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This fact sheet provides information for health care providers about rabies post-exposure prophylaxis (PEP) administration with regard to bat exposures.
The Ministry of Health and Long-Term Care (the “Ministry”) has adopted new policy for rabies post-exposure prophylaxis (PEP) administration with regard to bat exposures.
Q : Why is the Ministry changing policy regarding bat exposures?
A : Recent research by Dr. DeSerres in Quebec demonstrated that the risk of acquiring rabies as a result of non-contact bat exposures is extremely low. This risk was calculated by gathering denominator data on exposure to bats in the general population. Similar to a previous study conducted in the United States, the study revealed that non-contact exposure to bats is frequent, and that current intervention reaches only a small percentage of exposed persons. This means that the risk is so low that the consequences and cost of vaccination outweigh the benefits.
Q : When should PEP be given for bat exposures?
A : With respect to human exposures to bats, PEP is recommended only when a bat bite or scratch has occurred,
when there is direct contact with a bat AND either of the following cannot be eliminated;
Q : What does ‘direct contact’ mean?
A : Direct contact means that the bat should be observed to touch or land on the person. This would include if the bat was handled by a child, stepped on with bare feet, flew into a person, or was touched when the person reached into its hiding place. 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 membrane.
Q : If the bat was dead when the exposure occurred, should I still offer PEP?
A : The rabies virus is inactivated by exposure to sunlight, heat, and desiccation. PEP is not recommended after contact with a dry bat carcass.
Q : How is this policy different from the ministry’s previous recommendations?
A : Previous ministry policy regarding bat exposures adhered to that found in the Canadian Immunization Guide, 7th Edition, which prescribes PEP administration in instances where contact with a bat cannot be ruled out, including when a bat is found in the same room as a sleeping person, unattended child or cognitively impaired individual.
Q : What should I tell someone who has woken up to find a bat in the room?
A : If it is determined that there was no bat bite or scratch and no observed physical contact with the bat, PEP is not recommended and the person should have the bat safely removed by their local animal control officer. The chance of getting rabies from this type of exposure is extremely low.
Q : What should I do when someone presents with a bat exposure?
A : Determine the need for PEP as described above. 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.
According to the Health Protection and Promotion Act, any animal bite or other animal contact that may result in rabies in persons must be reported as soon as possible to the local medical officer of health.
Q : Can the bat be tested for rabies?
A : If there has been no exposure requiring PEP, as defined above, the bat should not be captured for testing. Attempting to capture the bat puts the individual at risk for coming in direct contact with the bat, which potentially exposes them to rabies.
If there has been an exposure, as defined above, 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.
Q : Can I delay PEP administration until I receive test results on the bat?
A : Unless exposure 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.
Call the ministry INFOline at 1-866-532-3161
(Toll-free in Ontario only)
Hours of operation : 8:30am - 5:00pm
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