Rabies

Types of exposure

In the UK, rabies isn't found in land animals so the risk of rabies is therefore through:

• contact with a bat in the UK to European bat lyssavirus
• a bat bite whilst abroad
• an animal bite whilst abroad

There may also be people at risk of rabies through their job, for example:

• laboratory workers
• port officials

These people should consult their occupational health guidelines and national guidance. 

Immunisation and treatment

Protecting yourself from rabies can take the form of either pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP).  PrEP is taken before potential exposure to rabies, while PEP is treatment given following potential exposure to rabies.

Pre-exposure immunisation indications

Pre-exposure immunisation with human diploid cell rabies vaccine is indicated for certain higher-risk groups. Full details can be found in chapter 27 of the PHE green book.

Post exposure rabies treatment

Guidance on post-exposure rabies treatment is also available in chapter 27 of the PHE green book.

Any healthcare professional asked to assess rabies risk should use this guidance for full advice and consult with an infectious diseases physician.

Bat bites

Bats and their roosts are protected by UK law and only trained bat handlers should handle bats. Further information on this can be found by visiting the Bat Conservation Trust website.

Bat bites are considered a risk for rabies in all countries in the world, except New Zealand. Risk is thought to be low in the UK and Ireland. Inadvertent exposure to a bat can occur, for example, when a bat enters a household. If a bat bite has occured, initial first aid should be implemented immediately by:

• cleaning the wound thoroughly by flushing with water under a running tap for several minutes
• washing with soap or detergent
• applying iodine or alcohol
• applying a simple wound dressing

Then seek medical advice promptly by contacting a GP or NHS 24 for assessment if in the UK. If abroad seek medical advice urgently but post exposure treatment may not be readily available.

Bat teeth are very fine and it can be difficult to know if a bite has occurred or not. Bat bites are often felt rather than seen, and there might not be an obvious skin break.

If, for example, a bat was found in a room where someone was sleeping, and there wasn't any obvious skin break, post-exposure treatment should be considered.

An animal bite whilst abroad

Rabies is present in land animals throughout the world, with the exception of a few countries including the UK. Risk may be classified as:

• no
• low
• high

A list of rabies risk in land animals by country can be found on the PHE website.

The risk to humans is mainly through dog bites, but any potential rabies exposure from an animal whilst abroad needs to be medically assessed urgently. Where there is a wound, initial first aid should be implemented immediately by:

• cleaning the wound thoroughly by flushing with water under a running tap for several minutes
• washing with soap or detergent
• applying iodine or alcohol
• applying a simple wound dressing

Then seek medical advice urgently.

Access to post exposure rabies treatment abroad can be difficult or not possible. If a rabies exposure has taken place abroad, and post exposure treatment isn't readily available, the affected person may need to make arrangements to travel to another country for treatment, or even return home. This is one reason why many travellers choose to have rabies vaccination before going abroad.

If a person is unable to obtain post exposure treatment while abroad, they should be assessed and if necessary have treatment on return, even if time has lapsed.

If treatment has started abroad but not completed it should be completed when back in the UK.

Any healthcare professional asked to advise on assessment of a potential rabies exposure should seek advice from an infectious disease physician and refer to the following PHE guidance for advice on rabies treatment:

• Rabies: Guidelines on managing rabies post exposure treatment 
• Rabies: Updated Green Book Chapter. This update includes the addition of an accelerated pre-exposure schedule and the recently updated post exposure treatment.