Research and analysis

HPR volume 12 issue 39: news (2 November)

Updated 21 December 2018

Updated guidance on managing rabies exposures

Classical rabies is an acute viral encephalomyelitis caused by several members of the Rhabdoviridae family. It transmits through infected saliva, via bites or scratches from rabid animals (in particular dogs). Because it is almost invariably fatal once symptoms develop, rabies still poses a significant public health problem in many countries in Asia and Africa where 95% of human rabies deaths occur. Post-exposure treatment using rabies vaccine - with or without human rabies immunoglobulin (HRIG) - is highly effective in preventing disease if given correctly and promptly after exposure. Approximately 2000 people each year require post-exposure treatment in England, of which 12% were potentially exposed to bats in the UK and 88% exposed to an animal overseas [1].

Following a review by the Joint Committee on Vaccination and Immunisation (JCVI) in February 2018, the guidance for rabies post-exposure treatment (PET) and pre-exposure prophylaxis in the UK was updated in June this year [2]. Further details can be found in chapter 27 of the ‘Green Book’, ‘Immunisation against infectious disease’ [1], and Public Health England (PHE)’s guidelines on managing rabies post-exposure treatment [3].

A special rabies edition of PHE’s monthly publication for immunisation practitioners, Vaccine Update [4], was published following the recent revisions to the guidance. This provides additional in-depth guidance for health professionals about the changes to rabies pre-exposure prophylaxis, information on rabies risk from animal bites abroad, administration of rabies immunoglobulin, advice on how to manage a patient with a bat bite, rabies prevention for immunosuppressed patients and how health professionals can contact PHE’s Rabies and Immunoglobulin Service (RIgS).

New bat rabies virus detected in England

The UK has been free of rabies in terrestrial animals since 1922. However a rabies-related virus – European Bat Lyssavirus-2 (EBLV-2) – has been regularly found in Daubenton’s (Myotis daubentonii) bats across the UK in recent years [1]. EBLV-2 is a virus related to the ‘classical’ (terrestrial) rabies virus that is prevalent in Africa and Asia and can lead to clinical rabies infection in humans.

In October 2018, the presence of a different type of bat rabies virus, European Bat Lyssavirus-1 (EBLV-1) – responsible for the majority of bat rabies cases reported in Europe [5] – was confirmed for the first time in the UK in a serotine bat (Eptesicus serotinus). The occurrence underlines the fact that, while the risk of catching rabies from a bat is very low, all bats (whatever species) should be considered a potential risk of rabies.

Because infected bats may not show signs of illness – bat bites in the UK are felt rather than seen and may not bleed or leave an obvious mark on the skin – all bat bites, scratches or other exposures in the UK or abroad should be assessed promptly by a health professional so that post-exposure treatment can be arranged if needed.

PHE leaflet on bat and rabies risks

PHE, with the Department for Environment, Food and Rural Affairs (Defra) and the Animal and Plant Health Agency (APHA) have produced a new leaflet for the public on rabies risk associated with bat contact [6]. It provides advice on what to do if someone finds a bat, if a bat comes into their home or if their pet catches a bat, as well as steps to take if they have had contact with a bat.

References

1. The ‘Green Book’ Immunisation against infectious disease.
2. New rabies risk assessment and control regime, HPR 12(24), 6 July 2018.
3. PHE website (June/July 2018). Guidelines on managing rabies post-exposure (June 2018).
4. PHE (August 2018). Vaccine Update: issue 282, rabies special edition.
5. WHO website. Rabies Bulletin Europe.
6. PHE (2018). Bat contact and rabies risks [leaflet].

Infection reports in this issue

• Laboratory reports of respiratory infections made to PHE from PHE and NHS laboratories in England and Wales: weeks 40 to 43, 2018.

• Laboratory reports of hepatitis A and C in England and Wales, April to June 2017.

Chemical and environmental hazards reports in this issue

• Lead Exposure in Children Surveillance System (LEICSS) annual report, 2017.