Rabies
Rabies is a viral disease transmitted to humans usually by a bite or scratch from an infected animal (usually a dog). The virus attacks the central nervous system causing, progressive damage to the brain and spinal cord. Once symptoms are present, rabies is almost always fatal.
Human rabies cases are often unreported so it is difficult to provide reliable figures on the incidence worldwide. The disease is estimated to cause 59,000 human deaths annually. Rabies is rare in travellers with only 25 human deaths in the UK from imported rabies since 1946.
Although rabies cases are rare in travellers, animal bites and scratches are common. It is important that travellers visiting areas where rabies occurs are aware of the risk and know what to do if they are bitten or scratched. The disease is preventable if the correct post-exposure treatment (PET) is provided quickly. PET can be expensive and difficult to obtain in some areas.
Prevention
Contact with wild or domestic animals during travel should be avoided. Travellers should also be advised:
- not to approach animals.
- not to attempt to pick up an unusually tame animal or one that appears to be unwell.
- not to attract stray animals by offering food or by being careless with litter.
- be aware that certain activities may attract dogs (e.g. running, cycling).
The following advice can be given regarding first aid following a possible rabies exposure:
- Urgent action is required; treatment should be commenced as soon as possible after the exposure.
- Immediately wash the wound with detergent or soap and running water for several minutes.
- Apply a disinfectant to the wound such as an iodine solution (tincture or aqueous solution of povidone-iodine) or 40-70 percent alcohol.
- Apply a simple dressing to the wound.
- Seek immediate medical advice about the need for PET and possible antibiotics to prevent a wound infection.
- Tetanus vaccine may be necessary if the traveller is not up to date.
- Suturing of the wound should be postponed until PET has started.
Rabies vaccine
Individuals considered at risk of exposure to rabies viruses within the UK include:
- laboratory workers routinely handling rabies virus.
- workers at Defra-authorised quarantine premises and carriers.
- bat handlers who regularly handle bats, including on a voluntary basis, in the UK.
- veterinary and technical staff who due to their employment maybe at increased rabies risk.
Individuals considered at risk of exposure to rabies travelling outside the UK include:
- animal workers who regularly travel to rabies enzootic areas.
- travellers to rabies enzootic areas especially if:
- visiting areas where access to post-exposure treatment and medical care is limited.
- planning higher risk activities such as cycling and running.
- long-stay travellers (more than one month).
- health workers in rabies enzootic areas who may have direct contact with rabies infected patients.
See our Country Information pages to see individual recommendations for each destination.
A course of pre-exposure vaccines simplifies PET when this is required, two further rabies vaccines are administered on days 0 and 3 - 7 in the event of a possible rabies exposure. These vaccines should be obtained as soon as possible after the exposure. For individuals who have not had pre-exposure rabies, four doses of rabies vaccine are usually recommended over one month plus rabies immunoglobulin may be recommended in the event of a high risk exposure. Immunoglobulin is in short supply worldwide, and may not be available in many countries.
Vaccine schedules
| Vaccine | Route of administration |
Schedule | Pre-exposure recommendations** |
Age range |
| Rabies Vaccine BP (Human diploid cell vaccine) (HDVC) [discontinued] |
Intra-muscular | 3 doses Day 0, 7 and 21 or 28* Rapid Regimen: 3 doses Day 0, 3, 7 and a further dose at 1 year |
Primary course (3 doses of vaccine) Booster dose** |
***No minimum age stated in the Summary of Product Characteristics (SPC) |
| Rabipur (Purified chick embryo cell vaccine) (PCECV) |
Intra-muscular | 3 doses Day 0, 7 and 21 or 28* Rapid Regimen: 3 doses Day 0, 3, 7 and a further dose at 1 year |
Primary course (3 doses of vaccine) Booster dose** |
***No minimum age stated in Summary of Product Characteristics (SPC). See Interrupted or accelerated course information below for further details. |
The Summary of Product Characteristics (SPC) should be consulted prior to the administration of any vaccine.
*A third dose can be given from day 21 if insufficient time before travel.
**Routine booster doses are not recommended for most travellers. See Rabies. Chapter 27. Immunisation against infectious disease.
***Although the vaccine can be given at any age, the rapid regimen is 'off-license' in some age groups, see the Interrupted and Accelerated Courses information below. The risk of animal bites may be higher once the child is independently mobile. Children are often bitten around the face or head, a type of bite considered to be a higher risk due to the expected shorter incubation period.
Interrupted or accelerated courses
Ideally, those at risk should receive pre-exposure vaccination with three doses of rabies vaccine before travel. Both the 0, 3, 7 and 365 (i.e. a fourth dose at 1 year) day schedule and the 0, 7 and 21 day schedule can be given using either product, where there is less than four weeks before departure. The 0,3,7 and 365 day schedule is 'off-license' in some age groups and with some vaccine brands but can be given according to Ch 27 immunisation against infectious disease 'Green book' guidance.
In some vaccine shortage situations, the Medicines and Healthcare products Regulatory Agency (MHRA) and the Department of Health (DH) allow vaccine companies to import alternative vaccine products for use. See information on vaccine supply shortages and use of unlicensed medicines. Please contact the vaccine suppliers for information.
A risk assessment should always be undertaken when considering rabies immunisation.
Resources
- More detailed information can be found in our rabies factsheet
- UKHSA (previously Public Health England): Rabies: risk assessment, post-exposure treatment, management
- UKHSA (previously Public Health England): Rabies: summary of risk assessment and treatment
- UKHSA: Rabies post-exposure administration of vaccine and immunoglobulin
- UKHSA: Rabies and immunoglobulin service (RIgS)
- UKHSA (previously Public Health England): Rabies information for travellers
- Further details on the vaccines can be found in the SPC on the electronic medicines compendium
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Updated: 19 January 2023Recent Rabies Outbreaks
Rabies in Timor-Leste
As of 22 March 2024, one fatal human case of rabies was confirmed in Pasabe Subregion, Oecusse. This is the first confirmed human case of rabies in Timor-Leste.
Rabies in France ex Morocco
On 5 January 2024, a case of rabies was confirmed in a dog in Hyères, Provence-Alpes-Côte d'Azur. The female border collie dog was illegally imported to France on 16 December 2023 from Morocco. According to the report, the first clinical signs were detected on 20 December 2023.
Rabies in France
On 27 October 2022, a dog was confirmed to have rabies, following testing by the Institut Pasteur in France. The origin of the dog is currently suspected to be Morocco, although investigations are ongoing. The last reported rabies case in France was in an illegally imported puppy from Morocco in February 2020.
Rabies in Switzerland
On 30 June 2022, the Swiss Rabies Centre detected rabies virus in a bat. In the past 40 years, only four bat rabies cases have been confirmed in Switzerland, with the last reported in 2017 in Neuchâtel.
