In the UK the only bat to carry rabies is the Daubenton’s Bat [Picture on the Left] and this is not a common bat in the UK. The UK and Ireland are Classified as “low-risk” for bat exposure. Despite our “low-risk” status in 2002 a man died from rabies caught in the UK from bat exposure.

Although rabies is rare it is fatal so we must treat appropriately, Public Health England – Green book details this.

Risk Assessment

To establish patients risk and thus treatment you need to establish the Exposure Category and Country Risk [Link to Country Risk]

Exposure Category

Combined Country/Animal & Exposure Risk

Treatment

Obviously patients with wounds will need appropriate wound care and cleaning, specifics for rabies are below.

If in ANY doubt, or you feel you need advice about treatment contact: On-Call Microbiologist (who will contact PHE or Virology advice)

You will likely need to liaise with the duty pharmacist to obtain vaccine or HRIG – which may need to be sent from a different hospital. [it is probably worth trying to obtain the 1st weeks treatment if possible, to avoid treatment delays]

IN HOURS 08:30AM-5PM PLEASE CALL PHARMACY TO INFORM THEM TO EXPECT A DELIVERY OF IMMUNOGLOBULIN SO THIS CAN BE SEGREGATED FOR THE CORRECT PATIENT. PLEASE ASK TO SPEAK TO THE RESPONSIBLE PHARMACIST                      CRH (4218/4279) HRI (2422/7123) 

Rabies and Immunoglobulin Service (RIgS), National Infection Service, Public Health England, Colindale

• RIgS telephone number: 0330 128 1020.
• RIgS operates 7 days per week (9:30am to 5pm).
• The emergency out of hours service is only able to deal with calls about potential human cases of botulism or diphtheria, or the highest risk rabies exposures who have not already received one post-exposure dose of rabies vaccine (these are exposures to the head or neck, excluding those related to UK bats, or to an animal that is confirmed to have rabies).
• Health professionals calling about any other rabies exposures should administer a dose of rabies vaccine if the patient has not yet received any rabies vaccine (or if the next scheduled dose is due) and vaccine is available locally, and call back the next day after 9:30am to complete the risk assessment and confirm the timings for further vaccine doses.
• Information required – HERE