post rabies exposure risk assessment

Last edited 05/2019

post exposure risk assessment

Each case requires a full risk assessment based on the collection of the following information about the circumstances of the potential exposure. Health care professionals should try to collect as much of this information as possible to inform the risk assessment:

• patient name, date of birth, age and address
• date of exposure
• due to the potentially long incubation period for rabies there is no time limit for giving post-exposure treatment (PET) and all potential exposures should be risk assessed
• due to the potentially long incubation period for rabies there is no time limit for giving PET and all potential exposures should be risk assessed
• species and current health status of animal involved
• all warm blooded animals and bats, including those that are apparently healthy, may pose a risk
• if possible domestic dogs and cats should be observed for15 days to see if they begin to behave abnormally
• the vaccination status of the animal
• a regularly vaccinated animal is unlikely to be rabid but even vaccinated animals need to be reviewed as transmission of rabies may still be possible
• country of exposure
• the risk of rabies from terrestrial mammals according to geographical location (country, island and territory) is updated regularly and the most recent version can be found on  the PHE website https://www.gov.uk/government/publications/rabies-risks-by-country
• all countries should be considered as high risk countries for bat exposure, including  the UK
• type and site of exposure
• the assessment of exposure needs to take into account the risk of direct physical contact with saliva, neural tissue, and other body fluids
• the assessment will be different for terrestrial mammals and bats
• the circumstances of the bite (or other contact): unprovoked bites carry greater risk than provoked bites
• any previous rabies vaccination or post exposure prophylaxis

This should be recorded in the rabies post-exposure form which can be found in HPZone and on the PHE website (https://www.gov.uk/government/publications/rabies-post-exposure-risk-assessment-form-and-calendar )

Reference:

• (1) Public Health England (PHE) 2015. PHE guidelines on managing rabies post-exposure cases
• (2) Health Protection Agency (HPA) 2009. The Public Health Management of a Suspected Case of Human Rabies