Rabies & Animal Bites: Information for Healthcare Providers

Ontario Regulation 557/90 (O. Reg 557/90) sets out the duty to report animal bite and contact information: 

“A physician, registered nurse in the extended class, veterinarian, police officer or any other person who has information concerning either or both of the following shall, as soon as possible, notify the medical officer of health and provide the medical officer of health with the information, including the name and contact information of the exposed person:

1. Any bite from a mammal.

2. Any contact with a mammal that is conducive to the potential transmission of rabies to persons.”

(O.Reg 557/90, s.2(1)).

Fax completed Animal Exposure Reports (PDF, 1 page, 243 KB) to our Reportable Diseases fax line at 1-855-WDG-LINE (1-855-934-5463). 

• Immediately clean the wound with soap and water. The wound should be flushed out for approximately 15 minutes.
• Suturing the wound is not advised.
• Viricidal can be applied (such as alcohol solutions or iodine-based solutions).

(PHO, 2021)

WDGPH will complete the risk assessment with healthcare provider to determine whether the individual in question requires PEP 

For domestic animals (dog, cat or, ferret):

• Determine whether the animal is available for confinement
  • If YES, WDG Public Health will arrange for the animal to be confined for the 10-day confinement period and follow up afterwards.
    • If the victim was bitten on the head or neck, the health unit and the healthcare professional will still assess the need for rPEP. This is dependent on the vaccination status of the animal involved, the age and behaviour of the animal involved, the circumstances surrounding the exposure and the prevalence of rabies in the area
  • If NO, and the victim is able to provide detailed information regarding the location, time, and date of the incident along with a description of the animal’s owner WDG Public health will use this information in attempts to locate the animal.
    • If the animal is found, the animal will begin its 10-day confinement period and another risk assessment will be conducted to determine the need for rPEP.
    • If the animal is not found, a risk assessment will be conducted by the healthcare professionals and the health unit to determine the need for rPEP
  • If the animal has successfully completed the 10-day confinement period, then there is no need for rPEP
  • If the animal dies during confinement and displayed symptoms of Rabies, the health unit will arrange for the animal testing and rPEP should begin immediately.
• Note, a 14-day observation period can be used for livestock.

Confirmed Wildlife Exposure:

Determine if the animal is available for testing:

• If YES, WDG Public Health will arrange for the animal to be sent for testing
  • If the bite is to the individuals head or neck, rPEP should be initiated while waiting for the test results
  • If the bite occurred somewhere else on the body, then rPEP should be initiated depending on the prevalence of rabies in the area, and circumstances surrounding the bite
  • If the animals test results are positive begin rPEP immediately
  • If the animals test results are negative, there is no need for rPEP and any treatment already undergoing can be discontinued.
• If NO, initiate rPEP as soon as possible
  • In certain situations, other management recommendations may be provided by the health unit after a risk assessment. This can include the prevalence of rabies in the area and the circumstances surrounding the exposure.
• Note, bites of squirrels, chipmunks, rats, mice, hamsters, gerbils, guinea pigs, hares and rabbits and other small rodents, would only warrant rPEP if the behaviour of the biting animal was highly unusual.  Bites from larger rodents (e.g. beavers) require a risk assessment.

Confirmed Bat Exposure:

Definition of direct exposure:

• Direct exposure is when the bat has touched the individual’s skin or when bat saliva has contacted an open wound or a mucous membrane
  • For other exposure routes please see Assessment of exposure to bats, figure3, page 8

Determine whether there was direct exposure with the bat

• If YES,
  • If the bat bite/scratch is to the head or neck, rPEP should be initiated immediately.
  • If the risk is considered low, then rPEP can be postponed to 48 hours while waiting for bat  rabies test results.
    • Low risk situations when rPEP can be postponed to a maximin of 48 hours can include: contact with a dead bat, no obvious signs of a bite/ scratch, no obvious exposure of saliva to an open wound or mucous membrane and others.
  • If the bat  is available for testing:
    • The Health Unit will arrange for the bat to be sent for testing.
    • If the test result come back positive, rPEP should be followed through OR initiated immediately.
    • If the test result comes back negative, there is no need for rPEP and any treatment already started can be discontinued.
  • If the bat is NOT available for testing, then initiate rPEP immediately
• If NO direct exposure,
  • Determine if the bat was in the same room as the individual
    • If NO,
      • No further action required
    • If YES,
      • Is the individual able to provide a reliable history (e.g. child, cognitive impairment)
    • If NO, is there evidence of direct contact such a scratches or bites, or the individual was upset or crying while the bat was in the room
      • If YES, initiate rPEP immediately
      • If NO, no further action required

For more information about assessing the need for PEP please see the following links:

Management of Potential Rabies Exposures Guideline, 2020 (gov.on.ca)

 rabies-exposure-guidance-hcps.pdf (publichealthontario.ca)

For any clarification, please contact WDG Public Health Inspector line at 1-800-265-7293 ext. 4753 OR after hours (after 4:30PM) at 1-877-884-8653.

If a risk assessment determines that Rabies PEP is indicated, it should be initiated as soon as possible regardless of how long ago the exposure occurred.

Rabies Immune Globulin dose is determined based on individual body weight.

Rabies Immune Globulin Dose Calculation, appendix page 7

• NO prior rabies vaccines administration:
  • Rabies Immune Globulin on Day 0
  • Rabies Vaccine on DAYS 0,3,7,14
  • If immunocompromised or on antimalarial drugs an extra dose is administered on DAY 28
• If previously vaccinated:
  • Rabies booster on DAYS 0 and 3, it is same rabies vaccine used in unvaccinated individual.

Please note that Day 0 is always the day that the PEP series was initiated, which may not be the same day that the exposure occurred.

Post-exposure rabies vaccine is available free of charge to residents of Ontario.

Public Health Ontario: At a Glance: How to Administer Rabies Post-Exposure Prophylaxis Document:

This document provides detailed instructions on how to administer rabies vaccines. It describes:

• wound care
• administering rabies immune globulin (Rablg) for those who have not been previously vaccinated against rabies
• administering rabies vaccine

The National Advisory Committee on Immunization (NACI) recommends pre-exposure vaccination against rabies for the following populations:

• Laboratory workers who handle the rabies virus.
• Hunter and trappers in areas with confirmed rabies.
• Spelunkers (cavers).
•  Individuals who are travelling to countries where rabies is endemic and there is poor access to medical care
• Individuals who work in high-risk settings, where the risk of being exposed to rabies is higher, such as veterinarians and animal control

Pre-exposure vaccines are administered on days 0, 7 and anytime between day 21 and day 28 (Government of Canada, 2021).

Pre-exposure vaccines are available at your local travel clinic by appointment.  Pre-exposure rabies vaccines are not included in Ontario’s Publicly Funded Immunization Schedule.

For more information on rabies please visit the following links.

Public Health Ontario (PHO).  Management of patients with suspected rabies exposure: Guidance for health care providers working with your local public health unit

rabies-exposure-guidance-hcps.pdf (publichealthontario.ca)

U.S. Centers for Disease Control and Prevention (CDC):

Rabies Biologics | Specific Groups | CDC

City of Toronto Public Health: Rabies & Animal Bites Information for Health Professionals – City of Toronto

References:

Government of Canada. (2021). Rabies vaccine: Canadian Immunization Guide. Retrieved from https://www.canada.ca/en/public-health/services/publications/healthy-liv…

Public Health Ontario. (2021). At a Glance: How to Administer Rabies Post-Exposure Prophylaxis Document. Retrieved from https://www.publichealthontario.ca/-/media/Documents/R/2021/rabies-admin…