Rabies

Question 1

What type of virus is the rabies virus classified as?

Answer 1

RNA rhabdovirus (specifically a lyssavirus)

Question 2

What disease does rabies cause?

Answer 2

Acute encephalitis

Question 3

The rabies vaccine is a (live/inactivated) vaccine

Answer 3

Inactivated

Question 4

Who are considered at risk to rabies and offered pre-exposure prophylaxis with the rabies vaccine? (6)

Answer 4

Risk within the UK:

1. Laboratory staff who routinely handle the rabies virus
2. Workers at Defra-authorised quarantine premises and carriers
3. Those who regularly handle bats
4. Veterinary and technical staff

Risk of exposure outside when travelling outside the UK:

5. Animal control and wildlife workers who visit high risk areas
6. Travellers to rabies high risk areas who are undertaking higher risk activities or staying there more than 1 month

Question 5

What does the primary pre-exposure course involve to be immunised against rabies? (2 options)

Answer 5

3 doses administered of the rabies vaccine to be administered over 21 or 28 days (preferred schedule)
OR
An accelerated course of 3 doses over 7 days with an additional dose at 1 year

Question 6

For laboratory workers who handle lyssavirus containing material, when should they be given booster doses of the rabies vaccine?

Answer 6

1 year after the primary pre-exposure course

Then further booster doses should be given based on 6-month antibody levels

Question 7

For individuals who may have frequent unrecognised exposures to the rabies virus (such as bat handlers), when should they be given booster doses of the rabies vaccine?

Answer 7

1 year after the primary pre-exposure course.

Then further booster doses every 3-5 years or based on antibody levels

Question 8

When should individuals at infrequent risk of exposure to the rabies virus (e.g. recreational cavers, veterinarians) be given booster doses of the rabies vaccine?

Answer 8

Depends on antibody levels from at least 1 year after the primary pre-exposure course has been completed

Question 9

In a traveller who was given pre-exposure course of the rabies vaccine due to their risk levels, how many boosters do they need in their lifetime if they continue to travel to high risk areas?

Answer 9

1 booster dose in a traveller’s lifetime

Question 10

Is rabies a notifiable disease in the UK?

Answer 10

YES

Question 11

If you are cleaning, disinfecting and dressing a wound that may be a potential exposure to rabies, should you suture the wound before or after post-exposure rabies treatment has begun?

Answer 11

After treatment has begun

Closing the wound before treatment starts increases the risk of introducing rabies virus into the nerves

Question 12

The regimen used for post-exposure management of rabies depends on the composite rabies risk (green, amber or red) and the individual’s past medical history (immune status). What 3 factors are determining the composite rabies risk?

Answer 12

1. The country where the incident occurred
2. The type of animal involved
3. The category of exposure (based on how much contact with animal and saliva from animal)

Question 13

Rabies is a viral disease that causes an …

Answer 13

acute encephalitis

Following a bite the virus travels up the nerve axons towards the CNS in a retrograde fashion

Question 14

Is post-exposure rabies treatment required for individuals who are FULLY immunised (pre-exposure course complete or adequate antibodies) against rabies and have a green composite rabies risk?

Answer 14

NO

Question 15

Is post-exposure rabies treatment required for individuals who are FULLY immunised (pre-exposure course complete or adequate antibodies) against rabies and have amber or red composite rabies risk?

Answer 15

YES

2 doses of rabies vaccine (day 0 and between days 3-7)

Rabies immunoglobulin is NOT needed

Question 16

Is post-exposure rabies treatment required for individuals who are PARTIALLY immunised (incomplete pre-exposure course or low antibodies) against rabies and have a green composite rabies risk?

Answer 16

NO

Question 17

Is post-exposure rabies treatment required for individuals who are partially immunised (pre-exposure course complete or adequate antibodies) against rabies and have amber or red composite rabies risk?

Answer 17

YES

4 doses of the rabies vaccine (days 0, 3, 7, 21)

Question 18

Do individuals who have never received rabies pre- or post-exposure immunisation (non-immunised) require post-exposure treatment if they have a green composite rabies risk?

Answer 18

NO

Question 19

Do individuals who have never received rabies pre- or post-exposure immunisation (non-immunised) require post-exposure treatment if they have amber or red composite rabies risk?

Answer 19

YES

4 doses of the rabies vaccine (days 0, 3, 7, 21)

If red risk and < 7 days since exposure they should also be given rabies immunoglobulin

Question 20

Can individuals who are immunosuppressed or have HIV infection be given pre-exposure prophylaxis for rabies?

Answer 20

YES

but they may not develop a full antibody response

Question 21

Do immunosuppressed individuals with a green composite rabies risk need post-exposure treatment for rabies?

Answer 21

NO

Question 22

Do immunosuppressed individuals with amber or red composite rabies risk need post-exposure treatment for rabies?

Answer 22

YES

5 doses of the rabies vaccine (day 0, 3, 7, 14, 28 or 30)
AND
Rabies immunoglobulin

Question 23

What is the route of administration for the rabies vaccine?

Answer 23

IM