Rabies post exposure risk assessment
Infectious diseases
Rabies risk assessment
This guidelines are intended for use by healthcare professionals assessing for Rabies risk following potential exposure.
The full guidelines can be accessed here: Rabies post-exposure treatment: management guidelines - GOV.UK (www.gov.uk)
1. What is the rabies risk of the animal involved?
Bats
- In the UK/Ireland = Low risk animal
- Outside the UK/Ireland = High risk animal
Primate or rodent
- Low risk animals
Other terrestrial animal (e.g. dog etc)
- Country dependent risk
- Search and select country from Gov.uk list
2. What is the nature of exposure?
Categories for bats
Category 1 - No physical contact with the bat’s saliva
e.g. touching a dead bat, touching a bat with protective barrier/clothing, a bat in the same room as a person in the UK or Ireland
Category 2 - Uncertain physical contact
e.g. handling live bat without protective clothing, bat becoming tangled in hair, potential contact with a bat in the UK/Ireland in someone who is unable to give accurate and reliable history of exposure, any bat found in the room of a sleeping person outside of the UK/Ireland
Category 3 - Direct contact with saliva
e.g. all bites or scratches, contamination of mucous membranes with saliva or urine.
Categories for all other animals
Category 1 - No physical contact with saliva
e.g. touching, stroking or feeding animals
Category 2 - Minimal contact with saliva and/or unable to infiltrate wound with HRIG if needed
e.g. bruising or abrasions, licks to broken skin, scratches, bites which do not break the skin
Category 3 - Direct contact with saliva
e.g. severe or deep lacerations, bites that break the skin, contact of mucous membranes with saliva e.g. licking of mouth/lips
3. Composite rabies risk table*
*Note: If you are using a mobile phone to view this content, turn it to landscape to view the tables better
| Country or animal risk | Category 1 exposure | Category 2 exposure | Category 3 exposure |
| No risk | Green | Green | Green |
| Low risk | Green | Amber | Amber |
| High risk | Green | Amber | Red |
| Confirmed rabid animal* | Green or amber | Red | Red |
*Advice should be sought from on-call Infectious Diseases via NHS Lothian switchboard.
4. Post-exposure treatment based on composite rabies risk and vaccine status
| Post-exposure treatment | |||
| Composite rabies risk | Non-immunised or partially immunised | Fully immunised | Immunosuppressed |
| Green | None | None | None |
| Amber | doses of vaccine d0 d3, d7, d21 | 2 doses of vaccine do, d3-7 | HRIG and 5 doses of vaccine d0, d3, d7, d14 and d30* |
| Red | HRIG* and 4 doses of vaccine d0 d3, d7, d21 | 2 doses of vaccine do, d3-7 | HRIG and 5 doses of vaccine d0, d3, d7, d14 and d30* |
* HRIG is not required more than seven days after the first dose of vaccine, or more than one day after the second dose. HRIG is not required for partially immunised patients (unless immunosuppressed).
5. How arrange PEP in NHS Lothian
If risk assessment recommends post-exposure rabies vaccination or HRIG:
- Contact the RIDU registrar on-call in hours (0900-1900) to arrange vaccination.
- Rabies vaccine is also available via Emergency Departments at RIE and SJH for high risk injuries out-of-hours.
For very high risk exposures, such as severe and multiple bites to the head and neck or injury from a confirmed rabid animal treatment must be started as soon as possible and within 12 hours of reporting
- Contact the RIDU registrar on-call in hours (0900-1900)
- Out-of-hours the patient should be directed to the Emergency Department for urgent treatment
- Additional advice can be sought from the ID consultant on-call if required.