Rabies Information for Health Care Professionals
Rabies is a viral disease that attacks the central nervous system of all mammals, including humans. Once symptoms appear, rabies is almost always fatal.
Bats, foxes, dogs and raccoons are of primary concern in Niagara. Small mammals, such as mice, gerbils and hamsters have also been known to transmit rabies. Animals that are rabid will show a variety of signs ranging from withdrawal to aggression.
Transmission of rabies
Rabies spreads through infected saliva from bites and scratches. At this point there will be no symptoms of rabies in the person bitten.
When the virus enters the body, it spreads through the nervous system until it reaches the brain. Once in the brain, the virus multiplies quickly and symptoms appear. The distance of virus entry from the brain will determine the length of time it takes for rabies symptoms to appear.
In most cases, rabies symptoms appear from one to three months, but it can be as short as a few days or as long as several years after the exposure. It is never too late to start rabies vaccination.
Considerations for vaccination
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Exposure to the neck or head
For an exposure to the neck or head, it may be necessary to start rabies post-exposure prophylaxis right away.
Considerations should be given to delay rabies post-exposure prophylaxis even if:
- The animal is domesticated
- The animal is fully vaccinated against rabies
- The bite was provoked
- There's a low prevalence of rabies in the area
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Animal is available for observation
If an animal is available for observation for a prescribed period by the health department, rabies post-exposure prophylaxis doesn't need to be started right away.
You should wait the prescribed observation period before starting post-exposure prophylaxis.
This is part of the investigation by Public Health.
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Animal tests positive for rabies
If an animal has tested positive for rabies by the Canadian Food Inspection Agency, the local health unit will work with all partners, including the client's physician should such an event occur.
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Exposure from a bat
If the exposure is from a bat, there must be direct contact (the bat touching or landing on a person) AND a bite, scratch or saliva exposure into a wound or mucous membrane.
Factors that direct contact has happened include an individual waking up crying or yelling, or the presence of a new bite or scratch.
For children or adults unable to give a reliable history, any direct contact with a bat, even through clothes, should be a reason for intervention.
If you are unsure about your exposure, email Niagara Region Public Health and Emergency Services or call 905-688-8248 ext. 7590.
Report animal bites and scratches
There is a duty to report all animal bites and scratches to Niagara Region Public Health and Emergency Services as per Ontario Regulation 557. so that we can provide follow-up as necessary.
How to report
- Call 905-688-8248 ext. 7590 Monday to Friday, 8:30 a.m. - 4:30 p.m.
- After hours, call 905-984-3690 or 1-877-552-5579
- Fax 905-641-4994
- Report animal bites online
Contact
For more information, contact Niagara Region Public Health at 905-688-8248 ext. 7590 or 1-888-505-6074.
Post-exposure prophylaxis for rabies
Wound care
- Immediately clean any wound thoroughly with soap and water, and flush the wound with lots of water for at least 15 minutes
- Consider healing by secondary intention (no suturing)
- Consider the need for tetanus vaccine
Contact Public Health for rabies immune globulin and rabies vaccine.
Person | Rabies immune globulin* | Rabies vaccine** |
---|---|---|
Previously unimmunized and immunocompetent | Day 0 | Days 0, 3, 7 and 14 (4-dose series) |
Previously unimmunized and immunocompromised | Day 0 | Days 0, 3, 7, 14 and 28 (5-dose series) |
*Rabies immune globulin should be administered in and around the wound (bite, scratch) with the remainder given as a deltoid IM injection on the opposite side from the rabies vaccine.
**Rabies vaccine should be given as an IM deltoid injection.
Patient has been previously immunized against rabies
If your patient has been previously immunized against rabies, two doses of rabies vaccine (days 0 and 3), without rabies immune globulin, are recommended. Previously immunized individuals include:
- Completion of an approved course of pre-or post-exposure prophylaxis with approved rabies vaccine (Human Diploid Cell Vaccine or Purified Chick Embryo Cell Vaccine)
- Completion of immunization with other types of rabies vaccine or with Human Diploid Cell Vaccine or Purified Chick Embryo Cell Vaccine according to unapproved schedules as long as neutralizing rabies antibody has been demonstrated in serum
A complete course of Human Diploid Cell Vaccine or Purified Chick Embryo Cell Vaccine plus rabies immune globulin is recommended for those who may have received rabies vaccines in the past but don't fulfill the criteria above.
A serum sample may be collected before vaccine is given and if protective antibody (>0.5 IU/mL) is demonstrated the course may be discontinued, provided that at least two doses of vaccine have been given.