Rabies post exposure prophylaxis

Rabies transmission occurs in many parts of the world. See the ‘Further reading’ section for a country-by-country risk guide.

The decision to administer post exposure prophylaxis is always directed by a team within the UK Health and Safety Agency (UKHSA). Your specialist nurse or GP will contact the team on your behalf. Treatment is dictated by whether or not you have had rabies vaccinations prior to your exposure, your medical history, where the exposure was on your body and in which country it occurred. You will either need no treatment, rabies vaccines only or rabies vaccines plus rabies immunoglobulin. Depending on the mammal that has bitten or scratched you, you may also need anti-viral or antibiotic prophylaxis. It is also worth checking your tetanus vaccination status, as animal mouths are generally unclean and carry a lot of bacteria.

If it is deemed that you need treatment, it will usually be because your exposure has occurred in a part of the world where rabies transmission occurs. In most cases, it is impossible to track or test the animal in question. As rabies is always fatal following the onset of symptoms, treatment is usually advised, as the benefit will always outweigh the risk. This does not mean that you have rabies infection. You will be assessed for any other symptoms when you attend, and have a medical review if this is deemed necessary. If you have any concerns or questions about your treatment, please talk to your specialist nurse or doctor.

RIG is a blood product which contains antibodies from people or horses that have been previously vaccinated with the rabies vaccine. If you are exposed to the rabies virus and have not had any pre-exposure rabies vaccine, RIG gives you short term protection against the virus whilst allowing your immune system to build up antibodies to the rabies vaccine and the virus itself.

Monitor yourself for any acute symptoms (e.g. fever, rash, breathing difficulties), as RIG is a blood product and seek medical attention in the event this occurs. The rabies vaccine is inactivated (not a live vaccine) and may carry with it a small risk of side effects, common to any vaccination, e.g pain at injection site, muscle pain, mild fever, local skin reaction. This should all resolve on its own but you should seek medical attention if it does not.

Do not stroke, play with or feed animals

Be aware that some actions/activities attract animals, e.g running, cycling and carrying food

If you are bitten, scratched or licked over broken skin by a mammal, wash the area with running water for 15 minutes and seek medical attention immediately.

Consider a course of rabies vaccinations before travelling. This will mean you are unlikely to need RIG if you have an animal exposure but you should still seek medical advice as you may require post exposure rabies vaccines or other treatment.

In some areas of the world, animals are very used to tourists, meaning they may approach you. Always factor this in if you plan on visiting areas where you are likely to have close contact with animals.

Rabies post exposure schedules vary depending on which country you are in. When you return to the UK, the safest thing to do is to treat you in line with UK guidelines. This may be different to what you were initially expecting but is safe.

https://www.gov.uk/government/collections/rabies-risk-assessment-post-exposure-treatmentmanagement

Animal Bites – Patient Information Leaflet – Available from the Hospital for Tropical Diseases

The Hospital for Tropical Diseases
2nd Floor, Mortimer Market Centre
Capper Street, London
WC1E 6JB
020 3447 5968
Switchboard: 020 3456 7890
Website: www.uclh.nhs.uk
Email: uclh.htdadmin@nhs.net

Have you travelled to a tropical country in the last 6-12 months and are you acutely unwell? You can be seen in our emergency walk-in clinic Monday to Friday 9am-4pm. Our travel medicine service offers specialist travel advice including for individuals with complex health conditions. We offer this on a privately and via NHS referral basis. Please contact: uclh.htdadmin@nhs.net or 020 3447 7999 for more information about our services.