ARV schedule

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The query "ARV schedule" is broad - it could mean antiretroviral therapy schedules for HIV, anti-rabies vaccine schedules, or something else. Let me clarify before diving in.

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Here is a comprehensive summary of the Anti-Rabies Vaccine (ARV) schedule from authoritative sources:

Anti-Rabies Vaccine (ARV) Schedule

Step 1 - Wound Management (All Categories)

Thorough wound washing with soap and water, then irrigation with 1:9 diluted povidone-iodine
Tetanus prophylaxis and antibiotics if indicated
Suturing should be delayed or loosely done after RIG infiltration

Step 2 - WHO Exposure Categories and PEP Decision

Category	Type of Contact	PEP Required
I	Touching/feeding animal; licks on intact skin	None
II	Nibbling of uncovered skin; minor scratches/abrasions without bleeding	Vaccination + wound care
III	Transdermal bites/scratches; licks on broken skin; mucous membrane contact with saliva; bat contact	Vaccination + RIG + wound care

Post-Exposure Prophylaxis (PEP) Schedules

A. Intramuscular (IM) Regimens

1. Essen Regimen (5-dose) - for Category II & III

Days 0, 3, 7, 14, 28 - 1 IM dose each day
1.0 mL or 0.5 mL into deltoid (anterolateral thigh in children <2 yr)
Used in immunocompromised patients

2. Abbreviated Multisite IM Regimen (Zagreb / 2-1-1) - 4 doses

Day 0: 2 doses (one in each deltoid/thigh)
Day 7: 1 dose
Day 21: 1 dose

3. US 4-Dose Regimen (current CDC/ACIP standard since 2010)

Days 0, 3, 7, 14 - 1 IM dose each day (deltoid only)
Day 28 dose removed from standard schedule in 2010
Day 28 still given for immunocompromised patients (5-dose series)

B. Intradermal (ID) Regimen (WHO-endorsed for endemic countries)

2-site ID Regimen (2+2+2+0+2)

0.1 mL at 2 sites on days 0, 3, 7, and 28 (day 14 is skipped)
One ID dose = one-fifth of the IM dose

Rabies Immunoglobulin (RIG) - Category III / Unvaccinated

Type	Dose	Notes
Human RIG (HRIG)	20 IU/kg body weight	Preferred; infiltrate around wound
Equine RIG	40 IU/kg body weight	Used when HRIG unavailable; skin test not predictive

Key RIG rules:

Administer once only, at or as soon as possible after first vaccine dose
Not indicated after day 7 (endogenous antibody production assumed by then)
Never inject RIG in the same syringe or site as vaccine
Infiltrate as much as possible into/around wound; remainder IM at distant site

Pre-Exposure Prophylaxis (PrEP)

For high-risk individuals (veterinarians, lab workers, travelers to endemic areas, spelunkers):

Route	Schedule
IM	1 mL or 0.5 mL on days 0, 7, and 21 or 28
ID	0.1 mL per site on days 0, 7, and 21 or 28

Antibody titer check every 2 years for at-risk individuals; booster if <0.5 IU/mL

Previously Vaccinated Individuals (PEP after prior complete vaccination)

2 doses only - days 0 and 3 (IM or ID)
No RIG needed
Alternative: single-visit 4-site ID regimen (0.1 mL × 4 sites on day 0)

Special Populations

Population	Modification
Immunocompromised	Full 5-dose IM series; check antibody titer 2-4 weeks post-vaccination
Pregnant	Not a contraindication; vaccinate normally
Children <2 yr	Use anterolateral thigh instead of deltoid
Gluteal route	Contraindicated - associated with rare vaccine failures

Available Vaccines (Cell-Culture & Embryonated Egg-Based)

Human Diploid Cell Vaccine (HDCV) - e.g., Imovax
Purified Chick Embryo Cell Culture Vaccine (PCECV) - e.g., RabAvert
Vero cell-derived vaccines
Potency: ≥2.5 IU per single IM dose

Note: Neural tissue vaccines (older type) are still used in some developing countries but carry risk of neuroparalytic complications (post-infectious encephalomyelitis, Guillain-Barré) and should be phased out.

Sources: Park's Textbook of Preventive & Social Medicine; Harrison's Principles of Internal Medicine 22E (2025); Tintinalli's Emergency Medicine; WHO Expert Consultation on Rabies (3rd Report)

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