Due to a shortage of rabies vaccine and rabies immunoglobulin (RabIg) in Ontario, Peel Public Health and Toronto Public Health will be immediately and temporarily implementing measures to conserve the remaining supplies of each product. These measures are being taken to ensure that rabies vaccine and RabIg are available for high risk exposures, and to prolong our remaining stock until we receive resupply from the Ontario Ministry of Health (ministry). The ministry has not provided us with a date for further shipments.
Effective immediately, the following measures will be implemented:
- Eligibility Criteria for rPEP (vaccine + RabIg):
- rPEP will be provided only for High-Risk Exposures, including:
- Bats (direct contact)
- Wild animals (e.g., raccoons, coyotes) if there are signs of unusual behaviour or illness
- Domestic animals with a travel history from countries with high rates of rabies
- Travelers returning from high-risk countries who have been exposed
2. Measures to Conserve RabIg
- RabIg will only be supplied for the following exposures:
- Transdermal bites or scratches from the tooth of an animal
- Contamination of a mucous membrane or broken skin with saliva from an animal
- Sufficient volume of RabIg will only be provided to thoroughly infiltrate into and around the wound (please provide your best estimate of the necessary volume of RabIg when requesting rPEP).
- Returning travellers who have already started a course of rPEP before returning to Canada will not receive RabIg if more than 7 days have passed after receiving their first dose of rPEP or if they have already received RabIg or purified equine rabies immune globulin (ERIG).
- Non-Toronto Residents:
- Non-Toronto residents who meet the rPEP eligibility criteria will be provided with the Day 0 vaccine dose and RabIg if they present at a Toronto emergency department within 48 hours of the exposure/incident.
- Non-Toronto residents who meet the rPEP eligibility criteria and whose primary care physician is located within Toronto will be provided with the recommended course rPEP (vaccine + RabIG).
- In all other cases, non-Toronto residents will need to seek rPEP from the public health unit in which they reside for the full course of rPEP OR to complete the rPEP started at a Toronto emergency department.
- 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.
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