Travel health update June 2026

This update focuses solely on rabies vaccine, which is in short supply. Should we follow national guidance and stick to a 3-dose schedule, or adopt a 2-dose regimen – or even use the dose-sparing intradermal route?

Rabies vaccine shortage isn’t a new phenomenon, and management of stock can be a logistical problem for the manufacturers, with global demand being one of the factors that can be unpredictable.Vaccine manufacture takes time and the quality control process to ensuring the vaccine is safe, sterile, and effective is paramount.In addition, enough stock must always be maintained for post exposure treatment.The death of a British tourist in June 2025, following contact with a puppy in Morocco four months earlier, raised public awareness of risk and will have increased demand for vaccine in the UK.

A news items posted on TravelHealthPro on 10 April 2026 stated that as of February 2026, the manufacturers Bavarian Nordic (Rabipur®) and Sanofi (Verorab®) have limited supplies. Rabies vaccine pre-exposure for travel is only given in GP surgeries who opt to provide the private travel vaccines which is now less common, and private travel clinics are the main providers of this vaccine.They will be more aware of the shortage problems, but it can be a balancing act. Even if a GP surgery is not providing rabies vaccine, the risk of this fatal disease should be highlighted to the traveller, and if indicated by the pre-travel risk assessment, the traveller should be advised to go to a service for vaccine. Of course, advice on prevention and post-exposure management should always be given.

In the UK we have two licensed rabies vaccines.Knowledge of the different products is important when establishing any previous vaccine history. Rabies Vaccine BP was supplied by Sanofi Pasteur for many years, but this product was discontinued in 2022. Rabipur was first licensed in 2016 but because of vaccine shortages, we also periodically used Verorab, then unlicensed in the UK.However, in November 2023 Verorab® gained a UK license. An item on TravelHealthPro from June 2024 (no longer available), included two new licensed indications:

1. Verorab® 0.5mL intramuscularly (IM) on day 0 and 7 (but regimen not to be used for immunocompromised individuals)
2. Verorab® 0.1mL intradermally (ID) x 2 doses on days 0 and 7 (one injection in each arm for adults and children and anterolateral leg for infants and babies)

At the time, NaTHNaC warned that the ID dosing schedule was not included in the Green Book, and the ID route was not advised, although this dose-sparing regimen is the World Health Organization’s preferred option. It also commented that a two-dose schedule would be considered as partially immunised in the UK. However, these schedules have recently been added to the NaTHNaC Rabies Factsheet as a footnote to Table 1 – see https://travelhealthpro.org.uk/factsheet/20/rabies

This is important to understand because private travel services are providing these two new schedules, 1) and 2) as detailed above, because they are included in the vaccine license, and if these travellers then return to their GP surgeries, it may cause confusion. Currently, the Green Book chapter still does not include these changes.

To return to the news item of April 2026 on TravelHealthPro, NaTHNaC indicates that both products could be given as a one-week regimen with 2 doses on D0 and at D7 in immunocompetent individuals (also used in the USA now as routine).Please make sure you read it in full at https://travelhealthpro.org.uk/news/900/rabies-vaccine-shortage-advice-for-health-professionals

We need the Green Book chapter on rabies (last updated in May 2023) to clarify what the UK policy is, so that practitioners are clear on what should be considered best practice.Private services are working within the legal parameters of the licence and basing their policies on recommendations from other official bodies such as the WHO and the US Centers for Disease Control.Until that time, all you can do in primary care is to be aware of the complexity of this topic.

• To test your knowledge of rabies prevention in travellers, undertake the Practice Nurse eLearning module, Rabies and traveller risk