Rabies (my personal favourite vaccine)

Keeping up to date: Things to know in practice currently:

• 4th September: Rabies post exposure risk assessment form and calendar updated with new immunoglobulin batch number, vial volume and expiry date.

• 14th August: Update to this page: Guidance, Rabies and Immunoglobulin Service (RIgS). Did you know? In 2024 there were 4,743 calls related to rabies prophylaxis or post-exposure treatment.

• 22nd July 2025: Oh no! My favourite post-exposure patient has died. RIP Ozzy. (at least it wasn't rabies that got him). Did Ozzy Osbourne really bite the head off a live bat?

• Rabies fears rise in Indonesia’s Bali as tourist hotspots declared ‘red zones’

• 17th July 2025: Really useful blog: Understanding the risks and management of rabies exposure for UK travellers

• 27th June 2025: Interim recommendations for the use of human rabies immunoglobulin were issued. 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. It seems the recent UK death has prompted a bit of a surge in inquiries for PET so the RIG will have to be managed tightly.

• 23rd June: MORE rabies in BBC news.... Rare rabies-like virus found in island bat on the on the Isle of Wight.

• 18th June: So sad, and so avoidable. A Yorkshire lady has died of rabies after a holiday in Morocco and an unfortunate and seemingly benign run in with a puppy. This NaTHNaC factsheet comes at a good time: Worldwide rabies risk reminder

• 4th June: Note the contact number has changed for the rabies immunoglobulin service.

• 3rd Feb 2025: Rabies post-exposure risk management forms updated - added information on Zimbabwean rabies vaccine alert. See the related NaTHNaC advice here.

• 22nd Jan 2025: The Medicines Control Authority of Zimbabwe announced that falsified rabies vaccine is circulating through unauthorised sources in Zimbabwe. They report this falsified product poses a significant threat to public health due to the possibility of lack of efficacy, harmful components and the risk of treatment failure in preventing rabies, a fatal disease.

• 1st Jan 2025: With effect from 1st January 2025, the responsibility for the marketing and distribution of Rabipur transitions from Valneva to Bavarian Nordic, in partnership with Polar Speed Distribution. I wonder if this means there may be some shortages of rabies vaccines ahead as often is the case when transitions are happening...

• AUGUST 2024: Worth looking at this advice about rabipur reconstitution before ordering in the supplies THAT ARE NOW AVAILABLE TO ORDER AGAIN!! Yay!

  (Do check out the product alert though)

• Note that both Rabipur and Verorab SPC's include provision for two dose primary schedules (0, 7d).

Cautionary tales

• Man succumbs to dog bite after failing to get vaccination in south-central Vietnam. The man did not get vaccination against rabies after being bitten by a strange dog

• 27-Year-Old Man Dies Of Rabies After Stray Dog And Cat Bites In Kalyan; Delayed Vaccine Blamed

• Another very sad (and likely preventable) death: Canadian child dies from rabies after bat found in bedroom.

• Another death 2 months after a bat contact in Minnesota at the end of September: Minnesota reports rare human death from rabies.

• A 7 year old boy dies 1 month after pet dog bite in Vietnam

• Another cautionary tale here of a man who died (also in Vietnam) after failing to be vaccinated.

• Don't forget about BATS which this article shared by the BGTHA highlights nicely. Campers beware!

• Woman in Delhi NCR dies of rabies, within days after drinking milk from infected cow.

• After Michigan patient dies of rabies from a transplanted kidney, donor's other recipients get preventive shots

• Dad dies after being bitten by bat as he tried to free it from his home

• Could my job have saved my life? My experience as a post-exposure rabies case.

Other useful links and further reading:

• Animal bites - some gruesome pics - beware!

• This was a revealing observational study published in TMAID in 2024, which really makes one think about the importance of rabies advice. It's a good read: Rabies knowledge gaps and risk behaviour in Dutch travellers: An observational cohort study

• This free webinar from the ISTM is a good watch Rabies in Travelers: Deadly but Preventable and this is available on the ISTM YouTube channel (9th October 2024)

• Very enlightening survey concluding that awareness and perception of rabies risk, and lack of consistent HCP discussion of the need for rabies PrEP may be major barriers to uptake of the vaccine for patients who are eligible to receive it.

• Rabies in humans: A treatment approach

• Rabies exposure in international travellers: Experience from a single travel clinic in Paris, France, 2018–2022

• Travel-related potential rabid animal post-exposure consultation at the Thai Travel Clinic, Hospital for Tropical Diseases, Bangkok, Thailand. Conclusions: Over half of the international travellers in this study delayed initiating rabies vaccine or immunoglobulin after potential rabid animal exposure. Some even DECLINED IT. As rabies is a fatal yet preventable disease, this review underscores the urgent need to raise awareness about the importance of prompt post-exposure management. Strengthening traveller education and advocating for pre-exposure immunisation are critical strategies to mitigate risks and improve outcomes.

• Podcast episode: Unravelling Rabies

• Delayed and incomplete rabies post-exposure prophylaxis among international travelers: A seven-year retrospective study at an emergency center in eastern Thailand, In this study, a large proportion of international travelers had delayed or incomplete PEP for rabies. The patient's age and wound characteristics and the animal type were key factors that influenced PEP adherence. These findings highlight the need for targeted interventions to improve adherence to rabies PEP among international travelers in regions where rabies is endemic.

• Travel-related potential rabid animal post-exposure consultation at the Thai Travel Clinic, Hospital for Tropical Diseases, Bangkok, Thailand. If you are short of time to read, the take home message is that most travellers only thought about rabies after an animal had a nibble—nearly 60% had serious exposures before seeking help.

  Delays in treatment were common, with many missing that all-important window for immunoglobulin. And despite the risks, barely 1 in 10 got the jab before they flew—so let’s shout louder about PrEP before people pack their bags!

Bits and bobs to casually drop into conversation

Did you know....

• Ozzy Osborne received post-exposure rabies vaccines after biting the head off a dead bat during a live gig (just to ruin his street cred - he actually thought it was plastic and was horrified to learn it was real as soon as he tasted blood! eek)

• It's NOT just spread by dogs!

• It's NOT just spread by rabid-looking animals

• It's ALWAYS fatal - one of the most deadly diseases we have

• Vaccines are pretty much 100% effective!! What a great investment for health

"Not so cute and fluffy now" A webinar with some information about rabies and post exposure treatment. May 2024