Rabies

Rabies virus is found in the saliva of infected animals. Bats may carry bat lyssaviruses which are very closely related to the rabies virus and cause a similar illness. Exposure to rabies may lead to spinal cord and brain inflammation. An exposure from an infected animal occurs through:

  • a bite
  • a scratch
  • a lick onto broken skin or mucous membranes, such as eyes, nose or mouth

The time from a rabies exposure to developing symptoms is usually between 20 to 60 days but may range from five days to a year. Symptoms start with a:

  • headache
  • fever
  • general weakness
  • numbness or tingling around the bite

The disease then progresses to include muscle spasms, fear of water, convulsions.

It's important to note that once symptoms develop there's no specific treatment available and the infection is fatal. It's therefore crucial that anyone who may be exposed to rabies receives post-exposure treatment promptly and appropriately.

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Guidance

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.

Entitlement to pre-exposure immunisation

Pre-exposure immunisation with human diploid cell rabies vaccine is available free from the NHS for certain eligible groups, such as licensed bat handlers or people travelling to a country where rabies is present. A full list of eligible groups can be found in chapter 27 of the PHE green book.

View advice for pre-exposure vaccination and arrangements for obtaining the vaccine.

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:

For all infection prevention and control guidance visit the A-Z ​pathogens section of the National Infection and Prevention Control Manual.

Resources

  • We have produced advice for the general public on how to reduce rabies risk if you find a bat or if you come into contact with a bat. View our leaflet.
  • Healthcare professionals can find recommendations for pretravel rabies vaccination, including country specific information, on the TRAVAX website.
  • Information for the general public can be found by visiting the fitfortravel website.

Contacting hospitals

Scottish hospital main switchboard numbers for on call infectious diseases are below:

Aberdeen Royal Infirmary
0345 456 6000
Crosshouse Hospital, Ayrshire
01563 521 133
Dumfries and Galloway Royal Infirmary
01387 246 246
Queen Elizabeth Hospital, Glasgow
0141 201 1100
Monklands Hospital, Lanarkshire
01236 748 748
Ninewells Hospital, Dundee
01382 680 111
Raigmore Hospital, Inverness
01463 704 000
Victoria Hospital, Fife
01592 643 355
Western General Hospital, Edinburgh
0131 537 1000