Supply Constraints with Rabies Vaccine in the UK (update 2)

Further to recent news on supply constraints with Rabies vaccine in the UK, while resumption of normal supply of Rabipur is not expected until July 2024, limited supplies of Verorab are available from Sanofi Pasteur.

Verorab is currently only available in packs of 10, with a cap of 30 doses per customer per month.

To discuss ordering please contact Sanofi Pasteur Customer Services:

• 0800 854430 or GB-vaccinecustomerservices@sanofi.com

Verorab Summary of Product Characteristics (SmPC).

Advice for health professionals

Risk assessment

Whilst supplies are still restricted, clinics might need to consider prioritising pre-exposure vaccine stock for those travellers at highest risk

Pre-exposure prophylaxis (PrEP) should be considered for all travellers to endemic areas under the following circumstances and dependant on the individual risk assessment:

• Travellers who may not be able to promptly access post-exposure advice and treatment or where medical care might be limited
• Travellers should be advised that even if medical care can be promptly accessed, human rabies immunoglobulin, if indicated, may not be available at their destination.
• Those travelling for extended periods (>1 month).
• Those at higher risk of contact with animals and bats, including cave explorers, cyclists/runners, zoologists, botanists, volunteers in animal sanctuaries and veterinary surgeons.
• Those working or living in remote areas.
• Children, who may lack awareness of the need to avoid animals or to report an animal bite.
• Healthcare workers who are likely to come into close contact with a patient with rabies.

Please see the TRAVAX Rabies page for further information and the Individual Country pages for information on country specific rabies risk.

Any traveller to a rabies risk area should be given clear advice on bite avoidance, wound management and seeking of medical attention if they think they are exposed. This advice is of even greater importance when the traveller has not received PrEP.

Administration of vaccine for Pre-Exposure Prophylaxis

Whilst the Green Book recommends the intramuscular, rather than the intradermal, route for pre-exposure prophylaxis use of rabies vaccine, it also notes that that suitably qualified and experienced healthcare professionals may give the vaccine via the intradermal route for pre-exposure prophylaxis. Clinics considering this approach should ensure local training, risk assessments, and protocols are in place. The SmPC of the vaccine being used to deliver intradermal vaccination should be consulted. Where the intradermal route is not covered by the manufacturer’s Product Licence then ‘off label’ use of the intradermal route is the responsibility of the prescriber.

If a pre-exposure rabies vaccine course is interrupted or doses delayed due to supply constraints, there is no need to restart a vaccine course.

• Please see the TRAVAX Intervals Between Vaccinations page for more information.

Travellers may want to consider obtaining rabies vaccine at their destination.

• Foreign, Commonwealth and Development Office: Doctors and medical facilities worldwide list

Advice on boosters for travellers with frequent or infrequent exposure

Routine boosting is not recommended. Travellers that have received a previous course of rabies vaccine should be reminded of the importance of bite avoidance, wound management and seeking of medical attention if they think they are exposed to rabies.

Post Exposure Treatment Guidance

For information relating to post exposure rabies guidance and how to obtain HRIG and rabies vaccine for post exposure treatment (PET), please see the TRAVAX Rabies Post Exposure Guidance page.

Please note that whilst in the UK an intramuscular regimen is currently recommended for PET, international practice varies and WHO recommendation includes additional regimens and routes.