Rabies is an acute viral infection that is nearly always fatal once symptoms appear.
The rabies virus can be transmitted through the saliva of infected warm-blooded animals like dogs, cats, monkeys, bats, and other wildlife, with dog bites accounting for over 99% of human rabies deaths worldwide. In the UK, 12% of people requiring post-exposure treatment (PET) for rabies were potentially exposed to bats in the UK, while 88% were exposed to animals abroad.
PET, which includes the rabies vaccine and, in some cases, rabies immunoglobulin, is highly effective at preventing the disease if administered promptly following exposure. There is no cure for rabies once symptoms develop.
Contact Details (to be used by HCPs only)
PHE Rabies and Immunoglobulin Service (RIgS)
Colindale Duty Doctor Service (out-of-hours)
📞 020 8200 4400
⏰ Weekends and bank holidays, 9am - 5:30pm
Risk Assessment & Management
When a patient presents with a bite, scratch, or lick from an animal, it is essential to assess the risk to determine the appropriate PET.
Public Health England’s Rabies and Immunoglobulin Service (RIgS) provides assistance with risk assessment. Based on the information, a risk categorisation (red, amber, or green) is made, which influences the PET to be administered.
Gather as much information as possible before contacting RIgS:
- Patient details → name, date of birth, age, address, NHS number.
- Exposure details → date of exposure, species of the animal, current health status of the animal.
- Location→ country of exposure, site of the bite or exposure on the body.
- Health status→ whether the patient is immunosuppressed or has any allergies.
- Previous rabies treatment → any prior rabies vaccinations or rabies immunoglobulin treatment.
- Patient weight→ this is especially relevant when considering rabies immunoglobulin.
🚨 In urgent cases, such as severe bites to the head and neck, Colindale Duty Doctor can assist via a consultant on-call (contact details above).
Bat bites
In the UK, European Bat Lyssavirus (EBLV) types 1 and 2, which are related to rabies, can be found in bats.
If bitten or scratched by a bat, a patient is at risk of rabies infection. It’s essential to seek immediate professional advice for a risk assessment and arrange for PET.
- Bat bites are typically not visible and rarely draw blood, but any exposure should prompt immediate consultation with a healthcare professional.
- A prompt risk assessment is critical, and the patient should start a course of rabies vaccination over 21 days.
- Individuals who regularly handle bats (e.g. in their job or voluntary work) should be vaccinated against rabies and receive prompt post-exposure treatment if bitten.
For further advice, contact RIgS (details above) or consult the resources below.
Rabies Vaccine Provision for Post-Exposure Treatment
In cases where a patient presents after a potential rabies exposure (whether from a bat bite in the UK or animal bite abroad), it's crucial to begin the rabies vaccine treatment without delay.
Rabies vaccine may not always be available locally, but it can be sourced via PHE. The first dose of the vaccine should ideally be given within 24 hours of exposure.
- Previously, rabies vaccines were available for pick-up from Colindale, but this will no longer be possible after September 2020. NHS sites must now ensure they can access vaccines through emergency processes.
- Any vaccine administered will be replaced free of charge by PHE when RIgS is contacted the next working day.