Rabies: summary of risk assessment and treatment
Updated 1 May 2024
Applies to England
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Health professionals involved in the assessment and management of potential rabies exposures should take the following steps:
1. Determine the combined country and animal risk
Check the A to Z list of countries and their category of risk for rabies.
2. Determine the category of exposure
| Category | Terrestrial mammals | Bats | ||||
|---|---|---|---|---|---|---|
| 1 | No physical contact with saliva | No physical contact (no direct contact with the bat’s saliva) | ||||
| 2 | Minimal contact with saliva or unable to infiltrate wound with HRIG if needed | Uncertain physical contact (where there has been no observed direct physical contact (with saliva) but this could have occurred) | ||||
| 3 | Direct contact with saliva | Direct physical contact with bat’s saliva |
3. Determine the composite rabies risk
| Country or animal risk | Category 1 exposure | Category 2 exposure | Category 3 exposure | |||
|---|---|---|---|---|---|---|
| No risk | Green | Green | Green | |||
| Low risk | Green | Amber | Amber | |||
| High risk | Green | Amber | Red | |||
| Confirmed rabies | Green or amber | Red | Red |
Specific advice regarding the risk from certain animals or bats in different countries should be taken into account when using these summary tables.
4. Determine the post-exposure treatment required
Post-exposure treatment:
| Composite rabies risk | Non immunised or partially immunised | Fully immunised | Immunosuppressed |
|---|---|---|---|
| Green | None | None | None |
| Amber | 4 doses of vaccine: d0, d3, d7, d21 | 2 doses of vaccine: d0, d3-7 | HRIG and 5 doses of vaccine: d0, d3, d7, d14 and d30 |
| Red | HRIG* and 4 doses of vaccine: d0, d3, d7, and d21 | 2 doses of vaccine: d0, d3-7 | HRIG and 5 doses of vaccine: d0, d3, d7, d14 and d30 |
*HRIG not required if more than 7 days after first dose of vaccine, or more than 1 day after the second dose, or for partially immunised patients (unless immunosuppressed).