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Guidance

Rabies post-exposure treatment: management guidelines

A practical guide to undertaking a risk assessment of potential rabies exposures and the correct use of post-exposure treatment (PET).

Updates to this page

From:
UK Health Security Agency
Published:
1 January 2013
Last updated:
30 June 2025
Show all updates

  1. In Table 1, corrected 20 IU/mg to 20 IU/kg.

  2. Added notice of interim recommendations and new interim recommendations guidance.

  3. Added link to "Rabies risks by country" list.

  4. Updated sections C1 and D1 of 'Rabies: guidelines on managing rabies post-exposure treatment'.

  5. Updated Rabies: guidelines on managing rabies post-exposure treatment and letter to A&E consultants and pharmacists.

  6. Updated Rabies: guidelines on managing rabies post-exposure treatment.

  7. Updated summary of risk assessment and treatment.

  8. Added letter for accident and emergency consultants and pharmacists.

  9. Updated guidelines on managing rabies post-exposure August 2020.

  10. Updated guidelines with reference to a new version of the form. Added clarification on category 2 and 3 bites. Updated information about compliance with Falsified Medicines Directive. Also added new telephone numbers for the Rabies and Immunoglobulin service and Animal Plant Health Agency.

  11. Updated summary and guidelines - see page 4 for details of changes.

  12. Added summary of risk assessment and treatment.

  13. Updated guidelines - see page 3 for details of changes.

  14. Patients started on alternative regimens section revised.

  15. Revised guidelines - see page 2 for details of changes.

  16. Updated information about the new Rabies and Immunoglobulin Service and updated risk assessment to include HRIG for primate category III bites to the head and neck.

  17. The document has been updated to reword section ‘B9 Imported pets (dogs, cats or ferrets)’, on page 14.

  18. Changes to the guidance include a new category of ‘partially immune’ for those individuals who are not fully immune but have received vaccine in the past, advice on what to do if it is more than 10 years since the last rabies vaccine, and information on dealing with animals imported into the country under the EU PETS passport scheme.

  19. First published.

Applies to England

Documents

Interim recommendations for human rabies immunoglobulin (HRIG) use

HTML

Rabies: guidelines on managing rabies post-exposure treatment

Ref: UKHSA gateway number GOV-14000

PDF, 741 KB, 46 pages

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Rabies: summary of risk assessment and treatment (text version)

HTML

Rabies: summary of risk assessment and treatment (visual version)

Ref: UKHSA gateway number GOV-14000

PDF, 82.1 KB, 1 page

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Letter to A&E consultants and pharmacists: important information regarding rabies post-exposure treatment

Ref: UKHSA gateway number GOV-14000

PDF, 109 KB, 2 pages

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Details

Interim recommendations for the use of human rabies immunoglobulin were issued on 27 June 2025. These recommendations supersede guidance on the use of rabies immunoglobulin within the UKHSA guidelines on managing rabies post-exposure treatment. The current guidance on use of rabies vaccine for post-exposure treatment remain the same.

Please refer to the Rabies risks by country list if undertaking a post-exposure risk assessment. The country risk list within the guidance document may not contain the latest and most up to date country risk information.

This guidance is aimed at duty doctors at the UK Health Security Agency Colindale, at health protection teams and other health professionals who may be involved in the assessment and management of potential rabies exposures.

Rabies is a viral encephalitis and can be fatal. Prompt treatment after exposure is the most effective way to prevent disease.

Post-exposure treatment (PET) using rabies vaccine with or without human rabies immunoglobulin (HRIG) is highly effective in preventing disease, if given correctly and promptly after exposure.

The letter is to all A&E departments and hospital pharmacists requesting them to hold or have access to rabies vaccines so that rabies post-exposure treatment can be started promptly.

This is guidance for healthcare professionals only. If you are a member of the public and are concerned that you might have been exposed to rabies, please refer to the NHS advice about rabies.

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