Rabies in Ontario

Details and maps of confirmed cases of rabies in Ontario

Ministry of Natural Resources and Forestry rabies control operations

What is rabies?

Rabies is caused by a virus that can infect any mammal, including humans. Birds, reptiles, amphibians and fish do not get rabies. In infected mammals, the virus is found in saliva and can be spread through three main ways:

• Bites that break the skin
• Getting infected saliva in an open cut, sore, or other wound
• Getting infected saliva in the mouth, nose, or eyes

The animals that most often transmit rabies in Ontario are bats, foxes, skunks and raccoons. Once signs of rabies appear, in any animal, the disease is fatal. A series of vaccinations and treatment with rabies antibodies can prevent infection in humans in most cases if administered soon after exposure.

Rabies management in Ontario

Rabies response and prevention in Ontario is a joint effort involving members of the public, Public Health, veterinarians, the Ministry of Health, the Ministry of Agriculture Food and Rural Affairs (OMAFRA) and the Ministry of Natural Resources and Forestry (MNRF).

Signs of rabies in animals

Signs of rabies in animals are generally seen in one of two forms: dumb rabies or furious rabies.

Dumb (paralytic) rabies

• Animals may become depressed and retreat to isolated places.
• Signs of paralysis or paresis (i.e. partial paralysis) may be seen.
  • Head and neck paralysis may result in abnormal facial expressions, drooling, drooping head, sagging jaw, or strange vocal sounds.
  • Body paralysis usually begins in the hind limbs and spreads to the rest of the body.

Furious rabies

• Animals may display extreme excitement and aggression.
• An animal may gnaw and bite its own limbs or body.
• Animals may attack objects or other animals for no apparent reason.
  • Bouts of furious behaviour usually alternate with periods of depression.

Table 1: Comparison of rabies in pets, livestock, wildlife and people

Reporting a rabies exposure

Rabies is a federally reportable disease in Canada. That means that human and animal health professionals must report suspected cases to the appropriate authorities. If you think you, or someone you know, may have been exposed to rabies (including bites from domestic or wild animals) you should contact your doctor or local public health unit. Animal owners should report any potential exposure of their animals to their veterinarian, and OMAFRA can provide additional assistance to veterinarians in these cases as needed.

Exposure of a person

If you are bitten by an animal or if infectious material (such as saliva) from an animal gets into your eyes, nose, mouth, or broken skin, wash the area immediately and thoroughly with lots of soap and water. Washing immediately can greatly reduce the risk of infection.

Contact your doctor or your local public health unit immediately, as they can help determine your risk of exposure to rabies. If the risk is significant, rabies antibodies can be administered followed by a series of rabies vaccinations over 2 weeks. This treatment is very effective for preventing rabies in people if done promptly.

Exposure of a domestic animal

If your animal has direct contact with wildlife (including bats), or another domestic animal with signs of rabies, avoid touching your pet with bare hands if it may have fresh saliva from the other animal on its body. Contact your veterinarian for advice as soon as possible following the incident. Your veterinarian will ask you some questions and perform a risk assessment to determine the appropriate action.

Vaccination

A general overview of rabies vaccine requirements is provided below. Contact your veterinarian for information on vaccine recommendations for your own animals.

Pets

Under the Ontario Health Protection and Promotion Act, Regulation 567, pet owners throughout Ontario are legally required to keep dogs, cats and ferrets over three months old vaccinated for rabies. Vaccination not only protects your pet from infection with rabies, but also helps protect you and your family if your pet is exposed to the virus by contact with a wild animal.

Contact your veterinarian for information on when and how often to vaccinate your pets. The first booster vaccine for rabies is always due 12 months after the animal's initial vaccine (this is called the "primary series"), but after that a rabies vaccine ("booster shot") is only needed every one to three years, depending on the vaccine used.

Livestock

Under the Health Protection and Promotion Act, Regulation 567, livestock owners in Ontario are legally required to have horses, cattle and sheep vaccinated for rabies, if the animals have contact with anyone other than their regular caretakers (e.g. animals used in petting zoos, horses used by riding schools or therapy programs, some livestock that go to certain fairs). For more information on whether this requirement applies to your animals, contact your local public health unit. In the case of livestock for which vaccination is not legally required, consult your veterinarian for more information about whether rabies vaccination is still recommended in your specific area.

Wildlife

Since the 1990s, the Ministry of Natural Resources and Forestry (MNRF) has run a very successful wildlife rabies vaccination campaign in Southern Ontario. Raccoons, foxes and skunks are vaccinated using special oral vaccine baits that are scattered on the ground for the animals to eat. The baits are distributed in areas where there is a higher risk for rabies in terrestrial wildlife (i.e. animals other than bats).

There is currently one type of vaccine bait, the Ultra-lite, that is used in Ontario for both fox and raccoon rabies control. Exposure to the bait is not harmful to people or pets; however, in the unlikely event that people or pets come in contact with the vaccine contained in the bait, contacting a doctor or veterinarian as a precaution is recommended.

Because all species of bat found in Ontario are insectivorous (i.e. they only eat insects), they cannot be vaccinated with oral baits. There is currently no effective way to vaccinate bats in Ontario.

Humans

Rabies vaccine (pre-exposure vaccination) is given to people at high risk of being exposed to rabies to help protect them from infection (e.g. veterinarians, animal control officers, laboratory workers). Contact your physician if you believe you should receive pre-exposure vaccination against rabies.

Testing for rabies

In Canada, testing for rabies is only performed at the Canadian Food Inspection Agency rabies laboratories in Ottawa, Ontario and Lethbridge, Alberta. Public health units will arrange for testing when a person is at risk. If a domestic animal is at risk, a veterinarian can arrange for rabies testing, with the assistance of OMAFRA. Generally speaking, testing is only performed if there is a person or a domestic animal that was exposed to the offending animal, in order to rule out the need for post-exposure treatment or monitoring.

The MNRF also performs surveillance testing for rabies in certain areas. This involves testing of suspicious or high-risk wildlife that are found dead or need to be euthanized for other reasons, but that have not had a high-risk contact with a person or domestic animal.

Post-exposure management

The steps taken after a person or domestic animal has been potentially exposed to rabies depend on the results of a risk assessment performed by a health care or animal health professional.

If a person is potentially exposed to rabies, the local public health unit will make recommendations on whether post-exposure prophylaxis (PEP) is required. If possible, the offending animal will be tested for rabies to rule out the need for PEP. However, if testing is not possible, or if testing confirms the animal had rabies, PEP may be recommended depending on the level of exposure. PEP consists of a series of rabies vaccines given on days 0, 3, 7 and 14 following the exposure, as well as a dose of rabies antibodies on day 0. There is a limited supply of PEP available, and the injections are expensive (the cost is covered by public health in cases of exposure), so PEP is only given when necessary after a complete risk assessment.

When a domestic animal is potentially exposed to rabies, your veterinarian can provide recommendations for post-exposure management. A rabies booster vaccination is recommended any time an animal has potentially been exposed, especially if the animal's vaccination status was not up-to-date. If possible, testing of the offending animal will be performed to rule out the need for post-exposure vaccination or monitoring. However, if testing is not possible, or if testing confirms the offending animal had rabies, then an observation or confinement period may be recommended. Observation and confinement periods range from 45 days to 6 months depending on the at-risk animal's rabies vaccination status. Animals that are out-of-date on their rabies vaccinations are considered higher risk and require longer confinement periods. Whenever possible, observation and confinement periods are carried out in the owner's home, if the requirements for restricting contact with the animal can be met.

Rabies Information for Ontario Veterinarians

The content and links below provide rabies response information for veterinarians, including details of risk assessment and sample submission procedures. Members of the public should always contact their veterinarian first if their animal is acting strangely or if there is any concern that the animal may have been exposed to rabies.

• Veterinarians or other animal health personnel with additional questions about rabies response procedures should contact OMAFRA's Agricultural Information Contact Centre at 1-877-424-1300. Requests for assistance with specific cases should be submitted using the online rabies response request form.

When and How to Report a Case of Potential Rabies Exposure

Human at risk

• The exposed individual needs to contact the local public health unit.
• If both a human and domestic animal are at-risk, human exposure always takes precedence. A risk assessment for the exposed animal will occur after public health has addressed the human risk.

Domestic animal at risk (no human exposure)

• The animal owner should contact their veterinarian for a complete risk assessment.
• Veterinarians can contact an OMAFRA veterinarian for assistance with the risk assessment, if needed, by completing the online rabies response request form. If assistance is required to complete the form, veterinary clinic staff can call the Agriculture Information Contact Centre (AICC) at 1-877-424-1300.
• If the offending animal is available and testing is warranted, veterinarians must contact OMAFRA for shipping and laboratory submission information.

Neurological domestic animal suspected of having rabies

• Veterinarian should carefully question the owner about potential exposure to the animal's saliva, as there is almost always some risk that a person or other animal has been exposed (in which case, see above).
• If an animal with signs of neurologic disease dies or is euthanized and rabies is a differential diagnosis, testing will only be recommended if there was exposure of a person or another (live) domestic animal. If there is no risk to other people or animals, testing is done at the discretion and expense of the owner/veterinarian.

Abnormal wildlife with no domestic animal or human exposure

• To report such an animal, contact the Ministry of Natural Resources and Forestry (MNRF) Rabies Information Line at 1-888-574-6656.
• The MNRF performs limited surveillance testing of terrestrial wildlife in certain areas, depending on the time of year. The MNRF is only involved in control of terrestrial rabies and therefore will not test bats for rabies.
• The MNRF will NOT send staff to capture or dispatch an abnormal animal. If the animal is suffering or threatening people or property (including domestic animals), contact the local animal control authority or the police.

Fights between domestic animals (e.g. dog vs. dog)

• No need for further action unless there is reason to believe that one of the animals has or may develop rabies (e.g. an animal with acute neurologic signs, or travel to a high risk area in the last 6 months).
• If a human has been bitten it must be reported to the local public health unit for appropriate follow-up.

What to do if a patient is exposed

The first step following a potential rabies exposure, beyond dealing with the animal's immediate medical needs, is to perform a complete risk assessment. If the assessment indicates a significant risk of exposure, then options for testing and/or post exposure management need to be considered.

Risk assessment information

A basic risk assessment includes 4 primary elements: Category of exposure, offending animal species, local rabies epidemiology, and animal behavior (which needs to be assessed within the context of the incident). Note that the vaccination status of the at-risk animal is not considered at this point - the initial assessment is for the risk of exposure to rabies, whereas vaccination status of the at-risk animal affects the risk of developing rabies. Vaccination status is one of the critical elements in determining post-exposure management of an exposed animal.

Click here for a rabies risk assessment flow-chart to help guide you through the process.¹ For a printable version (PDF), please email ag.info.omafra@ontario.ca.

1. Category of Exposure

The World Health Organization defines 3 categories of exposure based on the potential risk of rabies virus transmission:

• Category 1 - touching, licks on intact skin
• Category 2 - nibbling uncovered skin, minor scratches or abrasions that may have had contact with saliva or higher exposure are considered a risk for rabies virus transmission.
• Category 3 - Transdermal bite(s) or scratch(es) that may have had contact with saliva, licks on broken skin, or contamination of mucus membranes with saliva (e.g. licks)

2. Offending animal species

If the offending animal is a rabies reservoir species in Ontario (bat, raccoon, skunk, or fox), the exposure is considered higher risk. Other wildlife species (e.g. coyotes, groundhogs, muskrats, beavers, opossums, squirrels, rats, mice, chipmunks, rabbits), as well as pets, are of significantly less concern unless the animal is displaying neurologic signs.

3. Local rabies epidemiology

More recent cases of rabies in the area increase the risk of exposure of other animals. Because there are different circulating virus strains, certain reservoir species in some areas are considered higher risk than in others. View details and maps of confirmed cases of rabies in Ontario here. View a table of recent rabies cases by county and animal type here.

• There is a low risk (estimated 2-3%) of rabies in bats anywhere in the province (bat strain rabies)
• Skunks and foxes are of greater concern in northern regions and in Perth county, Huron county and parts of Waterloo Region and Wellington county (fox strain rabies)
• Raccoons are higher risk in the Greater Hamilton Area and surrounding regions, as well as along the border with the U.S. in Niagara and along the St. Lawrence River (raccoon strain rabies)

4. Offending animal behavior and circumstances of the event

Abnormal behaviour increases the likelihood that the offending animal may have clinical rabies and therefore the risk that it could transmit the virus. However, it is important to evaluate the animal's behaviour in the context of the incident. Nocturnal animals are not normally seen during the day, but if disturbed or driven to search for food due to harsh seasonal conditions, they may venture out during daylight hours. Similarly, animals that hibernate such as skunks and bats should not be seen during the winter, but they will come out if disturbed (e.g. bats in the attic of old houses disturbed by renovations). Also consider normal territorial behaviour, defense of young, desensitization of wildlife to humans (e.g. raccoons that appear overly "friendly" may have become accustomed to being fed by people in some urban areas). There could also be other potential causes for abnormal behaviour, such as Canine Distemper (which can affect raccoons, foxes and skunks) or a severe mange infestation.

What to do if a patient is exhibiting signs compatible with rabies

Inclusion of rabies on the differential diagnosis list for an animal with clinical neurological disease requires sound professional judgment. Factors to consider include the following:

• Risk of previous exposure to a rabid animal. In some cases, animal owners may report an observed encounter with wildlife, typically within the last 6 months. The risk of rabies transmission from such an incident should be evaluated according to the risk assessment described above. If there was no observed encounter, it is important to consider the risk of an unobserved encounter. This risk will be higher for animals that are allowed to roam outdoors off leash or entirely unsupervised, particularly in areas where rabid animals have recently been found. Travel to other countries, including some areas of the U.S. where there is a higher level of endemic rabies, is also a risk. Also consider the potential for exposure to bats, even for animals that are entirely indoors.
• Clinical course. Clinical signs of rabies are always progressive, and without medical intervention the vast majority of infected animals will succumb within approximately 10 days of signs appearing. If the animal's clinical course has been waxing and waning, or lasted longer than 10 days, then rabies is unlikely. Animals that have purely spinal neurological deficits are also far less likely to have rabies, although spinal rabies can occur very rarely.
• Vaccination history. Although no vaccine offers 100% protection, modern rabies vaccines are extremely effective. If the animal's vaccination status is, and has been, up-to-date for at least the last 6 months, then clinical rabies is significantly less likely. Remember that if an animal was only recently vaccinated for the first time, or only recently revaccinated following a lapse in the regular revaccination schedule, then the risk is higher, as the animal could have been exposed to the virus earlier while relatively unprotected.
• Other differential diagnoses. If there is another apparent cause for the animal's neurological signs, then rabies is significantly less likely. Consider other differentials such as trauma, neoplasia, sepsis, bacterial or fungal infections, and viral infections (e.g. canine distemper). If rabies is a differential for the animal's condition, the risk of exposure of any or other domestic animals to the patient's saliva, up to 10 days prior to the animal first exhibiting neurological signs or any behaviour change, must be evaluated. If there is potential for human exposure (which is very common in the case of any pet), then the local Public Health Unit must be contacted as well. All reasonable precautions should be taken to avoid further exposure of staff, owners and other animals to the patient's saliva. The animal will not be ordered destroyed by either the provincial or federal authorities assuming it can be safely confined. However, if the animal dies or is euthanized (as decided by the owner), then testing for rabies may be required if there has been a significant exposure.

Sample submission and testing

Rabies testing is performed by the Canadian Food Inspection Agency at laboratories in Ottawa, Ontario and Lethbridge, Alberta.

The required sample depends on the animal species being tested:

• Animals <500g (e.g. bats or small rodents) - send the entire animal
• Animals <100kg (e.g. dogs, cats, raccoons, foxes) - send the entire head, do NOT need to remove the brain
• Animals >100 kg (e.g. livestock) - send the entire brain

The Ministry of Health (MOH) has a contract with the Ontario Association of Veterinary Technicians to have registered veterinary technicians (RVTs) collect and submit samples on behalf of public health units under the OAVT Rabies Response Program (RRP). The program is only used by public health for submitting samples in cases of potential human exposure to rabies.

For cases in which potential domestic animal exposure has occurred, but no human exposure, samples should be collected and shipped by local veterinary or animal control personnel.

• Facilities should submit a request to OMAFRA for assistance by completing the online rabies response request form. If assistance is required to complete the form, staff can call the Agricultural Information Contact Centre at 1-877-424-1300. An OMAFRA veterinarian will call back to review the exposure risk assessment.
• If it is confirmed that testing is warranted, OMAFRA will provide the necessary shipping and submission information. There is no cost to the owner or clinic for shipping or testing in these cases.

In cases where other diagnostic tests or a full post-mortem on a domestic animal are requested, and the animal is sent to the local diagnostic laboratory (i.e. Animal Health Laboratory), the sample for rabies testing can be sent by the local laboratory to the CFIA. In these cases there is no additional expense to the client for sample collection or submission for rabies testing, but transportation to the diagnostic laboratory, post mortem fees, disposal fees and other diagnostic tests are at the expense of the animal owner.

Detailed sample collection and submission instructions and videos are available here, or by contacting OMAFRA through the Agricultural Information Contact Centre (1-877-424-1300).

Post-exposure management

If the offending animal is not available for testing or if testing confirms rabies infection, then post-exposure management options need to be considered. The recommendations provided by OMAFRA are based on previous recommendations used by the CFIA, and currently available scientific evidence. The management recommendations can be enforced under the Ontario Animal Health Act if they are not adhered to voluntarily.

The length of the post-exposure management period depends on the vaccination status of the at-risk animal at the time of exposure, and ranges from 45 days to 6 months. Details on the management recommendations can be found below.

Table 2: Recommended post-exposure management of dogs and cats potentially exposed to rabies, based on vaccination status

Observation Period versus Precautionary Confinement Period (PCP)

General requirements for Observation and Precautionary Confinement Periods

Observation Period

• Minimize the animal's contacts outside of the household
• Dogs are allowed off the property with a responsible age-appropriate handler but must be kept on a leash at all times
• Cats must remain indoors at all times

Precautionary Confinement Period (PCP)

• Animal must remain on the owner's property at all times unless medical attention is required
• Contact with the animal is limited to one age-appropriate caretaker
• No contact with other people or animals
• Dogs can only go outside on a leash and in a fenced area (i.e. double barrier)
• When indoors, the animal must be kept in a secluded area with double-door entry that allows the caretaker to observe the animal before direct contact, and prevents accidental escape

Click here for an example of the recommendations that should be provided to a dog's caretaker for a precautionary confinement period¹. For a fillable pdf version of the PCP recommendations please email ag.info.omafra@ontario.ca.

Post-exposure management - Livestock

Post-exposure management of livestock (cattle, horses, small ruminants) does not depend on the at-risk animal's vaccination status, but rather on the origin of the offending animal.

• If the offending animal originated from outside the herd/flock (e.g. an abnormal fox found in a sheep barn that may have bitten several animals), then a 60-day precautionary confinement period (PCP) is recommended for any potentially exposed livestock.
• If the offending animal originated from within the herd/flock (e.g. a cow within the herd develops neurological signs and rabies is a differential diagnosis), then a 40-day precautionary confinement period (PCP) is recommended for any potentially exposed livestock.

Issues such as use of working animals, use of animal products such as milk, and shipping of animals to slaughter (including cull animals) during the PCP require careful consideration. These are generally evaluated on a case-by-case basis based on consultation between the attending or herd veterinarian and OMAFRA staff. Submit a request to OMAFRA by completing the online rabies response request form. If assistance is required to complete the form, staff can call the Agricultural Information Contact Centre at 1-877-424-1300. An OMAFRA veterinarian will call back to discuss the post-exposure management recommendations.

10-day Public Health observation periods

Any domestic animal that bites a person and is reported to the local public health unit is placed under a 10-day (dogs and cats) or 14-day (most other domestic animals) observation period (Health Protection and Promotion Act, Regulation 557 3(2), (2.1)). If the animal remains clinically normal at the end of this period, then the risk that it could have been shedding rabies virus in its saliva when the bite occurred is negligible, and the victim of the bite therefore does not require post-exposure prophylaxis for rabies. These short observation periods are therefore for the benefit of the human victim. Domestic animals must not be euthanized during a public health observation period, other than for humane reasons. If the animal dies within this time period, the local public health unit must be informed so that rabies testing can be performed. Animals are also not to be vaccinated during a public health observation period. However, the incubation period for rabies in dogs and cats can be up to 6 months; therefore if a pet is the victim of a bite from a wild animal (for example), the recommended confinement period is considerably longer than 10 days.

When to vaccinate

If a client reports a potential rabies exposure of a domestic animal, a complete physical exam and booster rabies vaccination are recommended. Vaccinating an animal post-exposure is based on the same principle as post-exposure prophylaxis vaccination in people, whereby boosting immunity before the virus spreads from the local site of inoculation can help prevent it from reaching the central nervous system. The only time an animal cannot be vaccinated for rabies (other than for a medical contraindication) is when it is under a 10-day public health observation period for biting a person (see above.)

¹ Cette publication hautement spécialisée n'est disponible qu'en anglais conformément au Règlement 671/92, selon lequel il n'est pas obligatoire de la traduire en vertu de la Loi sur les services en français. Pour obtenir des renseignements en français, veuillez communiquer avec le ministère de l'agriculture, de l'alimentation et des affaires rurales au 1-877-424-1300.

For more information:
Toll Free: 1-877-424-1300
E-mail: ag.info.omafra@ontario.ca