Rabies: risk assessment, post-exposure treatment, management
Source: gov.uk (2025-10-29)

Guidance on assessing risk following rabies exposure, post-exposure treatment, and public health management of a suspected rabies case in the UK.

An alert was raised by Indian Immunologicals Limited (https://drugscontrol.org/pdf/couneterfeit_abhayrab_merged.pdf) regarding the identification of falsified rabies vaccine in circulation in India in early 2025. The falsified vaccine is labelled as ‘Abhayrab batch no KA24014’ but there are reported to be several discrepancies in formulation, packaging, labelling, and manufacturing to the legitimate Abhayrab vaccine.

UKHSA is undertaking a review of the records of individuals who have received rabies vaccine as part of their post-exposure treatment course in India, and is in the process of contacting GPs if their patients are recommended to receive additional vaccines to complete their post-exposure treatment course. Health care professionals with concerns about a patient who may have received falsified rabies vaccine in India can contact the UKHSA Rabies and Immunoglobulin Service (RIgS) (https://www.gov.uk/government/publications/immunoglobulin-when-to-use/rabies-and-immunoglobulin-service-rigs) for further advice.

Interim recommendations for the use of human rabies immunoglobulin (https://www.gov.uk/government/publications/rabies-post-exposure-prophylaxis-management-guidelines/interim-recommendations-for-human-rabies-immunoglobulin-hrig-use) were issued on 27 June 2025. These recommendations supersede guidance on the use of rabies immunoglobulin within the UKHSA guidelines on managing rabies post-exposure treatment. The current guidance on use of rabies vaccine for post-exposure treatment remain the same.

Rabies is an encephalitis caused by rabies virus, a member of the rhabdovirus family. It is an acute viral infection that is almost invariably fatal once symptoms develop.

Transmission is generally through the bite of an infected animal, usually dogs, but also cats, bats and other wildlife. A course of rabies vaccination can prevent infection and death.

It is important that a medical practitioner assesses all animal bites, especially:
- bat bites in the UK
- any other animal bites overseas
Diagnosis of rabies in the early stages is often difficult as symptoms may be non-specific.

Clinical rabies is a notifiable disease (https://www.gov.uk/government/collections/notifications-of-infectious-diseases-noids) in England.

See Green Book rabies chapter (https://www.gov.uk/government/publications/rabies-the-green-book-chapter-27)

See NaTHNaC rabies factsheet (https://travelhealthpro.org.uk/factsheet/20/rabies)

See Vaccine update: rabies special edition (https://www.gov.uk/government/publications/vaccine-update-issue-282-august-2018-rabies-special-edition)

For further assistance

Please contact the Rabies and Immunoglobulin service (https://www.gov.uk/government/publications/immunoglobulin-when-to-use/rabies-and-immunoglobulin-rigs-changes-to-the-current-service) or your local health protection team (https://www.gov.uk/health-protection-team). The Rabies and Immunoglobulin service is for healthcare professionals only. Members of the public should contact their GP or local health protection team.