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Rabies: Rabies vaccination for bat handlers - Questions and Answers

Do bats carry rabies?

Some bats in Europe carry rabies viruses called European Bat Lyssaviruses (EBLVs). There are two strains, EBLV1 and EBLV2. Classical rabies virus (the strain usually found in terrestrial (land living) mammals including dogs) has never been found in bats in Europe.

Do bats in the UK carry rabies?

The level of EBLV infection in all bats in the UK is unknown, but is likely to be low. To date only seven Daubenton’s bats have been found with the rabies virus EBLV2. One serotine bat was found to have antibodies to EBLV1 in 2004. Since 1986 the Veterinary Laboratories Agency has tested over 6,000 bats for lyssaviruses, over 70% of which were pipistrelles, submitted under a passive surveillance scheme. Apart from the cases noted above, all the bats tested under passive surveillance have been negative for rabies virus. In addition, the results from the third and final year (2006) of a three year study, testing Daubenton’s and serotine bats, have shown a low level of antibodies to EBLV2 in Daubenton’s bats. Combined data from 2004, 2005, 2006 and from a pilot study in 2003, indicate that the prevalence of antibodies to EBLV2 in Daubenton’s bats in England is about 2%. Results from a similar study in Scotland indicate a slightly higher figure.

What risk of rabies infection is there if I handle bats?

The risk of EBLV infection to humans is thought to be low. Since 1977, there have been five human deaths in Europe (three confirmed, two possible) from EBLVs. The most recent was that of a bat handler in Scotland in 2002. None of these individuals received rabies vaccination either before or after being bitten by bats. EBLV infection in humans seems to be similar to classical rabies infection; the symptoms have been the same and the outcome in all recorded cases has been fatal, so it is still essential to protect yourself from EBLV infection.

Does rabies vaccine give protection against European Bat Lyssavirus?

Although the vaccines were developed against the classical rabies virus, they are believed to give protection against EBLVs, and there is no evidence that they do not. Following immunisation or post-exposure treatment, no one has contracted rabies or shown signs of EBLV infection (i.e. nobody who has been vaccinated has died of EBLV and nobody exposed to EBLV who has been given post-exposure vaccine treatment has died). This evidence comes from other European countries, where EBLVs are regularly detected in bat populations and people who are bitten or scratched by bats are given post-exposure treatment. Furthermore, none of the patients who has become infected with EBLVs was vaccinated.

Is the vaccine safe?

There are two rabies vaccines licensed for use in the UK: Aventis Pasteur, a human diploid cell vaccine in use for about 20 years; and Rabipur, a chick embryo cell vaccine which has been licensed for use in the UK more recently, though it has been in use in other parts of the world for some years. Because the Rabipur vaccine is produced in cells from chick embryos, it should not be used for people who may be sensitive or allergic to chicken protein. There are few other contra-indications, but you should seek advice from your GP. The two vaccines are interchangeable. Modern rabies vaccines have a very good safety record. During more than 40 year’s experience of using rabies vaccines in the UK, severe reactions have occurred only rarely. When reactions do occur, most often these are what might be expected of any vaccination – a sore arm, pain at the injection site, slight fever or similar.

Am I obliged to be immunised?

Currently, you are strongly advised to ensure that you are vaccinated if you handle bats regularly. If you are a licensed bat handler, the relevant authority for your country may, in future, make vaccination a mandatory requirement of the licence.

Does the organisation that I work or volunteer for have responsibilities under the Health and Safety at Work etc Act 1974?

Employers have legal responsibilities to assess the risk of employees and others, including volunteers, being exposed to this agent as they perform work activities, and to put in place appropriate controls. This includes considering if immunisation is appropriate, and if it is, making arrangements for immunisation, free of charge, to employees who are considered vulnerable to the agent they are exposed to or likely to be exposed to.

How soon after being vaccinated can I work with bats?

The currently recommended schedule is 3 doses of vaccine on days 0, 7 and 28. This schedule is intended to stimulate a rapid immune reaction. The immune response will begin after day 0 and will contribute to protecting against rabies. Although protective levels of antibody will not be reached until the full course is completed, as vaccine is effective even if given after an exposure, bat workers may resume bat work as soon as they have received the first injection provided they then go on to complete the course.

How long does the vaccination last?

The vaccine is highly effective at producing an immune response and the Department of Health advice is that it is usually not necessary to check antibody levels via a blood test. Their current advice is that after the first course of vaccination the first booster injection is needed one year later and subsequent boosters at 3-5 yearly intervals.

What should I do if I have been bitten by bats in the past?

Each bat bite requires an individual assessment. Current Department of Health/Health Protection Agency advice is that following a bat bite, and if the individual in question is fully immunised against rabies, they should be offered 2 doses of vaccine. If, however, the individual is previously unimmunised or incompletely immunised, they should be offered 5 doses of vaccine, and may require rabies immunoglobulin as well.

What is the difference between immunoglobulin and vaccine?

Immunoglobulin is a preparation of antibodies collected from human donors who have been vaccinated in the past. It is a way of giving instant protection as the antibodies protect straightaway. However, they do not last very long. In contrast, it takes more than one week for your body to make its own antibodies following vaccination but the protection lasts much longer. Immunoglobulin is a blood product which, since the BSE epidemic, must be produced from non-UK donors.

My last dose of vaccine was more than 5 years ago and I have been bitten by a bat. How many doses of vaccine should I receive?

You will need to seek expert advice. As your protection cannot be guaranteed you may need to be treated as if you have not been vaccinated before and receive five doses of vaccine. You will probably not require immunoglobulin.

How is the vaccination given?

Vaccination is given into the upper arm, in the same way as most vaccines, and feels the same - like a ’flu vaccination. If you need vaccine and immunoglobulin these are given separately. If you have an obvious wound from a bite then some of the immunoglobulin should if possible be given at that site. If there is no obvious wound then immunoglobulin is given into the buttock. The old fashioned way of giving a vaccine in many doses into the stomach is no longer used.

I am up-to-date with vaccination, with a full course of three vaccines and a booster in the past 3-5 years. I get bitten regularly by bats. Do I need to have two doses of vaccine every time I am bitten?

You should avoid being bitten by wearing bite-proof gloves and protective clothing. Even if you are up-to-date with your immunisations you should still seek medical attention if you are bitten. Further doses of vaccine are usually advised to make sure that your antibody levels are high enough; the number of doses you need depends on how many doses of vaccine you have had in the past.

Will I have to pay for vaccination?

All bat handlers, whether licensed or not, are entitled to be immunised against rabies, free of charge. The vaccine is provided by the Health Protection Agency in England, or a designated vaccine holding centre in Scotland (local pharmacy departments) and can be obtained through your GP. The Department of Health has asked all GPs to give the immunisation free of charge but your GP can ask for an administration fee (although most do not). Volunteers and employees of conservation organisations may be able to claim the fee back from their organisation.

I have been bitten (or scratched) by a bat. What do I do?

The risk from EBLV seems to be confined to people who are bitten, scratched or have close contact between broken skin or mucosa (e.g. the nose, mouth and eyes), and bat saliva or neural tissue. You should immediately clean the wound thoroughly with soap and water. Then flush out all traces of soap. Additional cleansing of the wound site with an alcohol base or other disinfectant (e.g. iodine solution) is also recommended. Seek immediate medical attention to discuss vaccination. Rabies vaccine, and immunoglobulin if necessary, are available in England from the Health Protection Agency (tel. 020 8200 4400). In Scotland immunoglobulin is obtained through the Scottish National Blood Transfusion Service and vaccine through a designated vaccine holding centre (local pharmacy departments).

If an attack from a bat is unprovoked, the incident should be reported immediately and, if possible, the bat should be retained for analysis. If the bat is alive, please seek further advice from the Veterinary Laboratories Agency (tel. 01932 341111) or the Bat Conservation Trust (tel. 0845 1300 228). If the bat is dead, please send it to the Veterinary Laboratories Agency (specimen tubes and FREEPOST envelopes are available from the Bat Conservation Trust).

Are my family and pets at risk from bats in the house and should they be vaccinated?

The risk from EBLV seems to be confined to people who are bitten, scratched or have close contact between broken skin or mucosa and bat saliva or neural tissue. There is negligible risk from being in the same house as a native bat in the UK. EBLV infection has hardly ever been passed to other types of mammal. There have been a couple of cases in sheep in Denmark and one in a stone marten in Germany but no recorded illness in domestic pets such as dogs or cats. Neither family members nor pets need to be vaccinated. However, family members should not handle bats and pets should be kept away from them.

What constitutes a bite or scratch?

A bite or scratch is not a risk unless it penetrates the skin. Sometimes it is difficult to know whether you have been bitten so if you are concerned you should seek medical advice. Note that bat bites are often invisible; if in doubt, vaccination is usually advised in order to err on the side of caution. You should always wear bite-proof gloves when handling bats. The Bat Conservation Trust has advice on the types of gloves that are suitable for handling different bat species.

How long does the virus survive?

EBLVs do not survive outside the body of the host for long. However, the virus might survive inside a dead bat’s body for a few days, so dead bats should be handled with care.

This document has been produced by:

Agri-Food and Biosciences Institute, Northern Ireland Bat Conservation Trust, Countryside Council for Wales, Department for Environment, Food and Rural Affairs, Department of Health for England, Health Protection Agency, Health Protection Scotland, Joint Nature Conservation Committee, National Public Health Service for Wales, Scottish Government, Scottish Natural Heritage, Veterinary Laboratories Agency.

 

Page last modified: 12 June, 2008

Department for Environment, Food and Rural Affairs