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.
Health care providers must report animal biting incidents to Niagara Region Public Health for follow-up investigation (O. Reg 558/01).
- Monday to Friday, 8:30 a.m. - 4:30 p.m.
- 905-688-8248 ext. 7269
- After hours: 905-984-3690 or 1-877-552-5579
How is rabies transmitted?
Rabies is transmitted 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 some cases, rabies symptoms may not appear for up to six months after the bite. It's never too late to start rabies vaccination following an animal bite.
When should I consider 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 even in these circumstances to delay rabies post-exposure prophylaxis if the animal is domesticated, it's fully vaccinated against rabies, the bite was provoked, and there's a low prevalence of rabies in the area.
- 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.
- 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 (defined as the bat touching or landing on a person) AND a bite, scratch or saliva exposure into a wound or mucous membrane. Factors indicating that direct contact has occurred include an individual waking up crying or yelling or the presence of a new bite or scratch. In a child or an adult who is unable to give a reliable history, any direct contact with a bat should be considered a reason for intervention, including contact through clothes.
Post-exposure prophylaxis for rabies
- Wash and flush the wound with soap and water. This is probably the most effective part of preventing rabies.
- Consider healing by secondary intention (no suturing)
- Consider the need for tetanus vaccine
- Contact Public Health for rabies immune globulin and rabies vaccine
||Rabies Immune Globulin*
|Previously unimmunized and immunocompetent
||Days 0, 3, 7 and 14 (4-dose series)
|Previously unimmunized and immunocompromised
||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.
What if my 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.
For more information, contact Niagara Region Public Health at 905-688-8248 ext. 7590 or 1-888-505-6074.