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Rabies prevention for patients with overseas bites

Australia is free from rabies in land mammals, however scratches from bats can transmit Australian bat lyssavirus (ABLV). Bites or licks from dogs, cats or monkeys in Asia, Africa, and Central and South America can carry a high risk of rabies.

People who have potentially been exposed to rabies or Australian Bat Lyssaviruses (ABLV) should receive post-exposure prophylaxis (PEP) with rabies vaccine and, sometimes, human rabies immunoglobulin (HRIG). These treatments are provided free by NSW Health and are accessed via your local public health unit.

All potential exposures from a land mammal (alive or dead) in a rabies-prone area, or from a bat anywhere in the world should be reported to the public health unit for consideration of rabies PEP, even if PEP has been commenced overseas. Exposures up to 10 years ago are still considered for PEP.

It is imperative that post-exposure prophylaxis is commenced as soon as possible as there is no known effective treatment for rabies or ABLV infection which usually result in death.

Exposures requiring post-exposure prophylaxis:

  • nibbling of uncovered skin, minor scratches or abrasions without bleeding
  • single or multiple transdermal bites or scratches
  • contamination of mucous membrane with saliva from licks
  • licks on broken skin
  • superficial or minor scratches from a bat (sometimes difficult to determine thus a high degree of caution is considered)

Appropriate wound care and management must also be performed:

  • Wash the wound/s with soap and running water
  • Apply povidone-iodine solution or other virucidal treatment
  • Avoid suturing (as HRIG may be required)
  • Consider infection with other pathogens (e.g. tetanus) and treat accordingly

Doctors should contact their local PHU on 1300 066 055 for advice. PHU staff will determine if rabies vaccine and HRIG is indicated and will order the doses for administration at your practice, or the emergency department if out of hours.

See the Australian Immunisation Handbook for more information.

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