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Health Professionals Update – Vol. 18, No. 20

August 19, 2025

From:
Hetal Patel, MD, MPH, CCFP, FRCPC
Associate Medical Officer of Health

In this issue

Critically low stock of rabies immunoglobulin and vaccine

Key messages:

  • Effective immediately, Peel Public Health will be implementing measures to conserve rabies immunoglobulin and vaccine due to shortages in Ontario.
  • Rabies immunoglobulin and vaccine will be provided for high-risk exposures only.
  • Prior to requesting rabies post-exposure prophylaxis (PEP), physicians must contact Peel Public Health to discuss risk assessments and to determine if PEP is warranted. Keep in mind that PEP is not warranted in all cases.
  • Physicians can contact Peel Public Health at 905-799-7700. A Public Health Inspector is available 24 hours a day, 7 days a week to receive reports of potential animal exposures. An Associate Medical Officer of Health is also available for consultations, if required.

Critically low stock of rabies immunoglobulin and vaccine

Effective immediately, Peel Public Health will implement measures to conserve rabies immunoglobulin and vaccine due to shortages in Ontario. These measures are required to ensure that there is vaccine available for the highest-priority individuals and to prolong our remaining supplies. We will notify you once rabies immunoglobulin and vaccine supplies have stabilized. The Ontario Government Pharmacy has not provided us with a date for when this may happen.

Rabies is a disease of public health significance (O. Reg 135). Rabies is a virus transmitted through the saliva of infected mammals through bites, scratches or contact with the mucus membranes (e.g., mouth, nose, eyes).

Vaccine delivery adjustments

Rabies post-exposure prophylaxis (PEP) consists of 4 vaccine doses (days 0, 3, 7, and 14). As of Tuesday, August 19, 2025, Peel Public Health will deliver the first 2 doses together (day 0 and 3) and then the next 2 doses (Day 7 and 14) together to conserve the vaccine supply.

Delivery of rabies immunoglobulin, if warranted, will still occur with the first dose of rabies vaccine (Day 0).

Immunoglobulin and vaccine eligibility criteria

Rabies immunoglobulin and vaccine will be provided for high-risk exposures only. This includes patients who have had contact with the following:

  • Bats (direct contact).
  • Wild animals (e.g., raccoons, foxes, skunks, coyotes) with signs of unusual behaviour or illness.
  • Domestic animals with a travel history from countries with high rates of rabies.
  • Ontario/Canadian travelers returning from countries where rabies is endemic.

All animal exposures and bites which can transmit rabies must be reported to the patient’s local public health unit as required under the Health Protection and Promotion Act and Ontario Regulation 557. Physicians can contact Peel Public Health at 905-799-7700. Public Health will do a risk assessment, prioritizing the highest risk exposures for immediate vaccine. Exposures to domestic pets such as cats, dogs, and ferrets, may not be considered high-risk and may not warrant rabies vaccine, especially if the animal can be isolated for a 10-day period.

Non-Peel residents

Non-Peel residents who meet the above vaccine eligibility criteria will be provided with the Day 0 vaccine dose and immunoglobulin if they present at a Peel emergency department. The remainder of their doses will be provided from the health unit in which they reside.

For non-Peel residents who meet the vaccine eligibility criteria and whose primary care physician is located within Peel, they will be provided with the full course of vaccine and immunoglobulin for post-exposure prophylaxis.

In all other cases, non-Peel residents will need to seek rabies immunoglobulin and vaccine from the health unit in which they reside.

Peel Public Health will continue to monitor the situation and provide updates as we receive further information from the ministry.

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The Health Professionals Update (HPU) is distributed to physician offices in Peel region via fax or email. Share this update with other health professionals in your clinic.

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