1. What is the rabies risk of the animal involved?​

 Bats

• In the UK/Ireland = Low risk animal
• Outside the UK/Ireland = High risk animal

Primate or rodent

• Low risk animals

Other terrestrial animal (e.g. dog etc)

• Country dependent risk
• Search and select country from Gov.uk list

2. What is the nature of exposure?

Categories for bats

Category 1 - No physical contact with the bat’s saliva

e.g. touching a dead bat, touching a bat with protective barrier/clothing, a bat in the same room as a person in the UK or Ireland

Category 2 - Uncertain physical contact

e.g. handling live bat without protective clothing, bat becoming tangled in hair, potential contact with a bat in the UK/Ireland in someone who is unable to give accurate and reliable history of exposure, any bat found in the room of a sleeping person outside of the UK/Ireland

Category 3 - Direct contact with saliva

e.g. all bites or scratches, contamination of mucous membranes with saliva or urine.

Categories for all other animals

Category 1 - No physical contact with saliva

e.g. touching, stroking or feeding animals

Category 2 - Minimal contact with saliva and/or unable to infiltrate wound with HRIG if needed

e.g. bruising or abrasions, licks to broken skin, scratches, bites which do not break the skin

Category 3 - Direct contact with saliva

e.g. severe or deep lacerations, bites that break the skin, contact of mucous membranes with saliva e.g. licking of mouth/lips

3. Composite rabies risk table*

*Note: If you are using a mobile phone to view this content, turn it to landscape to view the tables better

*Advice should be sought from on-call Infectious Diseases via NHS Lothian switchboard.

4. Post-exposure treatment based on composite rabies risk and vaccine status

 *HRIG = Human Rabies Immunoglobulin. Follow step 6 below to determine if HRIG required in patients with a Red composite rabies risk who are non/partially immunised and who are not immunosuppressed

5. How to arrange Rabies Post Exposure Prophylaxis (PEP) in NHS Lothian

If risk assessment recommends post-exposure rabies vaccination or HRIG:

1. Contact the RIDU registrar on-call in hours (0900-1900) to arrange vaccination. 
2. Rabies vaccine is also available via Emergency Departments at RIE and SJH for high risk injuries out-of-hours.

For very high risk exposures, such as severe and multiple bites to the head and neck or injury from a confirmed rabid animal treatment must be started as soon as possible and within 12 hours of reporting.

1. Contact the RIDU registrar on-call in hours (0900-1900) 
2. Out-of-hours the patient should be directed to the Emergency Department for urgent treatment
3. Additional advice can be sought from the ID consultant on-call if required.

6. HRIG prioritisation

Follow to steps below to determine which patients require HRIG

Step 1: Review high risk factors below 

• Patient is a child
• Animal that caused the bite has confirmed Rabies. 

YES to either: full HRIG indicated

NO to both: proceed to Step 2

Step 2 Review mitigating factors 

• Any rabies vaccine >7 days ago (including past vaccination)
• Had D0 + D3 vaccines
• Rabies Immunoglobulin in the form of monoclonal antibodies or animal derived antibody
• The wound occurred more than one month ago
• The wound is fully healed 

YES to any: HRIG not required, proceed to vaccination as per guidance

NO to all: limited HRIG indicated

HRIG dosing:

Full HRIG is indicated:

• Maximum of 20 IU / kg of body weight infiltrated into and around the cleansed wound, or remaining dose given as intramuscular administration 

 Limited HRIG is indicated:  

• 1 vial (regardless of dose contained) to be used for infiltration into and around cleansed wound, to a maximum dose of 20 IU / kg body weight 

 The interim UKHSA guidance on HRIG prioritisation (June 2025) should be reviewed prior to giving HRIG.