Overview

Rabies is a rare but very serious infection of the brain and nerves. It's usually caught from the bite or scratch of an infected animal, most often a dog.

Rabies is found throughout the world, particularly in Asia, Africa, and Central and South America.

It's not found in the UK, except in a small number of wild bats.

It's almost always fatal once symptoms appear, but treatment before this is very effective.

There's also a vaccine for people at risk of being infected.

Rabies vaccination

You should consider getting vaccinated against rabies if you're travelling to an area of the world where rabies is common and:

  • you plan to stay for a month or more, or there's unlikely to be quick access to appropriate medical care
  • you plan to do activities that could put you at increased risk of exposure to animals with rabies, such as running or cycling

Visit your GP or a travel clinic if you think you may need the vaccine.

Most people will have to pay for the rabies vaccine if it's needed for protection while travelling.

Even if you've been vaccinated, you should still take precautions to avoid coming into contact with rabies if you're travelling in an area where rabies is found and ger medical advice straight away if you've been bitten or scratched.

Some people may need the rabies vaccine because they could come into contact with rabies through their work.

If you think this applies to you, speak to your employer or occupational health provider.

How to avoid being bitten or scratched

All mammals (including monkeys) can carry rabies, but it's most common in:

  • dogs
  • bats
  • raccoons
  • foxes
  • jackals
  • cats
  • mongooses

They can spread the infection if they bite or scratch you or, in rare cases, if they lick an open wound or their saliva gets into your mouth or eyes.

Rabies is not spread through unbroken skin or between people.

While travelling in an area where rabies is a risk:

  • avoid contact with animals – some infected animals may behave strangely, but sometimes there may be no obvious signs they're infected
  • avoid touching any dead animals

If you're travelling with a child, make sure they're aware of the dangers and that they should tell you if they have been bitten, scratched or licked by an animal.

Check them for any wounds if they come into contact with an animal.

For information about areas where rabies is a risk, see:

What to do if you have been bitten or scratched

If you have been bitten or scratched by an animal in an area with a risk of rabies:

  • immediately clean the wound with running water and soap for several minutes
  • disinfect the wound with an alcohol- or iodine-based disinfectant and apply a simple dressing, if possible
  • go to the nearest medical centre, hospital or GP surgery as soon as possible and explain that you have been bitten or scratched

If this happens while you're abroad, get local medical help immediately. Do not wait until you have returned to the UK.

If you have already returned to the UK without getting medical advice, it's still a good idea to get help, even if it's been several weeks since you were bitten or scratched.

It's unlikely you have been infected, but it's best to be safe.

Post-exposure treatment is nearly 100% effective if it's started before any symptoms of rabies appear.

Treatment after a bite or scratch

If you have been bitten, scratched or licked by an animal that might have rabies, you may need specialist medical treatment to stop you getting rabies. This is called post-exposure treatment.

Post-exposure treatment involves:

  • cleaning and disinfecting the wound
  • a course of the rabies vaccine – you'll need to have 4 doses over a month if you have not been vaccinated against rabies before, or 2 doses a few days apart if you have
  • in some cases, a medicine called immunoglobulin is given into and around the wound – this provides immediate but short-term protection if there's a significant chance you have been infected

The post-exposure treatment you need may be slightly different if you have a weakened immune system.

Treatment should be started promptly, ideally within a few hours of being bitten or scratched.

But it's often safe to delay treatment until the next day if the vaccine or immunoglobulin need to be specially ordered in by your doctor.

Symptoms of rabies

Without treatment, the symptoms of rabies will usually develop after 3 to 12 weeks, although they can start sooner or much later than this.

The first symptoms can include:

  • a high temperature (fever) of 38C or above
  • a headache
  • feeling anxious or generally unwell
  • in some cases, discomfort at the site of the bite

Other symptoms appear a few days later, such as:

  • confusion or aggressive behaviour
  • seeing or hearing things (hallucinations)
  • producing lots of saliva or frothing at the mouth
  • muscle spasms
  • difficulty swallowing and breathing
  • inability to move (paralysis)

Once symptoms appear, rabies is almost always fatal.

In these cases, treatment will focus on making the person as comfortable as possible.

Rabies in the UK

The UK has been rabies-free since the beginning of the 20th century, with the exception of a rabies-like virus is a small number of wild bats.

The risk of human infection from bats is thought to be low. People who regularly handle bats are most at risk.

There's only been 1 recorded case of someone catching rabies from a bat in the UK.

It's also rare for infected bats to spread rabies to other animals.

But if you find a dead or injured bat, do not touch it. Wear thick gloves if you need to move it.

If you find a dead or injured bat, you should report it and get advice by calling:

  • the Animal and Plant Health Agency (APHA) Rural Services Helpline on 03000 200 301 (if you're in England)
  • the APHA Rural Services Helpline on 0300 303 8268 (if you're in Wales)
  • your local APHA Field Service Office (if you're in Scotland) – find contact details for your nearest Field Service Office

If you have been bitten by a bat in the UK, go to your GP surgery, your nearest urgent treatment centre or your nearest hospital to get help and start post-exposure treatment.

 

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Prevention

A vaccine is available to help protect people at risk of being exposed to rabies.

But even if you've been vaccinated, you should get urgent medical help if you're bitten or scratched by an animal that may have had rabies.

Who should have the rabies vaccine

People going travelling

You should consider getting vaccinated against rabies if you're travelling to an area of the world where rabies is common and:

  • you plan to stay for a month or more, or there's unlikely to be quick access to appropriate medical care
  • you plan to do activities that could put you at increased risk of exposure to animals with rabies, such as running or cycling

It takes up to 4 weeks to complete the vaccine course, so you ideally need to start it at least a month before you plan to leave.

Pregnant women are advised to have the rabies vaccine if the risk of exposure to rabies is thought to be high and there's limited access to medical care.

People at risk through their work

Vaccination is also recommended for anyone at risk of being exposed to rabies through their job (paid or voluntary), such as:

  • people who regularly handle bats
  • people who handle imported animals, such as workers at animal quarantine centres
  • laboratory workers who handle rabies samples

If you think this applies to you, speak to your employer or occupational health provider. If you regularly handle bats in a voluntary role, speak to your GP about rabies vaccine.

Where to get the rabies vaccine

You may be able to get the rabies vaccination at your local GP surgery, but you may need to pay for it.

Alternatively, you can pay for the vaccine at a private travel vaccination clinic.

Will I have to pay for the rabies vaccine?

You'll usually have to pay for the rabies vaccine if you need it for protection while travelling.

The vaccine course involves 3 doses. Each dose usually costs around £40 to £60, with a full course typically costing around £120 to £180.

If you need the vaccine because there's a risk you could be exposed to the infection through your job, your employer should be able to provide it for you free of charge. Ask your employer or occupational health provider about this.

If you regularly handle bats in a voluntary role, you should speak to your GP to see if you are eligible for free vaccine.

How the rabies vaccine is given

The rabies vaccine is given as injections into your upper arm.

You'll need 3 doses of the vaccine, usually over a period of 28 days.

If you're planning to travel to an area where rabies is found, you should complete the full course of 3 doses before you leave.

Booster doses

If you've been vaccinated against rabies before but you continue to be at risk – for example, through your job – you may need further "booster" doses to ensure you stay protected.

Speak to your employer or occupational health provider about the booster doses you might need.

For travellers, 1 booster dose may be considered if you were vaccinated more than a year ago and you're travelling to a high-risk area again.

Side effects of the rabies vaccine

After having the rabies vaccine, some people have temporary soreness, redness and swelling at the injection site for 24 to 48 hours.

In rare cases, some people also experience:

  • a mild high temperature (fever)
  • a headache
  • muscle aches
  • vomiting
  • a rash

The vaccines used in the UK contain an inactive (dead) form of the rabies virus, so you cannot catch rabies by being vaccinated.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 16/10/2019 13:03:09