arv dose adverse effects and precautions

Rabies is an acute viral disease. It causes fatal encephalomyelitis in almost all warm-blooded animals, including humans.

 This virus can be found in wild and domestic animals. It is transmitted through the saliva of an afflicted animal. The virus spreads through bites, scratches, broken skin, and mucous membranes.

The rabies vaccine is used in 2 ways. Pre-exposure and -exposure. Post

Pre-exposure- In this method, such people are vaccinated, who are working in a high-risk situation or in a place of rabies risk. In post-exposure, the vaccine is applied after the animal is cut. Both vaccinations are similar but differ in the vaccination schedule.

Rabies immunoglobulin is used only for post-exposure prophylaxis.

Contemporary vaccines of cell-culture or fetal-egg origin are more safe and effective than older vaccines, which originated in brain tissue. 

ARV is a lyophilized purified, inactivated rabies vaccine containing inactivated rabies virus (L. Pasteur 2061/Vero strain propagated in Vero cells). 

Rabies vaccine dose for humans in India

ARV Vaccine	Rout	Dose	New Case/days	Pre-immunized
Pre-exposure	Intramuscular	0.5 ml	Days - 0,  Days - 3, Days - 7, Days -14, Days -28.	Day -0, Days -7, Days - 21, or Days -28.
ARV vaccine	Rout	Dose	Post-exposure previously immunized individual	Post-exposure for immuno-compromised individua
Post-exposure	Intramuscular	0.5 ml	One dose of vaccine at one site on 0,3 days	Passive immunization with rabies immunoglobulin along with post-exposure vaccination on 0, 3, 7, 14, and 28 days in category 2nd and 3rd.

Uses of rabies vaccine

1. Pre-exposure,
2. Post-exposure.

Pre-exposure vaccination - should be for people in a high-risk group.

such as:

1. laboratory staff handling the virus,
2. clinicians and persons attending to human rabies cases,
3. veterinarians,
4. animal handlers,
5. wildlife wardens,
6. travelers from rabies-free areas to rabies endemic areas.

Post-exposure vaccination

Exposure prophylaxis is required in the event of exposure to an animal bitten or exposed to rabies. In such situations, medical advice should be taken immediately.

1. persons after contact with/bite by a suspected case of or a rapid animal,
2. WHo recommendation for a course of action to be taken after contact with a suspected or confirm rabid animal.

Anti rabies vaccine dosage

reconstitute the lyophilized vaccine with .5 ml diluent. .5 ml vaccine should be administered by deep intramuscular route in the deltoid region in adults and anterolateral aspect of the thigh in children.

Immunization schedule:

pre-exposure 0.5 ml of the vaccine on days 0, 7, and 21 days or 28 only people who frequent risk of exposure should receive periodic booster doses.


post-exposure new case 0.5 ml of the vaccine on days 0, 3, 7, 14, and 28.

Contraindications in known hypersensitivity

1. pre-exposure prophylaxis,
2. severe febrile illness,
3. chronic progressive illness,
4. known hypersensitivity,
5. rabies immunoglobulin should be administered preferably as soon as possible after initiation of post-exposure prophylaxis in case of category 3 bites but not beyond 7 days from the first dose of vaccination, 
6. for previously immunized individuals 0.5 ml of vaccine intramuscularly at one site on day 0 and day 3 .the rabies immunoglobulin is not required in such cases,
7. for immunocompromised individuals, they should receive rabies immunoglobulin in addition to full post-exposure vaccination series as listed above both in category 2 and category 3 bites.

Rabies vaccine Precaution

1. concurrent use of immunosuppressive agents like corticosteroids should be avoided,
2. when anti-rabies immunoglobin is recommended along with the first dose of rabies vaccination, it has to be administered with a different site and away from the site of vaccination,
3. delay in the commencement of post-bite therapy, incomplete and irregular therapy  can cause the failure of vaccination,
4. the vaccine should not be administered into the gluteal region,
5. alcohol and other disinfecting agents must be allowed to evaporate from the skin,
6. as with any injectable vaccine, hypersensitivity or anaphylactic can occur with rabies vaccine and thus injection adrenalin and other medication including antihistamine should be readily available during vaccination.
7. rabies immunoglobin should be administered as soon as possible after initiation of post-exposure prophylaxis in case of category 3 bits but not beyond 7 days from the first dose of vaccination,
8. for previously immunized individuals 0.5 ml of vaccine intramuscularly at one site on days 0 and 3.
9. the vaccine should never be given by the intravascular route.

Adverse effects of ARV vaccine

1. mild pain,
2. erythema,
3. induration,
4. pruritus,
5. edema at the site of injection,
6. mild fever,
7. headache,
8. nausea,
9. dizziness,
10. high fever,
11. gastrointestinal symptoms,
12. lymphadenopathy,
13. rash,
14. arthritis,
15. anaphylaxis.