Synopsis
Assess mammal and bat exposures immediately, perform effective wound care, obtain UKHSA risk allocation, and deliver correctly timed vaccine and immunoglobulin before symptoms develop.
- Rabies virus and related lyssaviruses are transmitted when infectious saliva from a mammal reaches broken skin or mucosa; dogs cause most human rabies globally.
- Immediately wash every wound with soap and running water for about 15 minutes, irrigate thoroughly and apply a virucidal antiseptic when available.
- Record country, exact location and date, animal species and behaviour, provoked or unprovoked contact, ownership, vaccination, availability for observation or testing, wound site and depth.
Key red flags
A transdermal bite or scratch, saliva on broken skin or mucosa, or direct bat exposure in a rabies-risk setting needs urgent formal assessment.
Teeth or claws breach skin in a risk country or through direct bat contact, allowing saliva-contaminated inoculation.
Investigation priorities
Provide the information UKHSA needs to allocate green, amber or red risk.
Management branches
A possible rabies exposure has just occurred or presents with an untreated wound.
- Wash and flush wounds immediately with soap and running water for about 15 minutes, then use a virucidal antiseptic such as povidone-iodine when available.
- Remove visible foreign material and assess tendon, nerve, vascular and infection damage; update tetanus and manage ordinary bacterial bite risk separately.
Key medicines
Rabies vaccine for non-fully immunised exposureGive one full intramuscular dose on days 0, 3, 7 and 21 for a non-immunosuppressed person with UKHSA-classified amber or red risk who is not fully immunised.
Rabies vaccine after full immunisationGive one full intramuscular dose on day 0 and a second on day 3 to 7 for a fully immunised, non-immunosuppressed person with amber or red risk.