Rabies: post exposure prophylaxis (PEP)

After a potential exposure, the risk for rabies and the need for post exposure prophylaxis should be evaluated by a doctor. 
More information, including the different post exposure schedules, can be found in the guideline for post-exposure prophylaxis against rabies. 

The need for post exposure prophylaxis should be based on:

1. The probability that the animal is infected depending on the epidemiological risk factors.
2. The risk category of the patient based on the WHO exposure risk categories (animal, region and type of contact).
3. The patient’s history (e.g., PrEP, immunocompromised).

The treatment is best administered between 24 and 48 hours after the risk exposure. If no medical treatment was given within this timeframe, the treatment should always be carried out regardless of the timing of the exposure to the risk.

The ideal administration of the post exposure prophylaxis is:

• Vaccination within 24 hours.
• Human anti-rabies immunoglobulins (MARIG) within 48 hours and, at the latest, within 7 days of the start of post-exposure vaccination. No more immunoglobulins are given seven days after the start of the vaccination series. In contrast, MARIG is always administered if the vaccination sequence has yet to be started (e.g., more than 10 days after the risk bite).

Additional information

• Information about rabies for doctors
• Guideline for Post-exposure prophylaxis (PEP) against rabies
• Risk score for rabies PrEP vaccination of travellers
• Application form for rabies laboratory test FR | NL
• Presence of dog- transmitted human rabies map (WHO 2021)
• Rabies (CDC 2022)
• Rabies fact sheet (WHO 2021)
• Presence of wildlife rabies (rabies information system of WHO)

References

• Rabies vaccines: WHO position paper (WHO April 2018)