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Recommendations for Rabies Post-Exposure Prophylaxis with respect to Bat Exposures

The following recommendations pertain to rabies post-exposure prophylaxis (PEP) with respect to bat exposures. The following recommendations should replace any previous recommendations in Ontario with regard to bat exposures.

The main difference between the current recommendations and any previous recommendations is that PEP is no longer indicated for the scenarios where people are sleeping unattended in a room where a bat was found, or a bat is discovered in close proximity to an individual who is cognitively impaired or near a young child. In the following recommendations PEP is only indicated when there is direct contact with a bat as defined below.

Immediate washing and flushing of the wound or anatomic location that the bat contacted with soap and water is imperative and is probably the most effective procedure in the prevention of rabies. Suturing the wound should be avoided if possible. Tetanus prophylaxis and antibacterial drugs should be given as required.

With respect to human exposures to bats, post-exposure prophylaxis (PEP) is recommended only when a bat bite or scratch has occurred,

OR

when there is direct contact1 with a bat AND either of the following cannot be eliminated;

  • a bat bite or scratch2,
    or
  • saliva from a live bat entered an open wound or mucous membranes2.

Notes

1 – Direct contact means that the bat should be observed to touch or land on the person.

2 – An exception to administering PEP would be if the bat lands on the clothing of a person who can be sure that a bite or scratch did not occur and that the bat’s saliva did not contact an open wound or mucous membranes.

Extreme care should be taken to ensure that there is no further exposure to the bat if it is captured or handled. In the event that the bat is captured, it should be submitted for rabies testing. Unless exposure from the bat is to the head or neck region, PEP can be delayed for up to 48 hours until the rabies test result on the bat is obtained. If PEP was initiated, it can be discontinued if the bat tests negative for rabies.

Please note that spelunker exposure in caves will require special consideration.

For more information
Call the ministry INFOline at 1-866-532-3161
(Toll-free in Ontario only)
TTY 1-800-387-5559
Hours of operation : 8:30am - 5:00pm
 
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