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.
- Contact the UKHSA Rabies and Immunoglobulin Service for individual green, amber or red risk allocation; do not substitute a remembered country list for the current algorithm.
- A non-immunosuppressed person who is not fully immunised and has an amber or red exposure generally receives four intramuscular vaccine doses on days 0, 3, 7 and 21.
- A fully immunised, non-immunosuppressed person with an amber or red exposure generally receives two vaccine doses on day 0 and day 3 to 7, without routine HRIG.
- An immunosuppressed exposed person receives HRIG when indicated and five vaccine doses on days 0, 3, 7, 14 and 30, with specialist assessment of response.
- When UKHSA authorises human rabies immunoglobulin, use 20 IU/kg and infiltrate as much as anatomically feasible into and around all wounds; never exceed the calculated dose.
- Pregnancy and breastfeeding are not contraindications to post-exposure vaccination or immunoglobulin because untreated rabies risk is catastrophic.
- Rabies is clinician-notifiable in England; suspected symptomatic disease requires immediate health-protection, infection, neurology and critical-care coordination.
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.
Headache, fever, paraesthesia or pain at the bite followed by agitation, hydrophobia, aerophobia, dysphagia or autonomic instability suggests furious rabies.
Ascending flaccid weakness after an animal exposure may be paralytic rabies and can be mistaken for Guillain–Barré syndrome.
A bite to the face, head, neck, hand or genitals, multiple deep wounds or exposure in a child increases concern because innervation and inoculum may shorten risk pathways.
Immunosuppression changes the post-exposure schedule and requires HRIG plus five vaccine doses even when previous vaccination history appears reassuring.
Do not postpone prophylaxis while trying to source the animal or await laboratory testing unless UKHSA explicitly advises that observation or testing resolves the risk.
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.
- Avoid primary tight closure where possible; if closure is necessary, infiltrate authorised HRIG first and use minimal loose suturing after surgical advice.
- Do not apply irritants, cautery or a tight tourniquet, and do not allow excellent wound care to delay contact with UKHSA.