If possible, pre-exposure immunization should be delayed in immunocompromised individuals until the immunocompromised state has resolved. In North America, domestic dog and cat exposures may be managed differently than in other areas of the world, where the prevalence of rabies in these animals is higher, and where programmes to control the populations of stray dogs are not in place. If a bat tests positive for rabies, the need for post-exposure prophylaxis should depend on whether direct contact with the bat occurred and not the rabies status of the bat. 5006. Rabies is transmitted only when the virus is introduced into a bite wound, open cuts in skin, or onto mucous membranes such as the mouth or eyes. Read about nutrition, exercise, vaccinations, spaying and neutering, common parasites and preventing dental disease. If the suspect animal is a dog, cat or ferret that is healthy and available for observation, post-exposure prophylaxis may be withheld, pending the animal's status after a 10-day observation period. Petting a rabid animal or handling its blood, urine or feces are not considered exposures. Similar airborne incidents have not occurred in approximately 25 years, possibly because of elevated awareness of such risks resulting in increased use of appropriate preventive measures. The person responsible for observation of the animal should be advised to notify public health officials if the animal becomes ill or escapes during the observation period. Immunization against rabies is required by Ontario Regulation 567/90 Rabies Immunization under the Health Protection and Promotion Act for cats and dogs three months or older. If the dog, cat or ferret cannot be located, a decision should be made in consultation with public health officials regarding the need for post-exposure prophylaxis. Post-exposure prophylaxis should not be delayed more than 48 hours. The existing titre of rabies antibodies should be determined and expert opinion in the management of these individuals should be sought promptly. Dogs accounted for 4% and cats accounted for 2% of animal rabies cases. The rabies vaccine should be offered to people at potentially high risk of contact with animals. If you missed this year’s clinic, please call your veterinarian directly for more information about protecting your pet from rabies. If the bat is available for testing, post-exposure prophylaxis may be discontinued after consultation with public health officials if the bat tests negative for rabies. Any animal that has bitten a human or is suspected of being rabid should be reported to local public health officials. Because of suboptimal response, in general, immunocompromised persons should be counselled to avoid situations of rabies exposure. The RabIg provides immediate passive protection until the exposed person mounts an immune response to the rabies vaccine. A 10-year follow-up study of subjects who received three doses of HDCV, followed by a booster dose at 1 year, has shown the maintenance of protective antibody up to 5 years in 96.2%. If the dog, cat or ferret has or develops signs of rabies, post-exposure prophylaxis should be initiated as soon as possible. Following vaccination, neutralizing antibodies begin to develop within seven days and persist for at least two years. Your doctor can tell you how much it will cost. 2020 Low-Cost Rabies Vaccination Clinics The organizing of low-cost rabies vaccination clinics is another service that was affected this year by the presence of COVID-19 in our communities. Low-Cost Clinics . The decision should consider several factors, including the rate of occurrence of rabies in the area, if it was a domestic or stray animal, the type of exposure, the circumstances of the exposure, including whether it was a provoked or unprovoked exposure, and the severity and location of the wound. How prevalent is rabies in other animal species in the geographic area? Rabies incidence rates are similar in Canada and the US and are reported in cases per billion person-years because of the extremely low number of cases. Rabies Vaccination. The vaccination status and behaviour of a domestic animal. Vaccination should also be offered to travellers going to areas where rabies is widespread and there is poor access to medical care. In 2006, the CFIA tested 2,150 bats, 3.3% of which were positive. If pre-exposure immunization must be given to immunocompromised individuals, antibody response should be determined after completion of the series. A seroconversion rate of 95.1% was demonstrated in travellers who received three ID injections of HDCV or PCECV, with a booster after 12 months. The worker should use extreme caution to ensure that there is no further exposure to the animal. Expert opinion should be sought in the management of these individuals. RabIg is available on an emergency basis through local public health officials. If possible, the full dose of RabIg should be thoroughly infiltrated into the wound and surrounding area. In dogs, cats and ferrets, rabies virus excretion does not generally precede symptom development beyond 10 days. Transmission of rabies from salivary contamination of scratches, broken skin or the mucous membranes without a bite is rare. Rabies: The rabies vaccine is used to prevent infection caused by the rabies virus. Preventive rabies vaccination is recommended for people who: plan to travel to a high-risk area; work in high-risk jobs such as trappers; wildlife rehabilitators; veterinarians; slaughterhouse workers; You will get three shots over 21 days. If these animals - are alive and healthy at the end of the 10-day period, they would not have transmitted rabies in their saliva at the time of the bite. The WHO website includes a map of global areas where rabies transmission occurs: Rabies, countries or areas at risk. If the initiation of post-exposure prophylaxis is delayed until test results from the involved animal are available, a maximum waiting period of 48 hours is recommended. Between 1990 and September 2007, 36 bat-related human rabies cases were identified in Canada (3 cases) and the US (33 cases), resulting in an incidence rate of 6.7 cases per billion person-years. An active eradication program was put in place and, based on reports to September 2011, no rabid raccoons have been detected in Canada since 2008. Serious adverse events are rare following immunization and, in most cases, data are insufficient to determine a causal association. The Public Health Agency of Canada's National Microbiology Laboratory (NML) is the Canadian rabies reference laboratory. Rabies vaccine and RabIg may be given at the same time but at different injection sites, using separate needles and syringes. The decision to start post-exposure prophylaxis while awaiting the laboratory test results should consider several factors, including when the test results will be available, the species of animal, the rate of occurrence of rabies in that species and in other species in the area, the type of exposure, the circumstances of the exposure including whether it was a provoked or unprovoked exposure, and the severity and locations of the wounds. Rabies transmission occurs most commonly through a bite. Learn about the restrictions and public health measures that are in place. The Committee to Advise on Tropical Medicine and Travel (CATMAT) provides additional information on assessing a traveller's need for pre-travel vaccination or post-travel post-exposure prophylaxis, and identifies the rabies vaccines that meet the WHO's safety, potency and efficacy requirements. There is no evidence that interference occurs with antimalarial drugs other than chloroquine. Refer to Vaccine Administration Practices in Part 1 for additional information. Some immunocompromised people may never mount an appropriate immune response. Learn more about the rabies treatment from the Ministry of Health. This is the first City-sponsored low cost rabies clinic in recent history. Rabies is found on all continents except Antarctica. Pre-exposure rabies immunization should be offered to workers at high risk of occupational exposure to potentially rabid animals or to the rabies virus. A veterinarian should be consulted to determine if the animal is up-to-date with its vaccinations. Being sprayed by a skunk is also not considered an exposure. Local injection site pain, erythema and induration are commonly reported following administration of RabIg, as are systemic reactions such as headache and low-grade fever. If a dose of vaccine is delayed, it should be given as soon as possible and the schedule resumed, respecting the appropriate intervals from the latest dose. Les navigateurs désuets ne disposent pas de caractéristiques sécuritaires permettant d’assurer la sécurité de vos renseignements. If using the ID route for a booster dose, serology should be checked at least 2 weeks after the booster dose. Post-vaccination serology is recommended: after pre-exposure immunization using the ID route; following immunization of immunocompromised individuals or people taking chloroquine; or if there has been a significant deviation from the recommended vaccination schedule. Rabies immunoglobulin should not be given to persons who have previously received appropriate rabies vaccinations. Rabies may be transmitted to domestic pets during exposure to rabid wild or outdoor animals. Therefore, it is important for health care providers to consult local public health departments regarding local epidemiology and for public health officials to remain current, based on information from the Canadian Food Inspection Agency (CFIA) website: Positive Rabies in Canada. Refer to. Refer to Storage and Handling of Immunizing Agents in Part 1 for additional information. Systemic allergic reactions characterized by generalized urticaria and accompanied in some cases by arthralgia, angioedema, fever, nausea and vomiting have been reported. In these individuals, vaccine should be administered by the IM route only. Rabies testing of animals is done at the CFIA Rabies Laboratories at Ontario Laboratory Fallowfield (OLF - Rabies unit), and the CFIA Lethbridge Laboratory (LET-Rabies unit) using a fluorescent antibody test of brain tissue, which is the gold standard recommended by the WHO. Untrained individuals should never handle wild or stray animals or any domestic animal that is behaving unusually and children should be taught this precaution. Wherever possible, an immunization series should be completed with the same product. The virus is easily killed by sunlight, soap and drying. In a study of subjects who received HDCV in a five-dose post-exposure schedule as well as RabIg on day 0, all vaccinees reached a protective antibody titre by day 14 and remained at that level through day 90. In this circumstance, antibody concentration should be checked at least 2 weeks after completion of the vaccine series. Only eight instances of human rabies from cutaneous or mucous membrane exposures were found in a review published in 2002 and these were not well documented, raising the possibility of other routes of exposure. These incidents do not warrant post-exposure prophylaxis. The use of corticosteroids to attenuate the allergic response may inhibit the immune response to the vaccine. Immunosuppressive agents should not be administered during post-exposure prophylaxis unless essential for the treatment of other conditions. These clinics are on a cash only basis and will be administered first come, first … skunks, foxes and raccoons), bats, cattle and stray dogs and cats. The annual clinics are sponsored by Dr. Jeff Rabinovitch, DVM. 1 In most countries, the risk of rabies is an encounter with an animal. Larger rodents such as ground hogs (woodchucks) and beavers can potentially carry rabies, although it is rare in Canada. purified chick embryo cell culture vaccine. The second is Saturday from 10 a.m. to 1 p.m. The vaccine can be given as a 1.0 mL IM dose or a 0.1 mL ID dose. History of household exposure to a bat: 16.7%, * NACI has not yet deliberated on the use of KamRAB™ or HyperRAB®. Post-exposure prophylaxis of immunocompetent persons who have not been previously immunized with rabies vaccine consists of: local wound treatment; rabies immunoglobulin (20 IU/kg body weight) given on day 0 with as much as possible infiltrated into and around the wound; and four 1.0 mL IM doses of rabies vaccine given on days 0, 3, 7 and 14. Persons with minor acute illness (with or without fever) may be vaccinated. Vaccine providers are asked to report, through local public health officials, any serious or unexpected adverse event felt to be temporally related to vaccination. In an effort to help promote responsible pet ownership, PJ’s Pets & Petculture will be hosting Rabies Vaccination and Microchip Clinics at 10 locations across Ontario. In recent years, bat-related rabies has become the most important public health concern for rabies in the Americas and the Caribbean. Upcoming low-cost rabies vaccination clinics: Please check back often for updated clinic listings. Refer to Table 1 and Table 2 in Contents of Immunizing Agents Available for use in Canada in Part 1 for lists of all vaccines and passive immunizing agents available for use in Canada and their contents. Refer to Immunization of Travellers in Part 3 for additional general information. Post-exposure prophylaxis or testing of a bat is generally recommended after direct contact with the bat (refer to Bat Exposure) because it is very difficult to ensure that a bite did not take place. En savoir plus sur les navigateurs que nous supportons. Refer to Anaphylactic Hypersensitivity to Egg and Egg Related Antigens in Part 2 for additional information. If antibody levels fall below an acceptable concentration (less than 0.5 IU/mL), a booster dose of HDCV or PCECV is recommended. Call ServiceOntario, Info line at: 1-866-532-3161 (Toll-free in Ontario only) TTY 1-800-387-5559. Pre-exposure immunization and post-exposure prophylaxis result in antibodies that prevent the virus from entering the peripheral nervous system. Pre-exposure rabies immunization with either HDCV or PCECV should be offered to people at high risk of close contact with rabid animals or the rabies virus, for example: Rabies prophylaxis must be considered in every incident in which human exposure to potentially rabid animals has occurred, unless rabies is known to be absent from the local animal population. Rabies testing of animals is carried out mainly when there has been a possible exposure involving a human or other animal, or for special studies. The person has been immunized with a vaccine other than HDCV or PCECV. Local pain, erythema and induration are common. Humans. Rabies in these animals is rare in Canada with only three rabid ground hogs (woodchucks) detected from 1998 to mid-2011, two in Manitoba in 1999 and one in Ontario in 2000. The ID route should not be used in persons who are immunocompromised due to illness or medication, or are taking chloroquine, as the immune response to the vaccine may not be protective under these circumstances. Contact Us; Animal Centre Locations; Adopt; Volunteer ; Blog; Media Releases; Employment; SPCA Professional; Follow Us. Ontario controls rabies in wildlife by dropping baits that contain the rabies vaccine in urban, forested and rural agricultural areas. Wild animals like bats, raccoons, skunks, and foxes are the most common source of human rabies infection in the United States. Refer to Immunization in Pregnancy and Breastfeeding in Part 3 for additional general information. What health professionals need to know about rabies 2. Refer to Post-exposure prophylaxis of previously immunized individuals for information on the post-exposure management of these individuals. Exposures occurring in the course of caring for humans with rabies could, theoretically, transmit the infection. Rabies virus is readily demonstrable in brains of animals with neurologic symptoms. Rabies vaccine must never be given into the gluteal muscle due to the risk of a decreased immune response. Care should be taken to clean the wound to its full depth. Squirrels, hamsters, guinea-pigs, gerbils, chipmunks, rats, mice or other small rodents, as well as lagomorphs (such as rabbits and hares), are rarely found to be infected with rabies because it is believed that they are likely to be killed by the larger animal that could have potentially transmitted rabies to them. In Toronto, TTY 416-327-4282 Hours of operation : 8:30am - 5:00pm. This recommendation was revised (as described above) in 2009 based on the rarity of human rabies related to bats (one case in Canada reported approximately every 5 years). The immunogenicity of PCECV and HDCV for pre-exposure vaccination has been demonstrated in clinical trials. In evaluating each case, local public health officials should be consulted. Factors indicating that direct contact may have occurred include the individual waking up crying or upset while the bat was in the room or observation of an obvious bite or scratch mark. If the intradermal route is used, rabies vaccine should be administered only by fully trained staff in settings in which there is a well-established cold chain. Post-exposure prophylaxis should not be delayed beyond 48 hours while waiting for test results in wild animals. If it is possible to avoid exposure to rabies, pre-exposure immunization should be deferred in immunocompromised people until they are no longer immunocompromised. When considering the need for post-exposure management, the following should be reviewed: In addition, the availability of the animal for observation or testing influences the management of the animal and the exposed person. Symptoms progress quickly as the central nervous system is attacked, and the illness generally presents in one of two ways. To help protect people and pets from rabies, Ontario law (Regulation 567, Rabies Immunization) requires animal owners to vaccinate specific animals against rabies. Surveillance A bite, scratch, or saliva exposure into a wound or mucous membrane cannot be ruled out. restrictions et des mesures de la santé publique. Rabies is spread to humans when virus in the saliva of an infected animal enters through a bite, scratch, broken skin, the mucous membranes or the respiratory tract. National Advisory Committee on Immunization. Assessment of the exposure may also be difficult in a cognitively impaired adult. For subsequent vaccine doses, the limb where the RabIg was administered can be used. Refer to Immunocompromised persons. In such instances, the RabIg can be diluted in a diluent permitted by the specific product labeling to provide RabIg in sufficient volume for thorough infiltration of all wounds. Pre-exposure immunization is given to people at high risk of close contact with rabid animals or the rabies virus (e.g., people with occupational exposure to animals; laboratory workers handling the rabies virus; certain travellers; hunters and trappers in areas with confirmed rabies; and spelunkers). In these groups, antibody titres should be determined 7 to 14 days after completing the pre-exposure or post-exposure immunization series to ensure that an acceptable antibody concentration has been achieved. Because these small animals are not known to have caused human rabies in North America, post-exposure prophylaxis should be considered only if the animal's behaviour is highly unusual. Dogs, cats and ferrets that are apparently healthy should be confined and observed for 10 days after a bite, regardless of the animal's rabies vaccination status. If this is not possible, the animal should be humanely euthanized in a way that does as little damage to the brain as possible, and the head submitted for laboratory examination and rabies testing in consultation with the local CFIA veterinarian. Bites from an infected animal are the main route of exposure. Rabies is a viral disease that attacks the central nervous system of all mammals, including humans. This table and accompanying text are guides for management and do not replace clinical judgment. Apprenez-en davantage au sujet des restrictions et des mesures de la santé publique qui sont en place. Further information and testing advice may be obtained from the CFIA web site. Children, especially those who are too young to understand the need both to avoid animals and to report a traumatic contact, are considered at greater risk of rabid animal exposure and should receive pre-exposure immunization when travelling to endemic areas. If no acceptable antibody response is detected, the patient should be managed in consultation with their physician and appropriate public health officials to receive a second rabies vaccine series. Rabies vaccine and RabIg should never be mixed in the same syringe. Temporally associated neurologic events have also been very rarely reported but causal association with vaccination has not been established. If a person is touched by a bat (such as a bat in flight) and the bat is available for rabies testing, the health care provider may decide to delay post-exposure prophylaxis. Rabies is a disease of mammals, both domestic and wild. Initiation of post-exposure prophylaxis should not be delayed beyond 48 hours while waiting for laboratory tests, if the exposure is from a terrestrial animal in an enzootic area. 1 Certain areas of the world still have a major problem with rabies in dogs. The rabies vaccine and RabIg should be given at different anatomical sites on day 0, using a separate needle and syringe. Human rabies occurs very rarely in Canada, but if not prevented, is almost always fatal once symptoms develop. Generally, behaviour in wild animals cannot be accurately evaluated and should not be considered part of the risk assessment; however, some behaviours in bats may be considered abnormal and indicative of rabies, such as a bat attacking a person or hanging on tenaciously to a person. The risk of infection after exposure to rabid cattle is low. Both institutions consider the antibody titre of at least 0.5 IU/mL as an acceptable correlate of protection. In the event of exposure to a fox, skunk, raccoon or bat in areas where rabies is known to occur in these animals, post-exposure prophylaxis should begin immediately unless the animal is available for rabies testing and rabies is not considered likely. 1012 Bathurst Street. The test has a reported sensitivity of 98% to 100%. Pour avoir une meilleure expérience, vous devez : You are using an outdated browser that is no longer supported by Ontario.ca. Data are not available regarding the concurrent administration of rabies vaccines with other vaccines. NACI will review these immunizing agents and update the chapter in due course. The prevalence of rabies in developing countries is generally higher than in Canada, and there may be concerns about the potency of available vaccines in these countries. The virus then gains access to the central nervous system through peripheral nerves. Three doses of HDCV or PCECV are required and should be given on days 0, 7 and any time between days 21 to 28. If the incident involves a dog or cat, determining if it is a stray or domestic animal assists with the risk assessment. More severe bites may be more likely to suggest the animal is rabid and these bites may also provide more opportunity for transmission of the virus, because of the increased extent of exposure to saliva. The circumstances of the exposure - provoked, unprovoked. Efficacy, Effectiveness and Immunogenicity, Table 1: Risk Assessment Related to the Exposure to the Potentially Rabid Animal, Table 2: Summary of Post-exposure Prophylaxis for Persons Potentially Exposed to Rabies, by Animal Type, Simultaneous Administration with Other Vaccines, Vaccine and Immunoglobulin Safety and Adverse Events, Contents of Immunizing Agents Available for Use in Canada, map of global areas where rabies transmission occurs, Management of the person after exposure to a potentially rabid animal, Immunization in Pregnancy and Breastfeeding, Immunization of Immunocompromised Persons, Committee to Advise on Tropical Medicine and Travel, Post-exposure prophylaxis of previously immunized individuals, People with ongoing high risk of exposure, Storage and Handling of Immunizing Agents, Blood Products, Human Immunoglobulin and Timing of Immunizations, Reporting adverse events following immunization (AEFI) in Canada, Anaphylactic Hypersensitivity to Egg and Egg Related Antigens, Contraindications, Precautions and Concerns, Healthy and available for a 10-day observation period. 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