In Ontario, rabies post-exposure prophylaxis (RPEP) is recommended for administration approximately 2,000 times annually. Appropriate use of RPEP is important because the cost of rabies vaccine, rabies immune globulin, and other associated health care costs are substantial. Over the past three decades, the number of courses of RPEP administered in Ontario has not decreased consistent with the marked decrease in animal rabies cases (Middleton et. al., 2014). This prompted a review of the reasons why RPEP was being administered, using data from the integrated Public Health Information System (iPHIS) (Middleton et. al., 2017). Findings from the study revealed that the number of RPEP courses administered could be reduced by applying a risk assessment approach for certain exposures. This presentation will provide additional context to assist with understanding excess RPEP administration and support the use of a risk assessment approach.
By the end of this session, participants will be able to:
• Understand the relationship between rabies reservoir species, bridge vectors, and transmission of rabies to humans.
• Describe the relationship between the number of RPEP courses administered and the number of animal rabies cases in Ontario over time.
• Understand the variation in public health unit RPEP administration rates compared to reported animal rabies cases.
Presenters: Dr. Dean Middleton and Dr. Bryna Warshawsky
Dr. Dean Middleton is an Epidemiologist Specialist at Public Health Ontario. Dean joined Public Health Ontario in 2009, after working at the Ontario Ministry of Health and Long-Term Care for ten years. During these years, Dean has maintained a strong interest in rabies in Ontario.
Dr. Bryna Warshawsky is the Medical Director of the Communicable Diseases, Emergency Preparedness and Response Department at Public Health Ontario. Prior to joining Public Health Ontario in 2014, she was the Associate Medical Officer of Health for the Middlesex-London Health Unit. She is also cross-appointed in the Department of Epidemiology and Biostatistics at Western University, and a past Chair of the National Advisory Committee on Immunization.
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