The Public Health England (PHE) has issued updated guidance on the management of rabies post-exposure. The new recommendations reflect changes to rabies postexposure treatment as agreed by the Joint Committee on Vaccination and Immunisation (JCVI) in February 2018.
Changes have been made to definitions of exposures and animal/country risk, recommended number of vaccine doses for immunocompetent individuals, recommendations on the use of human rabies immunoglobulin (HRIG) and on the management of immunosuppressed individuals.
The category should be combined with information on country/animal risk stratification to determine the composite rabies risk. Low exposure category (Category 3) with low or high country/animal risk has a green composite risk. Category 2 and 3 exposures with low risk and category 2 exposure with high risk are classified as amber. Category 3 exposure with high country/animal risk has a red composite risk.
For green risk, no postexposure treatment is required. Patients in the amber risk grouping should receive 4 doses of vaccine on day 0 (d0), d3, d7 and d21 if non-/partially immunised. 2 doses of vaccine on d0 and d3-7 are recommended for fully immunised patients. For immunosuppressed individuals, HRIG and 5 doses of vaccine on d0, d3, d7, d14 and d30 are advised.
For patients who fall into the red category of composite risk, the recommendations are HRIG and 4 doses of vaccine on d0, d3, d7 and d21 for those who are non-/partially immunised. In fully immunised and immunosuppressed individuals, recommended postexposure treatment is 2 doses of vaccine on d0 and d3-7 and HRIG with 5 doses of vaccines on d0, d3, d7, d14 and d30.
The guidelines state that HRIG is not required if more than 7 days have elapsed since the first dose of vaccine, or more than 1 day has elapsed since the second dose or for partially immunised patients unless immunosuppressed.
