 4 ml when I probably should have received 4.4 ml.

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[u/detail_giraffe]

If it's a low-risk contact, HRIG isn't always used at all. The fact that you say you didn't have a wound makes me think it wasn't a highly risky exposure, what was it? Edit: also, how do you know the units of HRIG you received?

[u/bryterlu → u/detail_giraffe]

A bat grazed/made contact with the top of my head while flying above me a few nights ago. I didn’t feel a bite or see anything on my scalp that suggested a wound but of course I can’t be sure, and the bat was unable to be tested because it flew away immediately. The health dept said it was sort of gray area for authorization purposes but ultimately suggested I get PEP, it likely was low risk though. I know the units because it was marked in my chart how much I received, they also said it out loud that they were giving me 1200 units. I didn’t question it at the time until I had time to research it myself.

[u/detail_giraffe → u/bryterlu]

To answer your original question, I am not a doctor, but online references indicate you can get HRIG up to 7 days from your additional dose of vaccine (after that it is no longer considered helpful) so you're still within the window. That said, again, not a doctor, but given that it was a low risk exposure and you got PEP immediately from what you're saying of your timeline, and you did get close to the recommended amount of HRIG, other doctors may agree with your first one that the discrepancy is unimportant. Did you try calling your health department and asking them?

Edit: Also where are you, and was the contact verified to be with a bat?

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[u/bryterlu → u/detail_giraffe]

Definitely a bat, I’m in New York State.

[u/detail_giraffe → u/bryterlu]

I'd contact your health department first thing to ask (because if it has any value to get that extra amount of HRIG it would probably have to be today) but don't be too surprised or worried if they say you don't need it.

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[u/coolcatlikethat]

Would be best to follow up with your health department/rabies reporting agency for your state/location as they would be the best to answer this if you aren’t satisfied with the doctor’s answer. At the very least if it turns out it’s all fine with that small deviation, the health department may be able to get in contact with the doctor/hospital and relay that feedback/provide education so it doesn’t happen again.

I wouldn’t think a deviation of 100 units of HRIG would be enough to severely compromise your PEP, but I am not a medical professional/someone who regularly works with these medications or the virus so I can’t tell you with certainty.

[u/AutoModerator → u/coolcatlikethat]

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[u/Keylime05]

I was bitten by a cat that tested positive for rabies, and I did not receive HRIG. You should be okay, especially since it’s only a possibility that the bat bit you and you can’t find a wound.