PLEASE NOTE THE TWO DIFFERENT PATHWAYS FOR:
PRE-EXPOSURE VACCINATION
- Lothian Travel Clinic (charge for services)
- HSCP Vaccination Teams (volunteer bat handlers only)
POST-EXPOSURE VACCINATION/TREATMENT
- Adults: refer to on-call Infectious Disease between 0900-1900. At other times, or for complicated/high risk injuries, direct to ED.
- Children & young people: refer to Paediatric Infectious Diseases team or the on call Paediatric registrar/emergency team at RHCYP.
Details on the management of human and animal bites can be found in the East Region Formulary.
All patients should undergo wound care with thorough irrigation and consideration of decontamination and debridement where required and have a risk assessment for other infections depending on the animal species and nature of the injury.
Rabies risk assessment:
Rabies and the related bat lyssaviruses are carried in the saliva of infected animals:
https://www.hps.scot.nhs.uk/web-resources-container/bat-contact-and-rabies-risk/.
Exposure to humans may occur through:
- A bite
- A scratch
- A lick onto broken skin or mucous membranes (eyes, nose or mouth).
Post-exposure treatment (PET) should be initiated promptly, but can be administered at any point until the patient becomes symptomatic. The time from exposure to the development of symptoms is usually between 20-60 days, but may range from 5 days to several years.
In the UK, rabies is not found in terrestrial animals so the risk of acquisition is through:
- Contact with a bat (European bat lyssavirus)*
- Bat bite* whilst abroad
- Animal bite whilst abroad.
*Bats have very fine teeth and the bite may be felt but not seen. There may not be an obvious skin break and the history of exposure is therefore more important than the injury.
Bat bites anywhere in the world apart from the UK and Ireland are considered HIGH risk for rabies. In the UK and Ireland the risk is LOW. The risk from terrestrial animals is classified as NO, LOW or HIGH. A list of rabies risk from land animals by country can be found on the UK HSA website (available from: https://www.gov.uk/government/publications/rabies-risks-by-country). Potential rabies exposure should be assessed promptly.
Reference should be made to UKHSA guidance and specialist advice sought from the on-call Infectious Diseases team via WGH switchboard (0131 537 1000) if the composite rabies risk is Amber or Red. Provision of Human Rabies Immunoglobulin and rabies vaccination is through RIDU. The RIDU team is also happy to follow up patients who have been started on rabies PET whilst abroad.
Rabies vaccine used as part of PET is provided free of charge.
Pre-exposure rabies vaccination
Pre-exposure vaccination for those at risk of rabies exposure can be provided at a charge via the NHS Lothian Travel Clinics. Volunteer bat handlers are entitled to access rabies vaccination for free, and this is provided via the Community Vaccination Teams.
C.M & N.B 27-08-24
Specialist advice on risk assessment and management of potential rabies exposure can be sought from the Infectious Diseases consultant/registrar on-call via WGH switchboard 9am to 7pm. Most queries can be handled in-hours. Out-of-hours patients with high-risk injuries (injuries to head and neck, or contact with the saliva of an animal with confirmed rabies) should always be directed towards A&E.
Children and young people who may require urgent post-exposure vaccination must be discussed with the Paediatric Infectious Disease team or the on call Paediatric Registrar / Paediatric Emergency team at RHCYP.
It is crucial to distinguish between the pre-exposure vaccination and post-exposure treatment as the pathways differ:
For pre exposure rabies vaccination for individuals at risk of exposure please direct to:
- Community Vaccination Teams (volunteer bat handlers)
- Lothian Travel Clinic (charge for services).
Please note – the Travel Clinics and Community Vaccination Teams do not provide post-exposure treatment for rabies.
Bat contact and rabies risk (leaflet for patients and professionals).
