Rabies: guidance on pre-exposure and post-exposure measures for humans in Scotland
SHPN easy-read guide

Pre-exposure measures

The recommendation for pre-exposure prophylaxis (PrEP) should be arrived at after a risk assessment considering the individual’s occupation or activities.

The purpose of pre-exposure rabies vaccination is to reduce the:

• risk of developing rabies
• need for the number of doses of vaccine and/or administration of human rabies immune gobulin (HRIG) post-exposure where required

Any individual at risk for rabies – whether they have received vaccination or not – must be advised that they carry out immediate first aid and promptly seek assessment or advice on PET if they:

• are scratched, bitten or licked by any animal abroad
• suspect a bat exposure in the UK or abroad

Who is PrEP indicated for?

PrEP is indicated for those with occupations (voluntary or paid) that involve frequent exposure to the rabies virus or potentially infected animals.

This includes:

• laboratory workers who routinely handle rabies virus
• workers at Department for Environment, Food and Rural Affairs (DEFRA)
• authorised quarantine premises and carriers
• those who regularly handle bats, including on a voluntary basis, in the UK
• veterinary and technical staff who, by reason of their employment, encounter enhanced risk
• certain inspectors appointed under the Animal Health Act.1981 (but not dog wardens for whom the risk of exposure is low and for whom the rapid PrEP schedule would be more appropriate where required) – see section 3.1.4 of the SHPN guidance
• occupations which may result in continual or frequent exposure – for example:
  • animal control and wildlife workers
  • veterinary staff or zoologists who regularly work in rabies enzootic areas

PrEP should also be considered for some people travelling to some areas outside of the UK.

Up-to-date advice is available for health professionals from TRAVAX and the general public from fitfortravel.

PrEP is not indicated for those not described above.

Summary of Rabies PrEP recommendations

Table 1: Summary of Rabies PrEP recommendations

Post-exposure measures

Potential rabies prone exposures (PRPE) occur when there is contact between a person and potential rabies-infected mammal that could result in transmission, for example a bite or scratch from a bat.

Immediate actions

For all PRPEs:

• advise immediate wound care
• undertake risk assessment

Wound care for post-exposure management involves:

• cleaning the wound with soap or detergent
• flushing with running water
• applying a virucidal agent – for example, povidone-iodine solution or 40–70% alcohol
• covering with a dressing

Wound washing is the most effective first-aid treatment against rabies.

Refer to section 5.4 of the SHPN guidance for full details.

Risk assessment

Further public health actions are determined through risk assessment based on the:

• category of exposure, for example, a bite (see Table 2 of the SHPN guidance)
• country where the exposure occurred, for example, the UK/Ireland or overseas
• animal involved, such as a bat or a dog
• patient’s vaccination status (see Table 4 of the SHPN guidance)

For up-to-date information on country and animal risk, view the UKHSA rabies risks in terrestrial animals by country.

Who performs the risk assessment?

Unless the health professional providing immediate care to the exposed person is confident about being able to perform a full, expert risk assessment, then the person should be referred to their local pathway for risk assessment.

Contact details to access risk assessment and management in Scotland are available in the key contact details section of this guide and in Appendix 3 of the SHPN guidance.

People who are outside of Scotland

If a person seeks help from Scotland from abroad, they should be advised to make their way to a local medical facility for assessment without delay.

Access to assessment and treatment is variable by country.

In some circumstances travel to another country or even returning home may be necessary for treatment.