Rabies pre-exposure vaccinations

This page aims to provide bat volunteers and bat workers with information about pre-exposure rabies vaccination in the UK, reflecting the range of enquiries we receive at BCT. If you have been bitten, scratched or nibbled by a bat please seek immediate medical advice (even if you are already vaccinated against for rabies).

1. Pre-exposure vaccinations general information (including vaccination schedules)
2. Information for bat workers with severely impaired immune systems
3. Pre-exposure vaccinations for volunteers
4. Proof of vaccination forms
5. Information for trainees and trainers
   
6. Pre-exposure vaccinations for professional ecologists
7. UKHSA guidance on timing of rabies boosters
8. Rabies antibody testing
9. UKHSA and HPA leaflets
10. BCT advice and guidance

BCT cannot provide medical advice but we are happy to help with procedural questions if we can. Please read the text below before sending your enquiries as we hope most questions will be answered by the information on this web page. However, if you still have non-medical questions then please get in touch with Dr Allyson Walsh, Head of Conservation Services.

Additional information can be found on the GOV.UK website

Anyone handling a bat should wear gloves of an appropriate thickness to prevent bites getting through, anyone regularly handling bats should have pre-exposure vaccinations, and anyone bitten, licked or scratched by a bat, of any species, should seek prompt medical advice (even if they are already vaccinated).

Anyone handling bats regularly should have pre-exposure vaccinations as follows:

• Initial course of three vaccinations over a 28 day period (on day 0, day 7 and day 28)
• A single booster one year after the primary course has been completed
• Subsequent booster doses every three to five years (or as informed by rabies antibody testing; see items 7. and 8. below)

The above schedule is taken from Chapter 27 of the Green Book (Immunisation against Infectious Disease); information on vaccinations aimed at GPs and other medical professionals.

The way in which someone obtains the pre-exposure vaccinations will be different depending on whether they are a volunteer (see section 3. below), a trainee volunteer (see section 5.), or a professional bat worker (see section 6.).

There is specific guidance about rabies vaccinations for people who have severely impaired immune systems due to certain medications or illness and may wish to handle bats. These individuals may not respond fully to treatment with rabies vaccine following a bat bite and, as EBLV infections are fatal in humans, it may not be possible to treat them effectively.

In these cases, careful counselling is essential to ensure the person is made aware of the potential risks. Further details about who would be considered to be immunosuppressed and what they should do next is available in guidance published by the UK Health Security Agency (UKHSA). The guidance is aimed at medical professionals.

Any bat workers who have health conditions which may affect their immune systems are advised to discuss this further with their GP.

Rabies vaccines are free of charge for people who handle bats regularly, solely in a voluntary capacity across the UK (if you need pre-exposure vaccinations because you intend to work with bats outside the UK, you will need to get this from a private travel clinic - see suggestions in Section 6.). Vaccinations can usually be obtained through GPs but not all GPs will offer this service and some may charge a fee for the service, even if the vaccine itself is obtained from UKHSA. There is a ‘free vaccinations for bat workers advice letter’ that it may be useful for people to take a copy along when requesting pre-exposure vaccinations.

Please note: where the requirement for vaccinations relates to paid work then the employer will have to pay for the vaccinations (even if the person also regularly handle bats in a voluntary capacity), and the vaccine will need to be sourced privately (see item 6. below).

There are some differences across the different parts of the UK that it’s very important volunteers are aware of:

The UKHSA provide rabies vaccinations free of charge only for people who regularly handle bats in a voluntary capacity (see item 4. below about vaccinations for people in training).

There are guidelines available from UKHSA for GPs and other medical professionals about the process for requesting pre-exposure vaccinations. These can be found on the GOV.UK website. (This includes the form that GP has to complete with the help of the volunteer as it includes questions about why the person needs a free booster, how often bats are handled, etc. It is worth having a look at the form in advance to be clear about what information needs to be provided to the GP).

The management of the service is currently under review, but at this time requests for vaccine should be sent to UKHSA, using the UKHSA request form referred to above.

Pre-exposure rabies vaccine and rabies antibody tests should be available to volunteers free of charge from the NHS. Individuals should approach their GP practice for vaccinations (Please note: antibody tests are not free of charge for volunteers in other parts of the UK). If vaccinated by their GP practice volunteers may have to pay a prescription charge if they are required to do so normally.

Health Protection Scotland (HPS) are working on updating their document ‘Rabies: Guidance on prophylaxis and management in humans in Scotland’. When completed it will be available to download from their website, however until it is completed HPS are directing medical professionals to the Green Book Chapter 27.

The new guidance will still incorporate the previous advice on who is entitled to free vaccination. As an interim measure, until the full guidance has been published, HPS have put a link on the Rabies page of their website which links to the Scottish Government's Chief Medical Officer letter, which established that pre-exposure vaccinations are free for bat volunteers.

Pre-exposure vaccinations are available free of charge for licensed non-occupational bat handlers via their GP using an HS21 prescription.

For various bat volunteering activities you may need to provide proof of your rabies vaccinations. Please take a proof of vaccination document to your appointment for staff to complete.

Proof of vaccination document (England)

Proof of vaccination document (Wales)

Proof of vaccination document (Scotland)

Proof of vaccination document (Northern Ireland)

In England UKHSA will not provide free vaccinations for volunteers unless they are regularly handling bats. This means that where someone is about to start being trained in bat handling as a volunteer (e.g. as a trainee bat carer or in another capacity e.g. bat box checking or trapping) then UKHSA’s approach is that vaccinations should not be required provided people are wearing gloves, closely supervised and should anyone be bitten (which gloves and close supervision should minimise the risk of) they seek post exposure treatment asap.

Once someone is in a position to start handling bats without close supervision and will be handling bats regularly, then they should be vaccinated (and if they are a volunteer and not undertaking paid bat work they will be able to get free vaccinations). Some trainers have expressed concerns over this policy. In this section we provide some key questions from trainers and answers:

1. Why is it safe for trainees to handle bats without vaccinations, but experienced handlers, who are less likely to be bitten are recommended to be vaccinated? Why should anyone who has gone through the process of learning and developing their experience without vaccination bother to get vaccinated when they've got the hang of it?

UKHSA continues to emphasise the importance of pre-exposure vaccination for those regularly handling bats, and the fact that it is essential for anyone who is bitten, or exposed to bat saliva, to receive post-exposure treatment.

Anybody who handles bats should report an exposure to a health professional to allow them to be risk assessed for rabies post-exposure treatment (vaccine). Whilst training, the contact with bats should be well supervised so that any exposures can be easily identified and post-exposure treatment started promptly if needed. However, once an individual is practicing independently and handling bats on a regular basis on their own, there is a greater potential for unrecognised exposures to occur. This is why it is important these individuals are vaccinated to provide a degree of protection if an exposure was unfortunately not recognised at the time.

UKHSA is also aware that not everyone who starts training to be a bat handler will continue to handle bats on a regular basis after their training, therefore we need to ensure that the free vaccine provide by UKHSA on behalf of the Department of Health and Social Care is used to protect those at greatest risk on an ongoing basis. Vaccine is available to those who have completed training and will be handling bats on a regular and voluntary basis.

2. Some people are made more nervous by knowing that they are being supervised, and accordingly less skilled at handling bats. Why the need for supervision?

This issue about supervision is not that it will prevent bites occurring but that it will ensure that appropriate gloves are worn and enable any bites, scratches or mucous membrane exposures to bat saliva that do occur to be rapidly identified by the trainer, who can then confirm the trainee is assessed by a health professional for prompt post-exposure treatment (i.e. a course of rabies vaccine). This will also ensure the message about the importance of reporting bites to a health professional and the requirement for post-exposure vaccination is re-emphasised to bat handlers at all stages of their work.

Not wearing appropriate gloves and not reporting bites to a health professional were both issues that came out in the Bat Workers Study [results were shared in a special edition BCT bulletin in October 2018] and are key preventive measures that can be imparted to trainees during their training period which will hopefully embed these behaviours into their future practice. So supervision is also another opportunity to emphasise the importance of wearing appropriate gloves during training (and during independent practice) to minimise the risk of a bite actually penetrating the skin.

3. Is the change in guidance for rabies pre-exposure due to a decreased risk of rabies from bat bites?

No, the risk from bats in the UK has not changed nor has UKHSA’s position of the importance of pre- and post-exposure vaccination for handling bats on a regular basis. This change actually enables a greater emphasis to be put upon safe handling of bats and reporting of bites during the training process, with vaccination being a key requirement once they have completed their training, are committed to the role and will be acting as a bat carer or other bat volunteer (e.g. in bat box checks, trapping, etc.) working independently.

Anyone who is handling bats in an employed capacity is not entitled to free vaccine or free vaccination on the NHS and so should have the cost of their vaccinations covered by their employer or themselves if they are self-employed (this is true even if they are also a volunteer and indeed even in cases where they handle bats more for volunteering than in paid work).

People should be able to obtain their vaccinations either through their employer’s occupational health provider (for larger organisations) or from their own doctors surgery. However, not all surgeries will undertake private work (i.e. vaccinations that people have to pay for). There may be alternative doctors surgeries locally that will provide vaccinations or a Google search will find private GPs in an area and it is possible that one of them may be able to help.

Most travel clinics will provide pre-exposure rabies vaccination. Some bat workers have reported to us that not all clinics will do non-travel vaccinations. The best ones (based on feedback from bat workers rather than BCT recommendations) seem to be Superdrug, Nomad, and MASTA (this organisation works through local pharmacies). Some bat workers have used Boots Travel Clinics but a number of people have reported that they are one of the companies that won’t do non-travel vaccinations, so there does appear to be some variation between the individual Boots clinics.

Please see section 1. above for the general information about vaccinations and note the requirement for a one-year booster after the initial three doses of vaccine. At the time of writing, each vaccine dose costs around £40 to £65, with a full initial course of three doses typically costing around £120 to £195.

Vaccine shortages – there are occasionally limitations in the supply of one of the rabies vaccines available in the UK for occupational and travel needs. (NB: This does not affect the availability of vaccines for post-exposure purposes, so vaccine will always be available to anyone bitten by a bat.)

If the requirement is for an ongoing booster rather than a primary course of pre-exposure vaccine or a one-year booster, there is some flexibility around the timing of booster doses of vaccines (i.e. 3-5 years after the last booster or as informed by rabies antibody testing; see section 7. below). So people can either wait (if they are within these time frames) as vaccine supplies should improve in due course or they may need to contact other providers (see suggestions above).

UKHSA produce guidance on the timing of rabies boosters based on antibody levels. The guidance is aimed at health professionals in England and Wales but is very useful for bat workers to be aware of.

The document can be found on the GOV.UK website (please note that rabies antibody tests are only available free of charge from the NHS to volunteers in Scotland, in all other parts of the UK they have to be paid for. The test is offered by APHA and can be organised through a GP or occupational health scheme).

The Animal & Plant Health Agency (APHA) offer rabies antibody (serology) tests (to determine level of rabies antibodies) but from a blood sample taken at your doctors surgery. This service may be free to bat volunteers in Scotland but there is a charge for people based in the rest of the UK (that applies to both volunteer and professional bat workers). Further information about serology tests and timing of rabies boosters is in guidance from UKHSA (and this information is currently used across the UK), see item 7. above. The link to request a serology test from APHA is available on their website (but note this service is more commonly used for pets than humans, hence the wording).

If your doctors surgery is unsure of the process to request the tests, please ask them to email the Rabies Diagnostic Group at APHA at: RabiesDiagnosticGroup@apha.gov.uk. They will be asked to send a blood or serum sample (in a red or yellow cap vacutainer) to: Rabies Diagnostic Group, Viral Zoonoses, Virology Department, Animal and Plant Health Agency, Woodham Lane, Surrey, KT15 3NB. The sample should be submitted with a request form from the doctors. It is possible to arrange for the results to be sent to your doctors surgery but to have the invoice sent to you. If that is required than both the doctors details and yours will need to be provided with the submission.

UKHSA (formerly Public Health England, PHE) have information for members of the public who have been bitten or scratched by a bat. The information can be found by following the link from the GOV.UK website and includes information on bats and rabies, the risk of contracting rabies after a bat bite, and how to treat a bite.

Health Protection Scotland have produced their own version of the same leaflet which can be downloaded for use in Scotland from the HPS website.

BCT has a number of rabies related guidance documents:

• Good Practice Guidelines on Bats & Rabies
• Guidance on Wearing Gloves when Handling Bats
• Supplement to the Good Practice Guidelines on Disease Risk Management aimed at bat rehabilitators
• Frequently Asked Questions document aimed at bat handlers

Please note these documents are in the process of being reviewed and will be updated here when that work is completed (due summer 2024). If you have any questions about the current versions please email Dr Allyson Walsh.