Rabies risk assessment and treatment following bat exposure

Members of the public, volunteers and professionals who come into contact with bats and may therefore have had a potentially rabies prone exposure, are advised to seek urgent medical assessment and advice. It is therefore important that healthcare professionals who may be contacted in this respect are aware of how to conduct a risk assessment and to ensure that timely appropriate treatment is given when required.

In Scotland, Infectious Disease consultants usually assist with the risk assessment (see contacts later).

The risk assessment comprises:

• Collation of basic information about the individual (name, age, contact, general health status etc.)
• Details of exposure incident and categorisation of risk (see table 1)
• Assessment of composite rabies risk: Green, Amber, or Red (see table 2)

Table 1: categories of exposure to bats:

*Most bats found in houses and attics in the UK/Ireland are pipistrelles, which are not known to be infected with rabies-related viruses. Healthy bats avoid contact with humans therefore bats behaving normally (i.e flying into a room but not grounded or acting aggressively) do not constitute a risk.

**For countries outside the UK/Ireland, any bat found in the room of a sleeping or intoxicated person should be considered a category II exposure. In the USA 50% of human rabies with bat variant virus have resulted from unrecognised bat bites.

Frequently, individuals are uncertain about the nature of a bat exposure as bat bites can be difficult to see or feel.

Under Rabies Classification of Country Risk for Rabies, all bats in the UK are classified as ‘Low Risk’.    

Table 2: Composite rabies risk

Where there is wound, the individual should be advised to immediately clean the wound by thoroughly flushing with running water for several minutes and washing with soap.

The composite risk categorisation determines the recommended treatment as can be seen in table 3 below.

• Anyone with a Red or Amber categorisation should be referred for follow up and treatment (usually to the nearest Infectious Diseases Unit) without delay
• Anyone with Green composite risk categorisation needs no further referral or treatment.

 Table 3: Recommended treatment based on composite risk categorisation

Where can post exposure treatment be given and by whom?

In Scotland, post exposure rabies treatment is usually given in Infectious Disease Units where healthcare practitioners have experience in assessing risk, know how and where to access immunoglobulin and rabies vaccine, and know how to administer treatment.

An infectious disease physician should be consulted by healthcare practitioners when considering post exposure rabies treatment.

Further advice can be found the Rabies Green Book Chapter.

An information leaflet on bat contact and rabies risk is also available here (pdf download).

The Animal and Plant Health Agency (APHA) operates a passive surveillance programme whereby members of the public and those working with bats can submit dead bats they find to APHA. This is a passive system to improve understanding of EBLV in the UK.  It is NOT designed to support the risk assessment of exposed individuals.  If indicated post exposure treatment should be given urgently at the time of exposure and must not be delayed until results of any testing of the bat become available.