Guidelines on managing rabies post-exposure (September 2021)

Guidelines on managing rabies postexposure (January 2023)

UKHSA guidelines on managing rabies post-exposure (January 2023)

Contents

Document history ......................................................................................................................... 4 A. Introduction .............................................................................................................................. 6

Purpose and scope................................................................................................................... 6 Devolved administrations ......................................................................................................... 7 B. Post-exposure risk assessment: does the person need PET? ................................................ 8 B1. Patient details................................................................................................................... 10 B2. Date of exposure.............................................................................................................. 10 B3. Which country? ................................................................................................................ 10 B4. Species of animal: was it a bat, primate, rodent or other terrestrial mammal? ................. 11 B5. Country and/or animal risk ............................................................................................... 12 B6. Category of exposure ....................................................................................................... 12 B7. Site of bite: additional useful information.......................................................................... 14 B8. Imported pets (dogs, cats or ferrets) in UK ...................................................................... 14 B9. Suspicion that a pet dog, cat or ferret has been illegally imported ................................... 15 B10. Animals in quarantine..................................................................................................... 16 B11. Exotic pets, and non-indigenous animal in zoos or wildlife centres (in UK).................... 16 B12. Composite rabies risk..................................................................................................... 17 C. Significant past medical history ............................................................................................. 18 C1. Immunosuppression......................................................................................................... 18 C2. Other relevant history....................................................................................................... 18 C3. Previous rabies pre-exposure prophylaxis or post-exposure treatment ........................... 19 D. Treatment recommendations................................................................................................. 20 D1. Treatment based on risk assessment .............................................................................. 20 D2. What treatment has already been given? ........................................................................ 21 D3. Is vaccine required? ......................................................................................................... 22 D4. Is rabies immunoglobulin (HRIG) required? ..................................................................... 23 D5. Administering vaccine and HRIG ..................................................................................... 24 D6. How soon should treatment be started? .......................................................................... 25 D7. Is rabies antibody testing required? ................................................................................. 25 E. Logistics................................................................................................................................. 26 E1. Issuing rabies vaccine and HRIG ..................................................................................... 26

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UKHSA guidelines on managing rabies post-exposure (January 2023)

E2. The Rabies and Immunoglobulin Service (RIgS) ............................................................. 26 E3. Issuing HRIG from stockholders....................................................................................... 28 F. Governance issues ................................................................................................................ 29 G. Rabies vaccines compatible with UK schedule ..................................................................... 30 H. Source documents and useful references ............................................................................. 33 Annexe 1. Immunosuppression definitions................................................................................. 34 Annexe 2. Country or animal risk ............................................................................................... 36 Annexe 3. Summary of risk assessment and treatment ............................................................. 45

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UKHSA guidelines on managing rabies post-exposure (January 2023)

Document history

Date January 2015

June 2015 April 2016 June 2017 June 2018

April 2019 October 2019 August 2020

Reason for change

Issue number

PHE version. This updates `HPA guidelines on managing rabies 1.0 post-exposure prophylaxis (January 2013)'. 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. The guidance is also reformatted to PHE specifications.

Rewording of section `B9 Imported pets (dogs, cats or ferrets)',

1.1

paragraph `Background' to clarify that pets from EU or listed

countries do not need a blood test, and the waiting period is only 21

days post vaccination.

Updated information about the new Rabies and Immunoglobulin 1.2 Service and updated risk assessment to include HRIG for primate category III bites to the head and neck.

Updated contact information. Additional information provided on

2.0

what to do if a fully immunised patient has received HRIG as part of

the management. Revised information on the use of the revised

rabies risk assessment form.

Updated guidance in view of the changes to rabies post-exposure 3.0 treatment as agreed by JCVI February 2018. Specifically changes in definitions of exposures and animal and country risk, reduction in the number of vaccine doses for immunocompetent individuals to 4, change to the recommendations on the use of HRIG, and guidance on the management of immunosuppressed individuals.

Updated guidance clarifying risk assessment of possible bat

4.0

exposures, exposures to confirmed rabid animals, implications on

pet travel when UK leaves EU, and updated vaccines and

immunoglobulin compatible with UK schedule.

Updated version of the form, clarification on category 2 and 3 bites, 5.0 information about compliance with Falsified Medicines Directive and new phone numbers for RIgS and APHA.

Updated information on bats in the UK, PET passport scheme on 6.0 leaving the EU and process for issuing vaccine and immunoglobulin through Colindale.

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UKHSA guidelines on managing rabies post-exposure (January 2023)

Date

Reason for change

September 2021

Updated information on rabies vaccine availability in NHS Trusts in England, importation of animals into UK, definitions of immunosuppression, hours of operation of the RIgS team and availability of HRIG. Reformatted along UKHSA guidelines.

January 2023

Updated information on timing of blood samples for immunosuppressed patients and importance of taking the potency from the vial and not from the packaging.

Issue number 7.0

8.0

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