# Rabies Post-Exposure Prophylaxis

> Rabies post-exposure prophylaxis for NEET-PG Community Medicine: WHO exposure categories, wound care, RIG dosing and intramuscular and intradermal regimens.

- Canonical URL: https://prepelephant.com/topics/neet-pg/community-medicine/rabies-post-exposure-prophylaxis
- Exam / course: NEET-PG · Subject: Community Medicine
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Rabies Post-Exposure Prophylaxis", PrepElephant, https://prepelephant.com/topics/neet-pg/community-medicine/rabies-post-exposure-prophylaxis

## Direct answer

Rabies is virtually 100 per cent fatal once symptoms appear, so post-exposure prophylaxis must begin immediately: wound washing for 15 minutes with soap and running water, then vaccination by WHO exposure category — none for category I, vaccine alone for category II, vaccine plus rabies immunoglobulin for category III. India uses cell-culture vaccines by the Essen or Zagreb intramuscular regimens or the economical intradermal Thai Red Cross regimen, under the National Rabies Control Programme's target of zero dog-mediated deaths by 2030.

## What you must remember

- Exposure categories: I — touching or feeding animals, licks on intact skin (no PEP); II — minor scratches or nibbling without bleeding (vaccine only); III — transdermal bites or scratches, licks on broken skin, mucous or bat exposure (vaccine plus RIG).
- Wound care first: wash all wounds 15 minutes with soap and water, apply a virucidal antiseptic, avoid suturing, cover tetanus.
- Rabies immunoglobulin: infiltrate into and around all wounds — equine 40 IU per kg (after sensitivity testing) or human 20 IU per kg; never exceed the dose; usable up to day 7.
- Vaccine site: intramuscular into the deltoid (anterolateral thigh in children; never gluteal), or intradermal 0.1 mL per site.
- Regimens: Essen 1-1-1-1-1 (days 0, 3, 7, 14, 28) or Zagreb 2-1-1 (two sites day 0, then days 7 and 21) intramuscularly; intradermal Thai Red Cross — 0.1 mL at two sites on days 0, 3 and 7 (some add day 28), one vial serving several patients.
- Re-exposure in a vaccinated person: two doses only, days 0 and 3, no RIG; pre-exposure prophylaxis is two doses (days 0 and 7) for animal handlers.
- Programme facts: nerve-tissue vaccines are abolished; dog bites cause the overwhelming majority of human rabies in India; the action plan targets zero deaths by 2030.

## Common confusion

Category II versus III is the decision that matters most — broken skin, bleeding or mucous membrane contact moves the patient from vaccine-only to vaccine-plus-RIG, hidden in stems like "scratch with visible blood". The second confusion is intramuscular versus intradermal regimens and their day schedules; intradermal PEP is dose-sparing. Obsolete options also waste marks — nerve-tissue vaccines and gluteal injections are discontinued, and RIG is never repeated.

## Exam-focused takeaway

Questions are clinical vignettes: classify the exposure, state wound care, decide whether RIG is indicated and compute doses. Regimen questions test the day schedules of Essen, Zagreb and the Thai Red Cross method, and the two-dose re-exposure schedule. Vivas expect a category III bite managed end-to-end.

## Frequently asked questions

### What are the WHO categories of rabies exposure?

I — touching, feeding or licks on intact skin; II — nibbling or minor scratches without bleeding; III — transdermal bites or scratches, licks on broken skin, mucous or bat exposure.

### How is a rabies wound managed?

Wash with soap and running water for 15 minutes, apply a virucidal antiseptic, avoid suturing, cover tetanus — before vaccination.

### When is rabies immunoglobulin indicated, and in what dose?

For category III exposures (and category II in immunocompromised persons): equine 40 IU per kg or human 20 IU per kg, infiltrated into and around all wounds.

### What vaccine regimens are used in India?

Intramuscular Essen (days 0, 3, 7, 14, 28) or Zagreb 2-1-1 (two sites day 0, then days 7 and 21); or intradermal Thai Red Cross — 0.1 mL at two sites on days 0, 3 and 7 (some schedules add day 28).

### What if a previously vaccinated person is bitten again?

Two booster doses, days 0 and 3, no RIG.

### Why is the intradermal regimen preferred in busy clinics?

One vial immunises several patients the same day at far lower cost.