(RIgS) at UK Health Security Agency (UKHSA) have produced guidance for the management of patients with identified potential Rabies exposure.

The full UK Government guidance is accessed via this link which includes how to correctly fill in the online form required and should be read in conjunction with this guideline for the most up to date advice

In order to define which, if any, post exposure prophylaxis treatment is required, the online form from RIgS MUST be filled in and emailed to RIGS@ukhsa.gov.uk or PHE.ig.clerks@nhs.net

The information required to fill out the risk assessment form is as follows:

• Patient demographics – name, DOB, age, address, NHS number

• Date of exposure

• Country of exposure

https: https://www.gov.uk/government/publications/rabies-risks-by-country

• Species exposed to and health of animal (if known)

• Category of exposure (see full guidance to work out category)

• Site of exposure

• Patient immunosuppression status

• Patient allergies

• Previous rabies vaccination/immunoglobulin

For returning travellers who have been bitten and already commenced a course of treatment, the following additional information is required

• Date and time of each vaccine dose already given

• Vaccine schedule and route used

• Name (if known) of vaccine used

• If HRIG was used

Once the form is completed, a composite rabies risk (CRR) category will be given as Green, Amber or Red.

The need for treatment and a treatment schedule will then be advised once the patient vaccination status and immune system status are input into the form:

HRIG is not stocked on site and is issued either after discussion with RIgS or Colindale as appropriate for urgency and timing.

The Rabies vaccine is stocked in pharmacy and is prescribed on Epic as:

Once the form is completed and e-mailed, RIgS/Colindale need to be contacted to facilitate future vaccination scheduling delivery and stock replacement as per the following table. If seen out of hours, this can be done the next morning and it is the responsibility of the initial treating clinician to ensure that appropriate handover of this task (if required) occurs.

• RIgS 0330 128 1020

• Colindale Duty Doctor 0208 200 4400

The vaccine schedule days should be calculated as per the advised treatment schedule (D0 being the first day of vaccine delivery). It is important to know the day and date of further vaccines when contacting RIgS or Colindale so that arrangements to deliver future vaccine doses to the correct location can be done:

• Patients requiring further vaccinations on weekdays can have this at their GP surgery.

• Patients requiring further vaccinations on weekend days or bank holidays should be booked into Medical AECU as a planned reattendance.

The discharge letter to the GP must state that future doses of vaccination will need to be arranged at the GP surgery as RIgS will contact the GP surgery to facilitate vaccine delivery directly to them and advise a dosing schedule. The GP surgery will need to make the appointments and contact the patient to arrange this.

This guideline has been registered with the Trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt, contact a senior colleague or expert. Caution is advised when using guidelines after the review date.
This guideline is for use in Frimley Health NHS Foundation Trust hospitals only. Any use outside this location will not be supported by the Trust and will be at the risk of the individual using it.

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