Public Health England (PHE) has published updated guidelines for health professionals on rabies prevention taking account of new World Health Organization (WHO) recommendations.
The suite of documents – covering pre-exposure prophylaxis, risk assessment and post-exposure treatment – are available via the PHE website guidance collection: Rabies: risk assessment, post-exposure treatment, management.
Key changes to the guidelines include:
- Clarification of the employer’s role in providing pre-exposure vaccination to those who may have an increased risk of exposure to rabies through their work.
- Pre-exposure vaccine will only be provided by PHE for bat handlers where no formal employer can be identified.
- The option of an accelerated course of pre-exposure vaccination is introduced, where there is insufficient time to complete the routine 28-day course of pre-exposure prophylaxis.
- A composite rabies risk assessment protocol is introduced for post-exposure treatment, bringing together country and animal risks into a single risk rating, to recognise the increased rabies risk from some animal species in certain countries.
- A reduction from five to four doses of vaccine for post-exposure treatment in immunocompetent individuals.
- An emphasis on infiltration of human rabies immunoglobulin (HRIG) at the site of the exposure, rather than being given intramuscularly.
- Changes in the use of HRIG for certain exposures.
- New guidance for the management of immunosuppressed individuals.
The largest group covered by the guidelines are the approximately 2,000 people each year who require post-exposure treatment from PHE following an animal exposure overseas or a bat exposure in the UK. For this group, revised guidelines on managing post-exposure cases include a new four-step risk assessment process incorporating the country in which the exposure occurred, the animal involved, the category of exposure, and the immune status of the individual.
