Alberta’s Public Health Laboratory (ProvLab) is reporting an increase in requests for rabies serology testing from travelling patients (via their pharmacy teams or physicians) to help assess dosing of the rabies vaccine.
In consultation with the National Microbiology Laboratory, where rabies serology testing is performed, the ProvLab is requesting that samples meet the Public Health Agency of Canada (PHAC)/National Advisory Committee on Immunization (NACI) guidelines for rabies serology testing. The guidelines outline that serology testing in travellers is not required.
Rabies serology testing is only indicated in a few select circumstances:
- post-receipt of an intra-dermal rabies vaccine series or booster,
- post-receipt of a rabies vaccine series or booster in an immunocompromised patient,
- post-vaccination if there have been serious deviations in the planned vaccine administration or unclear quality of vaccine received outside of Canada, or
- routine monitoring of immune status due to a person’s ongoing risk of potential occupational exposure to the rabies virus, including the following:
- those at continuous risk (those who work with rabies virus in a research laboratory or vaccine production center) should check serology every six months; and
- those with frequent risk (rabies laboratory workers, spelunkers, those handling bats, veterinarians, veterinary staff, animal control and wildlife workers in areas where rabies is enzootic) should be checked every two years.
The following are situations in which rabies serology testing is NOT routinely indicated:
- individuals who have less frequent risk to potentially rabid animals or whose risk is likely to be from a recognized source, and
- travellers to enzootic areas (i.e., areas where a disease is constantly present in animal populations within a specified area, but usually only affects a small number of animals at any one time).
For patients who may have rabies virus exposure from an animal or bat bite, it is imperative the evaluating clinician consult with the Medical Officer of Health (MOH) on-call in your provincial zone to have the patient assessed for need of rabies post-exposure prophylaxis. Timeliness of this consultation is important. Routine rabies serology testing in this situation is NOT indicated.
Pharmacy teams, please note that all rabies serology requests are reviewed by the Microbiologist/Virologist-on-call (MVOC) at the ProvLab. Requests that do not meet indications, as outlined in the NACI/PHAC guidance, may be cancelled.
For guidance on rabies vaccination, please refer to the ‘Rabies Vaccines’ section from the PHAC/NACI guidelines (link above).
For more information, refer to the Alberta Precision Laboratories bulletin.