Guidance

Rabies and Immunoglobulin Service (RIgS)

Updated 20 February 2024

Applies to England

The Rabies and Immunoglobulin Service (RIgS) at UK Health Security Agency (UKHSA) Colindale is a cross-divisional service supporting the post-exposure treatment of serious infections, through the development of guidance, provision of clinical advice and issuing of immunoglobulins and anti-toxins following a detailed risk assessment.

This includes post exposure treatment and clinical management for rabies and botulism (TARGET – Tuberculosis, Acute Respiratory, Gastrointestinal, Emerging/Zoonotic Infections and Travel Health Division), hepatitis A and B (BSHSH – Blood Safety, Hepatitis, Sexually-transmitted Infections and HIV Division) and measles, chickenpox and diphtheria (Imms – Immunisation and Countermeasures Division).

RIgS staff comprise a multi-disciplinary team of nurses, a business manager and administrative support; they are hosted in Immunisation under a consultant virologist. Expert guidance and medical support is provided by consultants from each of the divisions responsible for their specific topic area.

Immunoglobulins and anti-toxins are rare products that are centrally procured by UKHSA from a range of manufacturers. Stock is held centrally at Movianto, UK on behalf of UKHSA, but also at a number of stockholders distributed throughout the country.

RIgS is a busy service; in the financial year 2019 to 2020 there were more than 4,000 calls; over 3,400 related to rabies prophylaxis or post-exposure treatment, about 250 calls related to hepatitis and more than 400 calls relating to varicella zoster or measles.

Routine service

RIgS operates between 8am to 5.30pm Monday to Friday. All requests for replacement vaccine and advice about issuing should be directed to this service (Tel: 0330 128 1020).

Requests for immunoglobulin/vaccine Monday to Friday will be ordered through Movianto for delivery to a named responsible clinician to arrive the next working day before 2pm. However, there may occasionally be specific urgent situations where HRIG is needed sooner than this, and in these circumstances UKHSA can issue immunoglobulin through a more rapid delivery.

Out of hours service

Clinical advice is available through the Colindale Duty Doctor service, between 9am and 7pm at weekends and bank holidays. Most calls can wait until the next day, so callers after 5:30pm are encouraged to call back the next morning to speak to RIgS or the Colindale Duty Doctor service (see Table 1). Vaccine should be sourced locally, and will be replaced through RIgS the next working day. There is no need to talk to the RIgS team or Colindale before arranging this.

If HRIG is required out of working hours and cannot wait until the next working day, the product may be able to be collected from a local stock-holder or be issued out of hours for delivery the next day. Arrangements for urgent delivery on non-working days should be made by calling the Duty Doctor between 9am and 7pm.

Table 1. Clinical advice, ordering and issuing of products from Colindale

	Advice, delivery and administration
Weekday working hours
Monday to Friday 8am to 5.30pm	Contact RIgS.
Monday to Friday 5.30pm to 7pm	Contact Colindale out of hours Duty Doctor service.
Weekday out of hours
Monday to Thursday 7pm to 8am	Administer vaccine and contact RIgS the next morning.
Weekend out of hours
Friday 7pm to Saturday 9am	Administer vaccine and contact Colindale out of hours Duty Doctor service the next morning.
Saturday and Sunday 9am to 7pm	Contact Colindale out of hours Duty Doctor service.
Saturday 7pm to Sunday 9.00am	Administer vaccine and contact Colindale out of hours Duty Doctor service the next morning (after 9am).
Sunday 7pm to 8am	Administer vaccine and contact RIgS the next morning.