How can I assess the risk of rabies exposure in patients presenting with animal bites in the UK?

To assess the risk of rabies exposure in patients presenting with animal bites in the United Kingdom, follow these steps:

• Evaluate the site and severity of the wound: Bites with broken skin, contamination of mucous membranes or skin lesions with animal saliva or body fluids, and bites on the head and neck are considered high-risk for rabies exposure.
• Consider the circumstances of the bite: Unprovoked bites carry a higher risk.
• Identify the species of the animal and its health status and behaviour: Abnormal behaviour in the animal in the days and weeks after the bite increases the risk of rabies.
• Assess the immune status of the patient: Take a history of rabies vaccination and any immunosuppression.
• Use the UKHSA Rabies post-exposure risk assessment form and calendar: This tool helps standardise risk assessment and should be completed for anyone at risk of rabies exposure.
• In England, securely email the completed risk assessment to the Rabies and Immunoglobulin Service: Include patient details such as name, date of birth, NHS number, date of exposure, history of immunosuppression, and allergies.
• Seek specialist advice if needed: Contact the local health protection team or the UKHSA Rabies and Immunoglobulin Service (tel. 0330 128 1020, Monday to Friday 8:30 am to 5 pm) or out-of-hours UKHSA Colindale (tel. 020 8200 4400). In Wales, Scotland, and Northern Ireland, contact the respective health protection teams or virology services.
• Note that the UK is considered a 'no risk' country for indigenous rabies in terrestrial animals: However, exposure to bats and their secretions is a potential rabies risk anywhere in the world.
• If the bite occurred abroad, assess the rabies risk based on the country of exposure: Use UKHSA guidance on rabies risks by country to categorize the risk as no, low, or high.

For initial wound management, remove any foreign bodies if possible, encourage bleeding if the wound is fresh, and irrigate thoroughly with warm running water or normal saline to reduce infection risk.