PREPARED BY: Environmental Health
DATE: September 26, 2024
SUBJECT: Rabies Prevention
BACKGROUND/PURPOSE
On September 6, 2024, the Brant County Health Unit reported a human case of rabies in a local resident, resulting from a bat exposure in Northern Ontario. This is the province’s first domestically acquired human rabies case since 1967.
Rabies is a viral disease that affects the central nervous system of warm-blooded animals, including humans. Once symptoms appear, rabies is almost always fatal. Exposures to rabies can happen in two ways – bite exposures and non-bite exposures. Bite exposures involve the penetration of teeth into flesh, while non-bite exposures involve the contamination of scratches, abrasions, or cuts of the skin or mucous membranes by saliva or other potentially infectious material, such as the brain tissue of a rabid animal. Transmission cannot occur by exposure to the blood, urine, or feces of infected animals.
In Canada, bats, foxes, skunks, and raccoons are the most common transmitters of the disease. The Canadian Food Inspection Agency - Animal Health Division data shows that bats are the most frequently reported animal with positive test results for rabies across Canada. To date in 2024, 42 bats have tested positive for rabies in Ontario (approximately 16% of the total bats submitted); including one from our region in July.
Rabies is a reportable disease in Ontario which is investigated in accordance with the Health Protection and Promotion Act, the Management of Potential Rabies Exposures Guideline, and the Rabies Prevention and Control Protocol. All potential rabies exposure cases are required to be reported to the local public health unit. Investigations are initiated within 24 hours of notification and include an assessment of rabies risk in the animal species, the behaviour of the animal implicated, confinement or testing of animals, and ensuring individuals requiring treatment have access to rabies post-exposure prophylaxis (rPEP).
Due to effective public health prevention and control measures and the availability of publicly funded rabies post-exposure prophylaxis, reported human rabies cases in Canada are exceptionally rare. The reporting of rabies cases in Canada began in 1924 and since then, there have been 26 cases of rabies in humans; all of which were fatal.
| Year | Total Animal Bite Investigations (all animals) | Total Bat Investigations | % of Confirmed Bat Exposures | Total rPEPT Issued (Total Investigations for all animals) | Total Bat Exposure rPEPT Issued | % of Bat Exposure rPEPT Issued |
|---|---|---|---|---|---|---|
| 2019 | 973 | 28 | 2.88% | 71 | 14 | 19.72% |
| 2020 | 770 | 16 | 2.08% | 53 | 9 | 16.98% |
| 2021 | 844 | 19 | 2.25% | 30 | 7 | 23.33% |
| 2022 | 858 | 19 | 2.21% | 56 | 9 | 16.07% |
| 2023 | 1075 | 34 | 3.16% | 60 | 16 | 26.67% |
|
2024 (As of 10-Sep) |
696 | 8 | 1.15% | 48 | 3 | 6.25% |
| T Rabies post-exposure prophylaxis includes rabies immunoglobulin and 4 (or 5) rabies vaccines over a series of weeks | ||||||
A review of local cases from Janruary-2019 to current informs that bat exposures represent an average of 2.29% of all cases investigated by the Public Health Inspectors within WEC. Due to the high-risk nature of these types of exposures, bat exposure investigations disproportionately account for an rPEP rate of 18.29%.
DISCUSSION
The WECHU sends out annual reminders to all local veterinarians, health care providers, hospitals, police and other agencies to remind them of their legal obligation to report any animal bite or scratch to the health unit. In addition, the health unit is currently running a rabies awareness campaign which started in May, aligning with Rabies Awareness Month, that is scheduled to end with World Rabies Day in September. The campaign utilizes various social media platforms, website, radio ads, and educational resources (e.g., fact sheets, posters) to promote rabies prevention tips, rabies vaccination for pets, timely reporting of rabies exposures, and animal owner responsibilities and obligations. In response to the recent rabies activity in the province, the WECHU has further increased social media messaging in September for rabies awareness.
In order to pursue additional rabies prevention efforts in Windsor and Essex County, a recommendation report will be provided to the Board of Health at the November meeting which will include municipal policy recommendations and equity-based strategies to reduce barriers to accessing high-risk animal removal services.