Inj arv is 4 dose or 5 dose
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anti rabies vaccine ARV schedule 4 dose vs 5 dose WHO ESSEN regimen
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Here is the complete answer:
Inj ARV (Anti-Rabies Vaccine) - Dose Schedule
ARV can be either 4 or 5 doses, depending on the regimen used. Both are WHO-approved.
1. Essen Regimen - 5 doses (original/classic)
| Dose | Day |
|---|---|
| 1 | Day 0 |
| 2 | Day 3 |
| 3 | Day 7 |
| 4 | Day 14 |
| 5 | Day 28 |
- Given IM in deltoid (or anterolateral thigh in children <2 years)
- 1 mL or 0.5 mL per dose (depending on vaccine type)
2. Zagreb (Zareb) Regimen - 4 doses (abbreviated multisite)
| Dose | Day | Sites |
|---|---|---|
| 1+2 | Day 0 | 2 doses - 1 in each deltoid/thigh |
| 3 | Day 7 | 1 site |
| 4 | Day 21 | 1 site |
- This is the 2-1-1 regimen
3. Simplified 4-dose IM Regimen (WHO alternative)
| Dose | Day |
|---|---|
| 1 | Day 0 |
| 2 | Day 3 |
| 3 | Day 7 |
| 4 | Day 14 |
- For healthy, fully immunocompetent individuals only
- Must receive wound care + rabies immunoglobulin (RIG) + WHO prequalified vaccine
- This is now the standard in India (Days 0, 3, 7, 28 per national guidelines)
India National Program (Current Standard)
India currently follows the 4-dose schedule on Days 0, 3, 7, and 28 (IM route), replacing the older 5-dose Essen regimen.
Immunocompromised patients receive a 5th dose (Day 28 becomes additional) per some guidelines.
Source: Park's Textbook of Preventive and Social Medicine
In which animal bite we have to give
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Here is the complete answer based on WHO categories (from Park's Textbook of Preventive and Social Medicine):
In Which Animal Bite Do We Give ARV?
ARV is given for Category II and Category III exposures. The decision is based on type of contact, not just the animal species.
WHO Category Classification
| Category | Type of Contact | ARV Required? |
|---|---|---|
| Category I | Touching or feeding animals, licks on intact skin | ❌ No ARV |
| Category II | Nibbling of uncovered skin, minor scratches/abrasions without bleeding | ✅ ARV alone |
| Category III | Single/multiple transdermal bites or scratches, licks on broken skin, mucous membrane contact with saliva, bat contact | ✅ ARV + RIG (Rabies Immunoglobulin) |
Which Animals?
ARV is given after bites/scratches from mammals capable of transmitting rabies, including:
- Dog (most common in India - >95% of cases)
- Cat
- Monkey
- Fox, jackal, wolf
- Bat (even without visible bite - Category III automatically)
- Rat/rodents - generally low risk, assessed case-by-case
- Any unidentified/wild mammal
Birds, reptiles, fish - do NOT transmit rabies, ARV not needed.
Key Decision Factors (Give ARV if ANY of these apply):
- Animal is a known rabies reservoir
- Animal looks sick or behaves abnormally
- Bite was unprovoked
- Animal is unvaccinated
- Animal cannot be traced
- Wound/mucous membrane contaminated with saliva
Special Rule - 10-Day Observation
For domestic dogs, cats, or ferrets - if the animal remains healthy for 10 days after the bite, PEP may be discontinued. But in developing countries like India, do NOT rely on vaccination status alone - start ARV immediately.
Source: Park's Textbook of Preventive and Social Medicine
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