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.
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. Report any suspected cases immediately when a person has been exposed to a rabid or suspected rabid animal.
An inspector will follow-up with the patient and will assess the appropriate response, which could be one of the following options. If the patient is 16 or under, ensure that the patient is also assessed further as per the Canadian Immunization Guidelines.
Option 1
Patient is okay, no further action.
Option 2
Recommend a rabies post-exposure prophylaxis.
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.
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:
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.
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.
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.
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:
Past rabies vaccine that doesn't meet these criteria
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.
Call 905-688-8248 or 1-888-505-6074 ext. 7590. (Monday to Friday, 8:30 a.m. - 4:30 p.m.) to request rabies immune globulin and vaccine.
After hours and on weekends, call 905-984-3690 or 1-877-552-5579.
The ordering physician will determine if the patient requires the fifth dose to ensure that the correct amount of vaccines is delivered. For assistance, call 905-688-8248 ext. 7590.
Due to cold chain requirements, do not send vaccine with patient.
