MEMO: Rabies Immune Globulin (RabIg) Sparing Protocol is Discontinued

TO: Health Care Professionals in the Niagara Region

FROM: M. Mustafa Hirji, MD, MPH, FRCPC, Medical Officer of Health and Commissioner (Acting)  

REFERENCE: Rabies Immune Globulin (RabIg) Sparing Protocol is Discontinued

DATE: Dec. 19, 2019  

Background

• Following the Canadian human rabies case from a bat exposure in July, the usage of rabies immune globulin (RabIg) increased significantly, resulting in a RabIg shortage within Ontario and across Canada
• A RabIg-sparing protocol was subsequently implemented to ensure product availability for all cases requiring rabies Post-exposure Prophylaxis (PEP)
• The provincial supply of publicly funded rabies vaccine and RabIg was replenished in September 2019 and has since remained stable

Discontinue RabIg-Sparing Protocol

• Given the stabilization of product supply, the administration of RabIg should now revert to regular practice using the current recommendations by the National Advisory Committee on Immunization (NACI)
• Regular practice includes that if it is not anatomically feasible to infiltrate the entire dose of RabIg into the wound/contact site, then the remaining volume of RabIg should be injected, using a separate needle and syringe, intramuscularly at a site distant from the site of vaccine administration

Notification & Further Information

• Please continue to report all rabies concerns immediately to Niagara Region Public Health & Emergency Services (NRPH&ES) by phone (during business hours at 905-688-8248 ext. 7590 and afterhours at 905-984-3690) and fax (905-641-4994)
• NRPH&ES staff are available to assist in the risk assessment to determine if a vaccine and RabIg needs to be dispensed

For further information, please contact the Environmental Health Division Duty Officer at 905-688-8248 ext. 7590 during business hours of Monday to Friday, 8:30 a.m. to 4:30 p.m.