Rabies & Other Lyssaviruses

Transmitted via the saliva or nerve tissue of infected animals — through bites, broken skin, or mucosal contact. Almost invariably fatal once symptomatic, so exposure management is everything. In Australia, any bat contact is a potential Australian bat lyssavirus (ABLV) exposure.

Prophylaxis

Pre-exposure — for people with bat contact, lyssavirus lab workers, and travellers per risk assessment.

Post-exposure prophylaxis (PEP) — prompt wound care + rabies vaccine ± immunoglobulin, depending on exposure grade, animal source, immune status and prior vaccination. Give PEP even after considerable delay. Exception: a domestic pet (dog/cat/ferret) exposure in a rabies-enzootic country where the animal remains known to be healthy 15 days later. Always discuss suspected exposures with an expert.

Grades of exposure (WHO)

Grade	Exposure	Action
I	Touching/feeding animals; licks on intact skin	No prophylaxis
II	Nibbling of uncovered skin; minor scratches/abrasions without bleeding	Vaccine (no immunoglobulin if immunocompetent)
III	Transdermal bites/scratches; mucosal or broken-skin contamination with saliva; direct bat contact	Vaccine + immunoglobulin (unless already vaccinated)

Any Grade II or III contact with a bat is managed as Grade III.

Wound management

Wash the wound thoroughly with soap and water and apply povidone-iodine. Do not suture the wound after a potential rabies exposure — leave it open.