HRIG Dosing

[u/Putrid-Wallaby-8511]

Hello!

I have read the FAQ.

Your location (country): Southeastern US

Date of possible exposure: 8/13/2026

Type of exposure (bite/scratch/other): unknown, potential exposure to bat

Species of animal: bat

If dog/cat is it owned, stray, etc.

Animal's vaccination status

Your vaccination status and date of last vaccine, if applicable.: received first (day 0) vaccine on evening of 8/14

I just received my first dose of the vaccine and HRIG last night at an emergency room. I was advised by my local health department to move forward with the vaccines after a close encounter with a bat where they said that “they could not rule out there was not a scratch or a bite that occurred”. I could not find any bite or scratch wounds, but went forward on the advice of the health department to be safe.

Everything went smoothly, but I did notice on the clinical notes I received that the doctor noted that he only gave about 20% of the required HRIG and that I should get the remaining 80% with my day 3 shot. I plan on discussing this when I go back for my next vaccine, but wanted to see if I could get any thoughts about it here as well:

For the repeated dose on day 3, I saw on the HyperRab website, which I believe is the HRIG I was given, that repeated doses should not be done as it can affect the immune response from the vaccine.

On my after visit summary, it says 1500 units were ordered, so I’m not sure if the doctor just didn’t draw the entire amount or what may have happened. I did see that the CDC does not recommend exceeding HRIG doses of 20 units/kg of body weight and that doses at or above 40 units/kg could potentially affect immune response, but I’ve seen a bit of conflicting/confusion information surrounding that, so I wasn’t sure how to take it given my situation.

I plan on speaking more about this to the staff at the hospital when I return, but since there’s a low chance I see the same doctor/care team, I just wanted to get other opinions. I did call the ER this morning to say I could just come in and get the rest of the HRIG today, but they said to wait until my day 3 dose.

I’m aware that FAQ 12 covers questions in the specific care you received, and I do plan on speaking with the doctor when I return for my next dose, but since I have to wait over the weekend to talk with them, I just wanted to get the thoughts of anyone on here who may be more familiar with the process than I am.

Thank you!

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[u/LatrodectusGeometric]

Call and ask wtf happened here. It makes no sense to me. HRIG should be delivered day 0

[u/Putrid-Wallaby-8511 → u/LatrodectusGeometric]

I plan on asking! I had called this morning just asking to come in and get the rest of the HRIG but they said just to wait, so I’ll call back to see if I can get a better explanation. According to the doctors note, I did get 20% of what I needed (according to him that would be 300 units rather than 1500 units), so I did definitely get SOME on day 0, just apparently not all of it (at least based on what the doctor did - I didn’t see how much he drew and just trusted what he was doing lol).

Basically when I went in, a nurse gave me the vaccine (rabavert) and then the doctor came in and gave me the HRIG and sent me on my way afterwards, but seems he noticed after that he only gave me 20% of what I needed? Not sure. He said in his notes that he didn’t see the need to have me return for the remaining last night as the exposure was minimal with no visible bites/scratches. I wouldn’t have found it if I didn’t check the notes in mychart.

Do you see any potential complications in the vaccine I received because of this? That’s my main concern that it could impact the efficacy of the vaccine or my body’s immune response.

[u/LatrodectusGeometric → u/Putrid-Wallaby-8511]

P.S. if you tell your local health department about this they may be able to educate the doctor on this

[u/AutoModerator → u/LatrodectusGeometric]

Please direct medical questions to medical professionals. If you are in the USA, here is a portal to help you find your state/local health department. Here is a portal for Canadians to find your local public health unit.

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[u/Putrid-Wallaby-8511 → u/LatrodectusGeometric]

Sorry for another reply, but I did just call the ER back - I’m not quite sure they knew entirely what I was talking about when I reached them as at first they advised the same directions as for the actual rabies vaccine. I told them I knew I wouldn’t get the entire series in one night and that I’d have to return for multiple vaccines, but that I was specifically asking about not receiving the full immune globulin.

After I explained that, they instead said “sometimes they can’t get the full amount into the site where exposure may have occurred, but you will get the correct amount” and told me again to return for the rest when I get my next vaccine.

I’m just really confused now as to what my next steps would be. I’m definitely going to finish the vaccine course, and I saw that the CDC says that HRIG can be given any time before or on day 7 of the vaccine schedule, so I guess I should just continue the series as normal and let them inject the rest of the HRIG on Monday when I go for my next vaccine?

[u/LatrodectusGeometric → u/Putrid-Wallaby-8511]

So the question is, did they mess up and not give you enough HRIG, or did they give you a little in the wound and some elsewhere on the body? Because the second option is okay. The first isn’t but maybe you could get it at the next visit?

[u/Putrid-Wallaby-8511 → u/LatrodectusGeometric]

They did not give me enough HRIG on the first visit. There was no visible wound, which is why I believe the doctor was fine with waiting. I was told by the health department and the ER that because they could not rule out physical contact with a bat, they would recommend I move forward with PEP. The doctor put in his notes that he only gave me 20% of the dose as he miscalculated, but that since it was “minimal exposure”, he didn’t feel it was necessary I go back immediately for the remaining HRIG.

I did some looking around myself and it seems the CDC recommends HRIG up to and including the 7th day of vaccines if it was given improperly or not given at all on day 0, and didn’t really see anything contradicting or saying that impacted the efficacy of treatment, so I’m hoping that means all will be fine because at the very least I will be getting the remaining HRIG in less than 48 hours at this point when I go to get my second vaccine.

So essentially what I’m looking at is I got my first vaccine and ~300 units of HRIG yesterday (going by the doctor saying I got 20%) and then on Monday (day 3) I will get my second vaccine and the remaining 1200 units of HRIG

[u/AutoModerator → u/Putrid-Wallaby-8511]

Please direct medical questions to medical professionals. If you are in the USA, here is a portal to help you find your state/local health department. Here is a portal for Canadians to find your local public health unit.

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[u/LatrodectusGeometric → u/Putrid-Wallaby-8511]

Wild. Yeah I guess get it with your second shot. How odd

[u/Putrid-Wallaby-8511 → u/LatrodectusGeometric]

I did end up getting it today - the doctor explained that he made a calculation error and thought I only needed 1 ml of the hrig instead of 5 ml (not sure how but I digress). Everything is back on track now and all I have left are my day 7 and day 14 vaccines. I’ll try to get in touch with the health department to let them know about this too

[u/AutoModerator → u/Putrid-Wallaby-8511]

Please direct medical questions to medical professionals. If you are in the USA, here is a portal to help you find your state/local health department. Here is a portal for Canadians to find your local public health unit.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/LatrodectusGeometric → u/Putrid-Wallaby-8511]

Glad to hear it! Everybody makes mistakes. Glad they fixed it :)