Guidance

Rabies: summary of risk assessment and treatment

Updated 1 May 2024

Applies to England

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).