Managing possible rabies exposures

In British Columbia, bats are the only known natural reservoir of rabies. While a human case of rabies did occur in 2019, this was the 2nd case in BC in over 95 years. The prevalence of rabies among bats has not changed. About 1%, and likely less, of bats carry the infection.

If a client presents with animal contact/potential rabies exposure:

• Approval and release of rabies prophylaxis (immune globulin and vaccine) can only be authorized by a Medical Health Officer (MHO).
• For rabies exposure consultations, during weekdays 8:30 – 16:30, call Fraser Health Public Health Communicable Disease Environmental Health Officer (CDEHO) at 1-866-990-9941 and select option 2. The MHO is available after hours (evenings, weekends, and statutory holidays) at 604-527-4806.
• Note – if the patient presents to your care shortly after the exposure, manage the exposed site similar to other wounds. It is very important to wash the contact site with mild soap and copious water for at least 15 minutes. Also consider updating tetanus vaccine as required.

Scenarios you may encounter and recommended actions:

• Direct contact with a bat
  If a patient reports direct contact (e.g., bite, scratch, unprotected handling/touching) with a bat, please call Fraser Health Public Health. Public Health will conduct a risk assessment to determine whether rabies post-exposure prophylaxis (RPEP) is indicated. RPEP is not indicated for every case of possible direct contact with a bat and will be provided at the discretion of the MHO.
• Bat in a room
  RPEP is generally not indicated if there is no history of direct contact. BCCDC guidelines indicate that if a bat was found in the house or if someone woke up with a bat in the room without any evidence it touched someone then RPEP is not indicated (BCCDC, 2021). A clear patient history of direct contact with a bat is important to document. When a bat is found in the room of a child or someone whose history may be less reliable, assessment of direct contact can be difficult and contacting Fraser Health Public Health is appropriate.
• Contact with other animals (not a bat)
  Terrestrial mammals are not known to be reservoirs of rabies in British Columbia. Therefore, rabies is extremely rare in pets and domestic animals or wildlife in B.C. Rabies risk is higher in animals recently imported from outside B.C. (in the last six months) or animals with signs compatible with rabies (BCCDC, 2021) or if the exposure occurred while travelling. Please call Fraser Health Public Health for an assessment in these cases.