Rabies vaccine shortage: advice for health professionals

Important advice on rabies vaccine shortage for health professionals

Rabies is a vaccine-preventable viral infection spread mostly by contact with the saliva of an infected wild or domestic animal. Transmission occurs mostly through bites, scratches or saliva coming in to contact with broken skin or mucous membranes (eyes, mouth, nose).

Bats can carry rabies, including in the United Kingdom (UK) [1].

In humans, rabies is almost always fatal, once symptoms appear [1, 2]. It is preventable by avoiding contact with animals and seeking prompt medical attention after any possible contact.

Rabies vaccine availability may occasionally be limited. During shortages, health professionals may need to:

• prioritise vaccination for people at highest risk, including:
• travellers to endemic areas for long stays
• young children
• individuals planning to have animal contact such as vets or animal handlers
• consider alternative licensed regimens
• delay vaccination briefly until stock returns – there is no need to restart courses (see interrupted vaccination schedules)
• consider advising the traveller to complete their course when abroad – the ISTM Global Travel Clinic Directory lists clinics worldwide if courses need to be completed abroad

As of February 2026, Bavarian Nordic: Rabipur® and Sanofi: Verorab® rabies vaccines are available in limited supplies [3].

In addition to the three-dose rabies vaccine schedule, the current licences for Verorab® and Rabipur® rabies vaccines allow a two-dose intramuscular injection course seven days apart.

With Verorab®, there is also an option for a two-dose intradermal schedule, given seven days apart (one injection in each arm for adults and children or each anterolateral thigh for infants and toddlers) [4]. Intradermal rabies vaccination relies on the whole 0.1 ml dose being given properly into the dermis (middle layer of skin) and should therefore only be given by health professionals experienced in intradermal techniques. The intradermal route should not be used for travellers taking chloroquine as malaria prophylaxis [1].

The UK Health Security Agency (UKHSA) Immunisation against infectious disease (the Green Book) Rabies chapter does not currently reflect this new licensing information [1]. The World Health Organization (WHO) recognises that pre-exposure rabies vaccine can be given by the intradermal or intramuscular route [5].

A two-dose schedule is considered as partially immunised in the UK [6]. However, WHO and the US Centers for Disease Control and Prevention both recommend a two-dose pre-exposure rabies vaccine course [5,7].

Travellers at occupational risk of rabies who cannot complete their vaccine schedule before departure, should be advised to contact their Occupational Health department /employer for additional mitigation measures that might be needed.

All travellers at risk should receive animal bite avoidance advice and clear instructions on what to do if they are bitten, scratched or licked, regardless of vaccination status.

A practical guide to undertaking a risk assessment of potential rabies exposures and the correct use of post-exposure treatment (PET) is available from the UKHSA [6].