Alert March - May 2012: Novartis have contacted the MHRA to inform of an issue potentially affecting the packaging of syringes in two batches of Rabipur (rabies vaccine, lots 490011C and 493011A ), currently on the UK market.  Packs of Rabipur contain an individually packaged empty syringe and needle, and a separately packaged vial containing the vaccine and an ampoule of diluent. The issue does not affect the vaccine or diluent. A  letter and alert have been posted (see PDF below) which highlight the potential issue (yellow discolouration, some mould) with the syringes, and ask HCPs to inspect them prior to use and discard the syringe if the inspection gives any cause for concern, otherwise the syringe may be used as normal. 

• MHRA Novartis letter 210312 (PDF, 172 KB) (21 March 2012)

Guidelines relating to pre- and post-exposure prophylaxis

• Rabies post-exposure form and calendar version 5 (Excel Spreadsheet, 156 KB) (7 December 2011)
• Rabies country risk table (updated 11 May 2012)
• Assessment for treatment post exposure to terrestrial animals (PDF, 54 KB) 
• Assessment for treatment post exposure to bats (PDF, 63 KB)
• Rabies Ig BPL Letter and Leaflet 191211 (PDF, 390 KB) (19 December 2011)
• Advisory letter for administration rabies vaccine only (PDF, 124 KB) (9 December 2011)
• Advisory letter for administration rabies Ig and vaccine (PDF, 127 KB) (9 December 2011)
• HPA Colindale Clinical Rabies Service (PDF, 92 KB) April 2010, amended 15 Sept 2010

• Rabies vaccination and interpretation of rabies serology - Advice for bat workers and their GPs (PDF, 25 KB)
  
  

  Other documents

• Immunisation against Infectious Disease (the Green book) – rabies (PDF, 81 KB)
• The Public Health Management of a Suspected Case of Human Rabies (PDF, 523 KB) updated July 2009
• DH Memorandum on Rabies - Prevention and Control (PDF: external link)
• Rabies: Guidance on Prophylaxis and Management in Humans in Scotland (PDF: external link)
• Revised WHO position paper on rabies vaccines (August 2010) (PDF: external link)

Useful articles on management of human rabies

Editorial: Recovery from Rabies. Jackson AC. New England J Med 2005;352:2549-50  (external link)

Survival after treatment of rabies with induction of coma  Willoughby RE et al. New England J Med. 2005;352:2508-14 (external link)

Medical College of Wisconsin rabies treatment protocols  (external link)

Wisconsin rabies treatment protocol (PDF, 87 KB)

Management of rabies in humans Jackson AC et al. Clinical Infectious Diseases 2003;36:60-3 (external link)

Human rabies: a disease of complex neuropathogenetic mechanisms and diagnostic challenges Hemachuda T et al. The Lancet Neurology 2002;1:101-9 (external link, requires free login)

Paralytic rabies after a two-week holiday in India Solomon T et al. British Med J. 2005;331:501-3 (external link)

• Rabies risks in terrestrial animals, by country
  A list of countries and islands with the risk of rabies in terrestrial animals.
  Added/updated: 11 May 2012