Rabies: summary of risk assessment and treatment (text version)
Updated 27 June 2025
Applies to England
漏 Crown copyright 2025
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Health professionals involved in the assessment and management of potential rabies exposures should take the following steps:
1. Determine the combined country and animal risk
Check the A to Z list of countries and their category of risk for rabies.
2. Determine the category of exposure
| Category | Terrestrial mammals | Bats | ||||
|---|---|---|---|---|---|---|
| 1 | No physical contact with saliva | No physical contact (no direct contact with the bat鈥檚 saliva) | 听 | 听 | 听 | 听 |
| 2 | Minimal contact with saliva or unable to infiltrate wound with HRIG if needed | Uncertain physical contact (where there has been no observed direct physical contact (with saliva) but this could have occurred) | 听 | 听 | 听 | 听 |
| 3 | Direct contact with saliva | Direct physical contact with bat鈥檚 saliva | 听 | 听 | 听 | 听 |
3. Determine the composite rabies risk
| Country or animal risk | Category 1 exposure | Category 2 exposure | Category 3 exposure | |||
|---|---|---|---|---|---|---|
| No risk | Green | Green | Green | 听 | 听 | 听 |
| Low risk | Green | Amber | Amber | 听 | 听 | 听 |
| High risk | Green | Amber | Red | 听 | 听 | 听 |
| Confirmed rabies | Green or amber | Red | Red | 听 | 听 | 听 |
Specific advice regarding the risk from certain animals or bats in different countries should be taken into account when using these summary tables.
4. Determine the post-exposure treatment required
Post-exposure treatment:
| Composite rabies risk | Non immunised or partially immunised | Fully immunised | Immunosuppressed |
|---|---|---|---|
| Green | None | None | None |
| Amber | 4 doses of vaccine: d0, d3, d7, d21 | 2 doses of vaccine: d0, d3-7 | HRIG and 5 doses of vaccine: d0, d3, d7, d14 and d30 |
| Red | HRIG [note 1] and 4 doses of vaccine: d0, d3, d7, and d21 | 2 doses of vaccine: d0, d3-7 | HRIG and 5 doses of vaccine: d0, d3, d7, d14 and d30 |
Note 1: HRIG not required if more than 7 days after first dose of vaccine, or more than 1 day after the second dose, or for partially immunised patients (unless immunosuppressed).
Interim recommendations for the use of human rabies immunoglobulin have been issued on 27 June 2025. These recommendations supersede guidance on the use of rabies immunoglobulin within the UKHSA guidelines on managing rabies post-exposure treatment. The current guidance on use of rabies vaccine for post-exposure treatment remain the same.