Rabies is a viral disease transmitted to humans usually by a bite or scratch from an infected animal (usually a dog). The virus attacks the central nervous system causing, progressive damage to the brain and spinal cord. Once symptoms are present, rabies is almost always fatal.
Human rabies cases are often unreported so it is difficult to provide reliable figures on the incidence worldwide. The disease is estimated to cause 59,000 human deaths annually. Rabies is rare in travellers with only 25 human deaths in the UK from imported rabies since 1946.
Although rabies cases are rare in travellers, animal bites and scratches are common. It is important that travellers visiting areas where rabies occurs are aware of the risk and know what to do if they are bitten or scratched. The disease is preventable if the correct post-exposure treatment (PET) is provided quickly. PET can be expensive and difficult to obtain in some areas.
Contact with wild or domestic animals during travel should be avoided. Travellers should also be advised:
The following advice can be given regarding first aid following a possible rabies exposure:
Individuals considered at risk of exposure to rabies viruses within the UK include:
Individuals considered at risk of exposure to rabies travelling outside the UK include:
See our Country Information pages to see individual recommendations for each destination.
A course of pre-exposure vaccines simplifies PET when this is required, two further rabies vaccines are administered on days 0 and 3 - 7 in the event of a possible rabies exposure. These vaccines should be obtained as soon as possible after the exposure. For individuals who have not had pre-exposure rabies, four doses of rabies vaccine are usually recommended over one month plus rabies immunoglobulin may be recommended in the event of a high risk exposure. Immunoglobulin is in short supply worldwide, and may not be available in many countries.
Vaccine | Route of administration |
Schedule | Pre-exposure recommendations** |
Age range |
Rabies Vaccine BP (Human diploid cell vaccine) (HDVC) |
Intra-muscular | 3 doses Day 0, 7 and 21 or 28* Rapid Regimen: 3 doses Day 0, 3, 7 and a further dose at 1 year |
Primary course (3 doses of vaccine) Booster dose** |
***No minimum age stated in the Summary of Product Characteristics (SPC) |
Rabipur (Purified chick embryo cell vaccine) (PCECV) |
Intra-muscular | 3 doses Day 0, 7 and 21 or 28* Rapid Regimen: 3 doses Day 0, 3, 7 and a further dose at 1 year |
Primary course (3 doses of vaccine) Booster dose** |
***Can be given from any age |
The Summary of Product Characteristics (SPC) should be consulted prior to the administration of any vaccine.
Ideally, those at risk should receive pre-exposure vaccination with three doses of rabies vaccine before travel. Both the 0, 3, 7 and 365 (i.e. a fourth dose at 1 year) day schedule and the 0, 7 and 21 day schedule can be given using either product, where there is less than four weeks before departure. The 0,3,7 and 365 day schedule is 'off license' in some age groups and with some vaccine brands but can be given according to Ch 27 immunisation against infectious disease 'Green book' guidance.
In some vaccine shortage situations, the Medicines and Healthcare products Regulatory Agency (MHRA) and the Department of Health (DH) allow vaccine companies to import alternative vaccine products for use. See information on vaccine supply shortages and use of unlicensed medicines. Please contact the vaccine suppliers for information.
A risk assessment should always be undertaken when considering rabies immunisation.