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Health Professionals Update - January 21, 2025: Vol. 18, No. 1

From: 
Dr. Nicholas Brandon, MD, MA, MSc, CCFP, FRCPC
Associate Medical Officer of Health

In this issue

Critically low stock of rabies vaccine

Key messages:

  • Effective immediately, Peel Public Health will be implementing measures (rabies vaccine to be delivered dose by dose) to conserve rabies vaccine due to shortages in Ontario.
  • Rabies vaccine will be provided for high-risk exposures only.
  • Prior to requesting rabies post-exposure prophylaxis (PEP), physicians should contact Peel Public Health to discuss risk assessments and to determine if PEP is warranted.
  • Physicians can contact Peel Public Health at 905-799-7700.  A Public Health Inspector is available 24/7 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 vaccine

Effective immediately, Peel Public Health will implement measures to conserve rabies 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 we have received shipments of rabies vaccine from the Ontario Government Pharmacy. The Ontario Government Pharmacy has not provided us with a date for when rabies vaccine stock will be available.

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 dosing adjustments

Rabies post-exposure prophylaxis (PEP) consists of 4 doses (Days 0, 3, 7, and 14). As of Tuesday January 21, 2025, Peel Public Health will deliver vaccine dose by dose, to conserve the vaccine supply. Peel Public Health currently has a good supply of immunoglobulin. 

Vaccine eligibility criteria

The rabies vaccine will be provided for high-risk exposures only. This includes patients who have hadcontact 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
  • Travelers returning from countries where rabies is endemic

NOTE: All animal exposures/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 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 above vaccine eligibility criteria and whose primary care physician is located within Peel, they will be provided with post-exposure prophylaxis on a dose-by-dose basis.

In all other cases, non-Peel residents will need to seek rabies vaccine PEP 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.

More information:

Contact us

The Health Professionals Update is distributed to physician offices in Peel region via fax or email. Share this update with other health professionals in your clinic. If you have any questions about this update, or if you receive the updates via fax and would like to switch to email you can contact us at healthprofessionals@peelregion.ca.