Rabies can be caused by one of 14 lyssaviruses, which includes the rabies virus. Transmission of the
virus occurs following a bite or scratch from an infected animal, or less commonly through an open
wound or mucous membranes. Without pre-exposure prophylaxis (PrEP) or post-exposure
prophylaxis (PEP), case fatality following an exposure event is almost certain once symptoms have
started.

In June 2023, a Chief Medical Officer letter was issued that called for all NHS Boards to have a
pathway in place for PrEP and PEP for rabies. For the latter, this placed a requirement for NHS
Boards to have a clear pathway for post-exposure assessment, vaccination and post-exposure care,
including during the out of hours period.

Simultaneously, Public Health Scotland have published the updated national rabies guidance in July
2023. This highlights the role of an Infection Specialist in risk assessing patients in Scotland.

Assessment pathways overview

An overview of the assessment pathways for NHS Ayrshire and Arran (NHS AA) is provided in figures
1, 2 and 3.