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During the summer months, the likelihood of individuals coming into contact with bats is potentially higher due to a number of factors including: increased activities outdoors; more time spent outside in the evenings; sleeping with windows open.
Bats, including those found in Scotland, may carry bat lyssavirus which can cause rabies. Rabies, although rarely contracted from bats, can be fatal in humans once symptoms appear. However, prompt treatment with rabies vaccine after an exposure is effective at preventing the disease. All bat bites, scratches or other exposures, whether in Scotland, the rest of the UK or abroad, should therefore be assessed promptly by a health professional so they can arrange post-exposure treatment if needed.
Members of the public, volunteers and professionals who come into contact with bats and may therefore have had a potentially rabies prone exposure, are advised to seek urgent medical assessment and advice. It is therefore important that healthcare professionals who may be contacted in this respect are aware of how to conduct a risk assessment and to ensure that timely appropriate treatment is given when required.
In Scotland, Infectious Disease consultants usually assist with the risk assessment (see contacts later).
The risk assessment comprises:
Table 1: categories of exposure to bats:
CATEGORY 1 |
No physical contact (i.e. no direct contact with the bat’s saliva)
|
CATEGORY 2 |
Uncertain physical contact (i.e. where there has been no observed direct physical contact (with saliva) but this could have occurred) For example:
|
CATEGORY 3 |
Direct contact with bats saliva For example:
|
*Most bats found in houses and attics in the UK/Ireland are pipistrelles, which are not known to be infected with rabies-related viruses. Healthy bats avoid contact with humans therefore bats behaving normally (i.e flying into a room but not grounded or acting aggressively) do not constitute a risk.
**For countries outside the UK/Ireland, any bat found in the room of a sleeping or intoxicated person should be considered a category II exposure. In the USA 50% of human rabies with bat variant virus have resulted from unrecognised bat bites.
Frequently, individuals are uncertain about the nature of a bat exposure as bat bites can be difficult to see or feel.
Under Rabies Classification of Country Risk for Rabies, all bats in the UK are classified as ‘Low Risk’.
Table 2: Composite rabies risk
Country/Animal Risk |
Category 1 Exposure |
Category 2 Exposure |
Category 3 Exposure |
No Risk |
Green |
Green |
Green |
Low Risk |
Green |
Amber |
Amber |
High Risk |
Green |
Amber |
Red |
Confirmed rabid animal* |
Green/Amber |
Red |
Red |
Where there is wound, the individual should be advised to immediately clean the wound by thoroughly flushing with running water for several minutes and washing with soap.
The composite risk categorisation determines the recommended treatment as can be seen in table 3 below.
Table 3: Recommended treatment based on composite risk categorisation
|
Post Exposure Treatment |
||
Composite Rabies Risk |
Non-immunised/ partially immunised |
Fully immunised |
Immunosuppressed |
Green |
None |
None |
None |
Amber |
Four doses of vaccine |
Two doses of vaccine |
HRIG and five doses of vaccine |
Red |
HRIG* and four doses of vaccine |
Two doses of vaccine |
HRIG and five doses of vaccine |
Where can post exposure treatment be given and by whom?
In Scotland, post exposure rabies treatment is usually given in Infectious Disease Units where healthcare practitioners have experience in assessing risk, know how and where to access immunoglobulin and rabies vaccine, and know how to administer treatment.
An infectious disease physician should be consulted by healthcare practitioners when considering post exposure rabies treatment.
Further advice can be found the Rabies Green Book Chapter.
An information leaflet on bat contact and rabies risk is also available here (pdf download).
The Animal and Plant Health Agency (APHA) operates a passive surveillance programme whereby members of the public and those working with bats can submit dead bats they find to APHA. This is a passive system to improve understanding of EBLV in the UK. It is NOT designed to support the risk assessment of exposed individuals. If indicated post exposure treatment should be given urgently at the time of exposure and must not be delayed until results of any testing of the bat become available.
Last reviewed: 08 November 2023
Next review: 31 October 2025
Author(s): Health Protection Scotland
Approved By: Paediatric ED Guidelines Group