Pre-exposure (prophylactic) immunisation and reinforcing immunisations
- to determine the need for pre-exposure immunisation, an individual risk assessment of potential exposures should be carried out
- requirement for booster doses is dependent on an individual's indication for preexposure prophylaxis and the likely frequency of ongoing exposures
- in those who may have frequent unrecognised exposures to the virus, e.g. bat handlers, a single reinforcing dose of vaccine should be given one year after the primary course has been completed
- further booster doses should then be given every three to five years or based on serology
- laboratory staff routinely working with the rabies virus should have their vaccine antibody tested at six monthly intervals to determine optimal timing for booster doses. Antibody titres of at least 0.5 IU/ml are considered protective (WHO, 2018b) (1)
- pre-exposure (prophylactic) immunisation for those within the UK
- laboratory staff routinely working with rabies virus
- workers at Defra-authorised quarantine premises and carriers
- those who regularly handle bats, including on a voluntary basis, in the UK
- veterinary and technical staff who, by reason of their employment, encounter enhanced risk
- pre-exposure (prophylactic) immunisation for those travelling outside the UK
- animal control and wildlife workers, veterinary staff or zoologists who regularly work in rabies enzootic areas
- travellers to rabies enzootic areas, especially if:
- post-exposure medical care and rabies biologics at the destination are lacking or in short supply
- or they are undertaking higher risk activities such as cycling or running
- or they are living or staying for more than one month
Routine booster doses are not recommended for most travellers (1)
- a single booster dose of vaccine can be considered, following a risk assessment, in those who have completed a primary course over one year ago and are travelling again to a high risk (enzootic) area
- complete pre-exposure primary course is considered to be three doses over 21-28 days or an accelerated three dose course (over 7 days) plus an additional dose of vaccine at one year (1)
Check uptodate details in the The Green Book before prescribing/administering a rabies vaccination.
Check the Summary of Product Characteristics (SPC) before prescribing/administering a rabies vaccine.
Reference:
- The Green Book. Chapter 27 - Rabies (April 2019)