Post-Exposure Anti-Rabies Treatment and Vaccine Distribution

Policy

Category: Rabies
Subject: Post-Exposure Anti-Rabies Treatment and Vaccine Distribution
Division: N/A
Policy Number: CA.81.01.106
Effective Date: January 17, 2013

POLICY STATEMENT

It is the policy of Wellington-Dufferin-Guelph Public Health (WDGPH) to have the Medical Officer of Health (MOH) or designate available on a 24/7 basis to receive and respond to reports of suspected rabies exposures in accordance with the Health Protection and Promotion Act and the Rabies Prevention and Control Protocol (2009 or as current).  The Public Health Inspector (PHI) will review all reports of animal bites.  All human exposures will be risk-assessed and significant exposures will be managed by providing the requesting physician with post exposure prophylaxis (rabies vaccine and rabies immune globulin [RabI]).  The Health Protection Division will ensure that individuals requiring rabies post exposure prophylaxis will have access to rabies vaccine and RabIg within 24 hours.

It is also the policy of WDGPH to maintain a reserve stock of rabies vaccine and RabIg in all area hospitals.

SCOPE

This policy applies to all PHIs and On-Call Managers who provide 24/7 Health Unit coverage and may need to dispense rabies vaccine and/or RabIg.

DEFINITIONS

Rabies Vaccine: 

Two rabies vaccines are currently marketed for active immunization of humans in Canada:

  • Imovox Rabies, Sanofi Pasteur Ltd.; and
  • RabAvert, Merck Frosst.

Rabies Immune Globulin: 

Two human rabies immune globulin (RabIg) products are approved for passive immunization in Canada.  RabIg provides rapid protection that persists for only a short period of time (about 21 days).

  • HyperRAB, Talecris Biotherapeutics Ltd.; and
  • Imogam, Sanofi Pasteur Ltd.

RESPONSIBILITIES

Directors will:
  • Ensure divisional policies and procedures are implemented across the Health Protection Division;
  • Ensure any dispensing errors are reviewed to understand causes and implement quality improvements; and
  • Review the Medical Directive CA.40.01.116, Dispensing Rabies Vaccine and/or Rabies Immune Globulin (RabIg) related to this policy with the MOH and the Rabies Program Manager on an annual basis.
Program Manager (Rabies) will:
  • Be responsible for training all new employees who will be responsible for dispensing rabies vaccine and RabIg on the Medical Directive CA.40.01.116, Dispensing Rabies Vaccine and/or Rabies Immune Globulin (RabIg),  all policies and procedures related to the Rabies Program (CA.81.01/02.101-103), and CA.70.01/02.300 Vaccine Storage and Handling;
  • Assist employees with any questions related to implementing the related policies, procedures or medical directive; and
  • Implement an auditing procedure to ensure compliance with the Medical Directive and related policies and procedures.
PHI’s and On-call Managers are responsible to:
  • Follow the Medical Directive CA.40.01.116, Dispensing Rabies Vaccine and/or Rabies Immune Globulin (RabIg) and all policies and procedures related to dispensing Rabies Vaccine and RabIg;
  • Follow policy and procedure CA.70.01/02.300 Vaccine Storage and Handling
  • Follow Privacy policy and procedure CA.58.01.102 Personal Health Information Protection Act (PHIPA) for protecting confidential information; and
  • Follow policy and procedure CA.50.01/02.101 Documentation Practices

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Procedure: CA.81.02.106   Post-Exposure Anti-Rabies Treatment and Vaccine Distribution
CA.40.01.116 Dispensing Rabies Vaccine and/or Rabies Immune Globulin (RabIg)
CA.50.01.101 and CA.50.02.101 Documentation Practices
CA.58.01.102 PHIPA
CA.70.01.101 and CA.70.02.101 Vaccine Storage and Handling
CA.81.01.101  Notification of Animal Human Exposure
CA.81.01.102  Biting Incidents Reported After Business Hours
CA.81.01.103 Follow-Up Investigation
Health Promotion and Protection Act
Rabies Prevention and Control Protocol, 2009
Vaccine Storage and Handling Protocol
MOHLTC Guidelines for Management of Suspected Rabies Exposures, January 2010
Canadian Immunization Guide (7th Edition, or as current): PHAC www.naci.gc.ca

APPROVED BY

Rob Thompson  


Procedure

Category: Rabies
Subject: Post-Exposure Anti-Rabies Treatment and Vaccine Distribution
Division: N/A
Procedure Number: CA.81.02.106
Effective Date: January 17, 2013

PROCEDURE

  1. When the rabies investigation appears to warrant the issuance of rabies vaccine or when a specific request for vaccine has been received from a physician, the Public Health Inspector (PHI) will consult with the Rabies Program Manager.
  2. If the animal cannot be located within 48 hours after the time of exposure, vaccine should be recommended to the person exposed.  Forego the 48-hour period if wildlife is involved and cannot be located.
  3. If the animal is rabid or suspected of being rabid or the bite was to the head and/or neck, the PHI shall release rabies vaccine immediately.  If the bite is to the head and/or neck, a risk assessment of the bite can be performed in accordance with the Ministry of Health and Long Term Care (MOHLTC) Guidelines, 2010.
  4. The correct does of immune globulin (# packages of RabIg) is calculated according to the Canadian Immunization Guide (20 IU/kg body weight).
  5. Either the Vaccine Coordinator, PHI, or On-Call Program Manager shall prepare the rabies vaccine order and include the fact sheet Rabies Vaccine and Immune Globulin (HPDRAB(FS)4) with the vaccine order.  The PHI, or On-Call Program Manager will complete the Rabies Post-Exposure Prophylaxis (PEP) Receipt Verification Form (HPDRAB(F)7). During regular business hours, Monday to Friday 8:30 a.m. to 4:30 p.m., the Rabies Post-Exposure Prophylaxis Receipt Verification Form must be co-signed by a PHI, PHN or Program Manager from Health Protection or a Public Health Nurse (PHN) from the School Health or Clinical Services teams from Community Health to confirm and verify the correct medication is being dispensed. 
  6. The cold chain must be maintained according to the policy and procedure CA.70.01/02.300 Vaccine Storage and Handling, and in accordance with the Vaccine Storage and Handling Protocol. The vaccine must be transported according to the procedure CA.70.01.300 Vaccine Storage and Handling using an insulated bag and delivered to the physician’s clinic by a PHI, the On-Call Manager or designate.
  7. The PHI/On-Call Manager must review the post exposure prophylaxis with the receiver to verify the correct product and dosages are being supplied.  The person receiving the vaccine/RabIg signs the form to confirm receipt of the correct amounts of vaccine and/or RabIg.
  8. The Vaccine Coordinator, PHI and any co-signer are responsible for checking expiry dates on rabies vaccine/RabIg prepared for dispensing.  The Vaccine Coordinator is responsible for ordering new vaccine/RabIg as required.   (Note: rabies vaccine expires at the end of the month noted on the package.)
  9. The copy of the completed rabies PEP Receipt Verification form will be send immediately to the Rabies Vaccine Clerk in the appropriate office for inventory and iPHIS.  Final reports will be entered into iPHIS via the Program Assistant.

REFERENCES AND RELATED FORMS, POLICIES AND PROCEDURES

Corresponding Policy:  CA.81.01.106  Post-Exposure Anti-Rabies Treatment and Vaccine Distribution
CA.40.01.114 Prescribing, Dispensing, Selling and Administering of Pharmaceutical Products
CA.40.01.116 Dispensing Rabies Vaccine and/or Rabies Immune Globulin (RabIg)
CA.50.01/02.101 Documentation Practices 
CA.58.01.102 PHIPA
CA.70.01/02.300 Vaccine Storage and Handling
CA.81.01.101 Notification of Animal Human Exposure
CA.81.01.102 Biting Incidents Reported After Business Hours
CA.81.01.103 Follow-Up Investigation
Rabies Vaccine and Immune Globulin (HPDRAB(FS)4)
Rabies Post-Exposure Prophylaxis (PEP) Receipt Verification Form (HPDRAB(F)7)
Rabies Post-Exposure Prophylaxis Receipt Verification Form
Health Promotion and Protection Ace
Rabies Prevention and Control Protocol, 2009
MOHLTC Guidelines for Management of Suspected Rabies Exposures, January 2010
Canadian Immunization Guide (7th Edition, or as current): PHAC www.naci.gc.ca

APPROVED BY

Rob Thompson