Medical Advisory: Rabies Post Exposure Prophylaxis (rPEP) Domestic Animal Exposures, Updated Reporting Form with Risk Categories and Bats

Key Messages

• Rabies Post Exposure Prophylaxis (rPEP) criteria for low-risk domestic animals
• Bat Exposures
• Updated Reporting Form with New Risk Categorization attached.

Low-Risk Domestic Animal Exposures

Domestic animals including unknown dogs and cats that are healthy, and/or vaccinated, or available for observation are considered low risk.  
Any exposure report regarding low-risk exposures should be faxed as normal and the case will be assessed and investigated (see “How to Report…”, below). If, after the case exposure has been assessed and rPEP is warranted, Hamilton Public Health will provide rPEP during regular business hours. We will no longer be providing rPEP after regular business hours for low-risk exposures. 
The following criteria are considered high-risk exposures:

• Bats, where there has been direct contact (see “Bat Exposures”, below)
• Domestic animals known Wild animals to have come from a rabies-endemic area in the last 6 months; or, exhibiting highly unusual behaviour (e.g. Neurological symptoms).
• Travellers returning from high-risk countries or a low-risk country (no rabies in pets) who have been exposed to a potentially rabid mammal and who meet one of the two following conditions:
  • Have not yet initiated post-exposure prophylaxis, and where the delay to initiate rPEP will be more than 48 hours; or  
  • Have started rPEP within the past 7 days but did not receive rabies immunoglobulin Rabid or suspect rabid domestic animals e.g. those with neurological symptoms.

Reports of high-risk exposures should be faxed as normal (see “How to Report…”, below) and call to request rabies vaccine and rabies immune globulin based on a consultation with Hamilton Public Health (see “How to Report…”, below).  

Delivery of rPEP for all exposures that do not meet the high-risk criteria outlined above will be deferred to the next business day.  

Bat Exposures  

Post-exposure rabies prophylaxis following bat contact is recommended when BOTH the following conditions apply:

• There has been direct contact with a bat; AND
• A bite, scratch, or saliva exposure into a wound or mucous membrane cannot be ruled out.

Direct contact with a bat is defined as the bat touching or landing on a person. When there is no direct contact with a bat, the risk of rabies is extremely rare and rabies rPEP is not recommended. Finding a bat in the room, even if the person was asleep generally does NOT merit administration of rPEP UNLESS direct contact is known to have occurred, or there is evidence of direct contact with the bat. 

When a bat is found in the room with a child or adult who is unable to give a reliable history, assessment of direct contact can be difficult. Factors indicating that direct contact may have occurred in these situations include the individual waking up crying or upset while the bat was in the room, or observation of an obvious bite or scratch mark. Post-exposure prophylaxis must be coordinated in consultation with Hamilton Public Health (i.e., do not commit to prophylaxis without Hamilton Public Health’s agreement).  Rabies vaccination is not a vaccine eligible to all Ontarians, unlike vaccinations for infections such as measles and tetanus.  As such, it should only be administered after careful assessment of the affected person’s risk of having been exposed, and in conjunction with a risk assessment performed by Hamilton Public Health staff. 

How to Report incidents for investigation of potential Rabies exposures

During Regular Business Hours (8:30am to 4:30pm, Mon-Fri): fax form* to 905-546-2787.  To request vaccine during business hours please call 905-546-2424 ext. 3327. Please leave a message with call back number. 

After Hours and Weekends: To report a rabies incident outside of business hours including domestic animals and non-bite exposures please fax reporting form* 905-546-2787. To request vaccine after hours/weekends for higher risk exposures please call the City of Hamilton Environmental Public Health Inspector on-call at 905-546-CITY (2489).