Rabies: risk assessment, post-exposure treatment, management

Guidance on assessing risk following rabies exposure, post-exposure treatment, and public health management of a suspected rabies case in the UK.

The World Health Organization (WHO) has issued a Medical Product Alert confirming the identification of falsified rabies vaccine being used in Philippines in December 2018 and January 2019. The falsified rabies vaccine is labelled as ‘Verorab’, however Sanofi Pasteur, the genuine producer of Verorab, has confirmed that they are not the manufacturer. There is no evidence that the falsified product has been distributed outside of the Philippines.

Health care professionals with concerns about a patient who may have received falsified rabies vaccine in the Philippines can call the Public Health England Rabies and Immunoglobulin Service (RIgS) for further advice.

Rabies is an encephalitis caused by rabies virus, a member of the rhabdovirus family. It is an acute viral infection that is almost invariably fatal once symptoms develop.

Transmission is generally through the bite of an infected animal, usually dogs, but also cats, bats and other wildlife. A course of rabies vaccination can prevent infection and death.

It is important that a medical practitioner assesses all animal bites, especially:

  • bat bites in the UK
  • any other animal bites overseas

Diagnosis of rabies in the early stages is often difficult as symptoms may be non-specific.

Clinical rabies is a notifiable disease in England.

See Green Book rabies chapter

See NaTHNaC rabies factsheet

See Vaccine update: rabies special edition

For further assistance

Please contact the Rabies and Immunoglobulin service or your local health protection team. The Rabies and Immunoglobulin service is for healthcare professionals only. Members of the public should contact their GP or local health protection team.

Rabies epidemiology

Rabies post-exposure treatment guidelines

Rabies pre-exposure prophylaxis (non-travel)

This form is only for non-travel related pre-exposure rabies vaccine requests.

Published 30 June 2014
Last updated 6 February 2019 + show all updates
  1. Added alert regarding falsified rabies vaccine in the Philippines.
  2. Added Rabies epidemiology transmission and prevention.
  3. Added Rabies: risks from bat bites.
  4. Added rabies special edition of Vaccine Update.
  5. Added link to updated rabies chapter of the Green Book.
  6. Added new guidance on 'Rabies: administration of vaccine and immunoglobulin' to 'Rabies post-exposure treatment guidelines' section.
  7. Added guidelines for requesting pre-exposure prophylaxis
  8. Added request form for pre-exposure vaccine (non-travel).
  9. Updated rabies post exposure risk assessment form and calendar (v19) and new letter for rabies vaccine and immunoglobulin batch SRC16187.
  10. Added guidance for administration of rabies immunoglobulin.
  11. Updated to include 'Rabies vaccine and immunoglobulin: administering Ig SRCN0820.
  12. Updated to include 'Rabies vaccine and immunoglobulin: administering Ig BP08947111P'.
  13. Updated to include 'Rabies vaccine and immunoglobulin: administering Ig SRCN0510'.
  14. First published.