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The Dose Transcript for October 17, 2024

Host: Dr. Brian Goldman

BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. ER physicians like me see lots of patients who've been bitten by an animal and fear they've been exposed to rabies. Despite that, in Canada, rabies cases and deaths are exceedingly rare. For decades, the only domestically acquired cases have come from exposure to bats. And that is exactly what happened recently to an Ontario child who caught rabies and died from it, prompting a lot of anxiety. So this week we're asking: What do I need to know about rabies? Hi, Isaac. Welcome back to the Dose.

DR. ISAAC BOGOCH: Thanks for having me back on, Brian.

BRIAN GOLDMAN: Hi, Scott. Welcome to The Dose.

DR. SCOTT WEESE: Thanks for having me.

BRIAN GOLDMAN: Isaac, have you ever seen a case of rabies in a hospital?

DR. ISAAC BOGOCH: I have. There was a case of rabies in Ontario years before the pandemic. It was acquired outside of Ontario. Sadly, this individual got ill. He had travelled back to Ontario. It was picked up by a very astute clinician, transferred to the hospital I was working at at the time, and unfortunately, this person succumbed to this illness.

BRIAN GOLDMAN: And was that case acquired in Canada or from travel to another country?

DR. ISAAC BOGOCH: No, it was acquired outside of Canada.

BRIAN GOLDMAN: That's probably where most of the experience of physicians who treat humans who've been exposed to rabies are going to see their cases. Scott, rabies is just slightly less rare in animals. Have you seen a case?

DR. SCOTT WEESE: Yeah, I have. And I've actually had one in my house. I had a rabid bat in my house once. [BRIAN: Wow.] So I've got personal experience with this, yeah.

BRIAN GOLDMAN: Fortunately, it didn't bite anybody in the house.

DR. SCOTT WEESE: Well, we didn't really know. That was the era when we considered a bat in the house to be exposure. So we did have the whole family and all the animals considered exposed, but didn't have any known bites.

BRIAN GOLDMAN: So does that mean that everybody in the household had to be, had to get rabies vaccinations?

DR. SCOTT WEESE: Yeah, the whole family. Plus, we happened to have some visitors over at the same time. It was a, [chuckles] it was a bit of a mess, but it kind of shows why we've got the response to rabies and also shows a lot of things we need to consider when it comes down to who actually is exposed.

BRIAN GOLDMAN: So interesting. This is, this is a disease where it's rare, but you better jump on it because it's basically 100% or almost 100% fatal. We're getting ahead of ourselves. This is a great conversation we've already started. But before we begin, I'm going to ask each of you to give us a hi, my name is. Tell us what you do and where you do it. Just ad-lib. Isaac, you go first.

DR. ISAAC BOGOCH: Hey, my name is Isaac Bogoch. I'm an infectious diseases specialist based out of the Toronto General Hospital.

BRIAN GOLDMAN: Scott, you're next.

DR. SCOTT WEESE: Hi, I'm Scott Weese. I'm kind of the veterinary version of Isaac. I'm an infectious disease vet at the Ontario Veterinary College in Guelph.

BRIAN GOLDMAN: And this is our first panel on The Dose. I'm excited. Scott, let's start with you. From the veterinary medicine perspective, what is rabies?

DR. SCOTT WEESE: Well, rabies is a disease caused by a rabies virus. And it's, it's an interesting one, and it's almost invariably fatal, like you said, but it's almost completely preventable if we identify the risk. Now, this virus is out there in various mammal species. It can affect any mammals, and that includes us, but we have a variety of reservoir species. And in Canada we focus on bats, obviously. Skunks, foxes, raccoons, as examples. We have dog rabies as a big problem internationally. And it circulates in those species and sometimes spills over into other species, including people, through a bite.

BRIAN GOLDMAN: Okay, since you've already started to talk about the animal species, if I had a buck for every patient who comes to the emergency department saying that they've been bitten by a rodent or by a squirrel, by a chipmunk, and saying, could they have rabies, I'd be rich. Can you get rabies from rodents? Can you get it from squirrels? Chipmunks?

DR. SCOTT WEESE: Well, one of the big challenges we have with rabies is that... you know, an infectious disease in general, it's hard to say absolutely no. But your bite from a squirrel, your bite from a mouse, the risk is exceptionally low toward zero. Because what has to happen is that squirrel has to have been bitten by a rabid animal, and the squirrel has to survive that to take time to develop rabies. And most of the time, if your squirrel or mouse has an encounter with a rabid animal, the squirrel or the mouse isn't going to come out of that alive. So we're worried about species that are bigger, that are able to either be reservoirs or that are able to survive an encounter with a reservoir, and then have contact with us. So it's one of these situations we have to have these discussions, right. You know, there's-- is there a theoretical risk? Yes. Is there a real risk? No. And that's a tough communication point.

BRIAN GOLDMAN: Isaac, over to you. What are the symptoms of rabies in humans?

DR. ISAAC BOGOCH: Rabies is basically the most lethal virus on the planet. About 100% of people that get the virus will succumb to this illness. It's terrible. And, you know, I think to the points that were raised earlier, while it's still rare in Canada, of course it can happen. But it's not as rare globally. There are about 60,000 deaths from rabies per year globally, most of them in Africa and Asia. When people get rabies, there's a couple of classic symptoms. Firstly, they have to have the appropriate exposure, which I'm sure we'll get into. But that's basically either a bite, a lick, a scratch with the saliva contaminated... anything that saliva contaminated. And it gets into, you know, a human host. It travels up through the peripheral nervous system and it gets into the central nervous system and starts causing symptoms. The initial symptoms are non-specific: you know, fevers, chills, sometimes headaches, sometimes muscle aches and pains. But then, you know, one of two syndromes will develop. One's called encephalitic rabies. The other, less common kind is called paralytic rabies. Encephalitic rabies in non-human animals is referred to as furious rabies, but the final common pathway, sadly, is coma and death. But there are some classic symptoms and signs of this. One that's pretty unique is called hydrophobia, where if you put, for example, a glass of water up to someone's face and ask them to drink, they will have an intense, visceral, negative reaction towards that: muscle spasms of the pharynx, muscle spasms of the diaphragm. I mean, you just don't see that with other infections. Another related symptom is called aerophobia, which is less common than hydrophobia. But a puff of air, a wind, a breeze, will also precipitate that visceral negative reaction. You're going to have muscle spasms as a result of that. Sometimes people will have this agitation. They might be combative. They might have contraction of facial muscles. Like, it's an, it's an awful disease, but ultimately it leads to coma and death. The less common type of manifestation in humans is paralytic rabies. In non-human animals, it's referred to as 'dumb rabies'. And that's a flaccid paralysis that might ascend through the body, and ultimately, the muscles involved with breathing are impacted and people succumb to that as well.

BRIAN GOLDMAN: Do we know why those symptoms of hydrophobia and aerophobia exist?

DR. ISAAC BOGOCH: So here's where the neurologists are going to call me and yell at me. But here's the short answer is: those are parts of the brain stem that are heavily involved with breathing and respiration. And when those become involved, you'll start to see those impacts. I'm sure I'm going to get some detail wrong on this and here comes some angry emails from some very smart neurologists.

BRIAN GOLDMAN: I know a lot of neurologists and, and I'm sure they're going to be listening very, very carefully. [Isaac laughs] Certainly if you look at the frequently asked questions that are put out by public health, they cite, 'an animal whose behaviour has changed or is behaving oddly.' As a doctor of veterinary medicine among us, can you tell us what that looks like?

DR. SCOTT WEESE: Well, that's a flag. It's not a guarantee. So with rabies, what happens, you get infected with this virus, it gets into your nerves, it goes to your brain. Then it starts to come out in your saliva. So when they're infectious and shedding the rabies virus, it's fairly late, but there's not a guarantee that they're abnormal at that point. So an animal looking normal isn't a 100% guarantee it's not rabid. On the flip side, an animal looking abnormal, there are lots of things that will make the animals look abnormal, but it does raise a lot of concern. So what we're worried about is, for wildlife's... examples would be: animals that have lost their fear of people. So, the animal that would normally run away when you see it, it starts approaching you. Or doesn't go away or looks depressed. It's just a behavioural change, an attitude change. With a domestic animal, a dog, it might be that they've become more depressed, they've become weaker, they're drooling, or they get very aggressive. So essentially it's a change from what we would expect. If it's someone's own animal and they're developing signs that just aren't them, that's something we would flag. But for wildlife in particular, it's animals that would be aggressive when they wouldn't normally be aggressive or approach us when they wouldn't normally do that. And that's a bit of a challenge because we conditioned some of these behaviours, right? If you're feeding a raccoon all the time in your backyard, yeah, that other raccoon's going to lose its fear of people. That's not a sign of rabies. That's a sign it likes food. You know, if you corner an animal, it's going to get aggressive because that its, you know, fight or flight response. So this is why we need to do investigations, when there are exposures, to look at the circumstances and figure out, okay, was that animal doing something normal or was this maybe a higher risk situation.

BRIAN GOLDMAN: Statistically speaking, Scott, which animals are the main sources of rabies in Canada?

DR. SCOTT WEESE: There's something to consider when it comes to wildlife. So one of the things is like I said before: we don't test all wildlife. We really have little idea what the prevalence of rabies virus is there. Because most animals that have rabies, you know, they're going about it in the bush; they get sick and they die and we never see them or we never test them. So our testing is really biased towards species and situations where we encounter them. Because we're going to test an animal typically when they've bitten a person. So, that-- there's some bias there. But if we look at what animals have rabies most often, most likely it's bats. Bats are really well disseminated internationally. In Canada, we've got them across the country. Rabies is an ever-present risk there. It's a low percentage of bats, but because there are so many bats and they can get it in human environments, you know, that's a concern. Other wildlife species, raccoons -- we have raccoon rabies in a couple parts of Canada, where the rates within local groups can be really high. We have fox rabies in parts of Canada. So the, these different areas where you have different strains or variants that can be more dense. But overall, your average wildlife encounter, the odds of that animal having rabies would be very, very low. With an almost invariably fatal virus, though, very low isn't the threshold we like.

BRIAN GOLDMAN: Isaac, why is it so rare-- even rarer that humans get rabies in Canada?

DR. ISAAC BOGOCH: There's a lot that goes into this. And obviously I'll lean heavily on Scott when we talk about vaccination of non-human animals, both domestic and wild. But for one thing, there's just less of a pool of animals with this virus in Canada, and more importantly, fewer human interactions with rabid animals in Canada versus other parts of the world. So, for example, we started collecting data in Canada on human rabies in 1924. And since 1924, there have been 28 rabies-related deaths in six provinces in the country. That's how rare this is. Obviously, we're talking about this tragic case in Ontario from this year that was a bat exposure. The other, more recent one, sadly, was a teenager in British Columbia in 2019 that was a bad exposure. But again, it is rare. But of course, it's extremely important to know that it's still here, there are still potential exposures, and here's what you can do if there is an exposure to actually prevent clinical rabies because we know it's invariably fatal.

BRIAN GOLDMAN: Scott, I want to get back to you. In my work as an emergency physician, it was told to me a long time ago, and I can't tell you how many times I have fed it back to patients who are nervous, for instance, about a dog bite or a cat bite, that I was once told that it is almost impossible for a domesticated dog or cat in Canada to give you rabies. Scott, am I right?

DR. SCOTT WEESE: Well, it's really rare, but it's definitely possible, and there are a few reasons for that. One, we don't have canine rabies variants. So it's a strain of rabies virus that circulates really effectively in dogs. We've eliminated that from Canada, the U.S., Mexico. And that's what kills that 50- to 60,000 people a year that Isaac mentioned. It's almost all from dogs because it's circulating around. And the issue with dogs is, you may have a bunch of bats that are rabid and a bunch of dogs that are rabid. We're at much greater risk from the dogs because they have close contact with us. So, dogs can get rabies, cats can get rabies. They can still get that in Canada because even though we don't have circulating dog rabies, dogs are susceptible to the other variants. So a dog that encounters a raccoon, a cat that goes outside and catches a bat -- those can be rabid. It's really rare because we don't have that many exposures, and we have, you know, reasonable vaccine coverage. But if you look at Ontario, we had two rabid dogs within the last few years, and these were imported dogs. So they came from Iran, they were infected before they got here, and it took a few months before they developed signs of rabies. So your average encounter with a dog is really, really, really low risk for rabies. But again, really, really, really low isn't where we want to stop with an almost invariably fatal infection. So it's important to consider that, yeah, the risk is really low, but we still have to pay attention to it and figure out if there was any risk. And there are some things that we can do with our domestic dogs to rule out rabies fairly effectively. We just need to make sure that people identify the risks so we can start down that pathway.

BRIAN GOLDMAN: Okay. Let's get to the whole prevention and treatment piece. Isaac, I have been bitten by a suspicious animal. What should I do next?

DR. ISAAC BOGOCH: The first thing to do is acknowledge that you've been bitten, or even potentially bitten or potentially exposed to a non-human animal. Obviously, rabies is front of mind for many people in the general public and, of course, for health-care providers. But there's a whole, whole lot of other things that need to be considered beyond rabies as well. So, the key thing here is if there is an animal bite, it's important to go seek medical attention. It's not really for, you know, that person at that time and place to determine is this a rabies exposure, yes or no? You know, maybe some people are savvy and can figure it out. But this is often something that's best done with a health-care provider.

BRIAN GOLDMAN: It's not beyond the scope of my practice as an emergency physician. We want to see people who have had animal bites and scratches because the saliva of dogs and cats, for instance, contain all manner of germs that can cause some very serious infections that are a lot more treatable the earlier you get to medical attention.

DR. ISAAC BOGOCH: I would add humans to that as well. I mean, we see human bite wounds, [chuckles] um, regularly, and man, those can get infected and they can be really bad. So, animals have lots of bacteria in their mouth. Sometimes the bacteria is pretty specific to the animal. Here's some funny names. You know, cats typically carry a bacteria called Pasteurella. Dogs carry another specific bacteria. Rats carry a very specific bacteria, and if they bite you, you can get an infection. You got to know that that can happen and get care.

DR. SCOTT WEESE: Yeah, can I jump in really quick? I think you got a really-- really good points there. And I think this is where some of the confusion sets in on what needs to be addressed, when. Right? Like, the big obvious dog bite you're going to see because someone's worried about the trauma. And you get to address, you know, the infection risk, you get to address the rabies risk. And that's something people are going to go to a health-care provider, hopefully, right away. Where we fall apart from the rabies side [indistinct] these minor bites. So, you got a little nip or you don't really realize there's a bite, and something that you don't need to get addressed as a wound or at least is lower risk as a wound. But if there's anything that breaks the skin, that's a potential rabies exposure. So, we've got kind of various things we need to be thinking about in terms of when and how people get care. I think that gets confusing sometimes. The other thing -- I like the comment about the cats, you know, the indoor cat. And this is actually a message that we have to get out to people. Just because your cat's indoor, doesn't mean there's no risk of rabies. And there are two sides of that. I often say, indoor cat, that's kind of aspirational, not necessarily what happens. Because you'd be surprised how many indoor cats we see that are hit by cars or tangle with wildlife -- because they sneak out. And the other aspect of that is, well, the cat may not go outside, but like I saw with my house, the bats can get inside. So if your bats never left the house, the bat comes in, there still is the potential of rabies exposure there. So your cat that tangles with wildlife certainly is much higher risk, but your indoor cat isn't zero risk.

DR. ISAAC BOGOCH: Yeah, I think Scott brings up a great point here, in the sense that this is the business of, you know, risk assessment and risk mitigation. And just like in medicine and in life, nothing's 100 or 0%. People want 0%, but you're never going to have 0%. But obviously, some, some exposures are far closer to zero than others. And again, to Scott's point, even a minor scratch or a lick or a potential exposure to saliva from an animal that could potentially carry rabies, for example, a bat. I mean, those are all very serious exposures. So even if it's not an overt bite from a bat, but, you know, a bat flies by and hits you or it nicks you, that's a serious issue. So even though the injury itself might be negligible or minor, that's a potential exposure and that needs to be dealt with urgently. But obviously that's a lot different from a domestic cat that you play with that's behaving completely normally where you accidentally get the same degree of injury -- that tiny little scratch or a nick. The risks are completely different from those two exposures where the injury might be identical. But the animal and the epidemiology of the risk is obviously very different.

BRIAN GOLDMAN: And just to underscore the risk of bats since both of you have talked about it: if you wake up from your slumbers and you discover a bat in your midst, assume that you've had direct contact with it and seek medical attention.

DR. ISAAC BOGOCH: I would.

DR. SCOTT WEESE: Yeah, and this is a tough area because that used to be the rule. And now there's a more risk assessment-based approach. So, you look at, you know, how long was the bat? What were the circumstances? Could the person report a bite? Can you inspect that person to find a bite? Realizing that bat bites are really small and can be missed. So, we're not in the era anymore where there's an automatic 'bat was in a household overnight -- we consider this exposure.' It gets you into a fairly complex risk assessment. And a lot of this comes down to, I think, the personal degree of, you know, how, how concerned are you and how risk averse are you? And there's always going to be a default to post-exposure prophylaxis, the treatment that we give. But this is, like Isaac said, it's a risk assessment. Whether it's a dog or a bat or whatever, we need to get that entry point to public health so they can do the risk assessment to figure out if there was a realistic risk of exposure. Because some of these are really clear. You know, a raccoon runs out of the brush, bites you in the leg and runs off -- that's exposure for sure. You know, the bat flies into your house, flies right back out. You don't touch it -- that's not exposure. But there are so many different grey areas in between, especially when it comes to did a bite break the skin? Where was saliva flying? Were there scratches that might have driven saliva? There's a lot more to it than just a, you know, a two-line flowchart that says yes/no at the end.

BRIAN GOLDMAN: But we're not saying that people listening to this should do their own risk assessment. They should go to public health and let public health do the risk assessment.

DR. ISAAC BOGOCH: That's exactly it. I think, like, that-- to your-- you gave an example of you woke up and there was a bat in the room. Okay. That, that's a great example. And, you know, the outcomes might be very different for different scenarios. You know, if the person in the room is a child, they can't give a history because they're too young or they can't explain, they don't have the capacity to explain everything that happened. That's very different from an adult, who perhaps was awake the entire time the bat was in the room and knows for sure that there was no direct contact with the bat. But if someone was... woke up and there's a bat in the room, and there's a period of time where they're not sure if the bat was on their face or, you know, if there was even a bite... again, I'm not saying what's going to happen with post-exposure prophylaxis or not. That goes back to the risk assessment that you both were talking about. But I think it's still very worthwhile to have that conversation with a health-care or public health specialist to [indistinct] undergo that risk assessment, to see if post-exposure prophylaxis is the right thing.

DR. SCOTT WEESE: And that's really the key, I think, the awareness piece. And that's where rabies cases happen in North America. They happen because the risk wasn't recognized. Like, we've got excellent ability to prevent rabies once public health knows. For me, every rabies case in North America is a public health failure. Not because public health screwed up, [but] because globally, we didn't have enough education out there. Once you identify there was a potential problem and someone goes to public health, then you should be well taken care of. It's getting people to realize that the bite might have happened, the exposure might have happened, who to talk to, and getting that done.

BRIAN GOLDMAN: Isaac, it's now deemed that this bite is suspicious and there's a significant risk. What's the regime to vaccinate people?

DR. ISAAC BOGOCH: The first question is: have you had rabies vaccinations in the past, yes or no? That's often the first branch. Most people have not had rabies vaccinations in the past. There's going to be a few exceptions, right? Veterinarians, people that work or travel to rural, remote underserviced areas. We're not talking about people with prior vaccination to rabies. So, if someone has no prior vaccination to rabies, they've had an exposure, it's deemed to be an exposure, you're likely going to get two different products. For starters, hopefully you're coming to care earlier rather than later, but there's no statute of limitations. You can come in one minute after the exposure or two weeks after the exposure. You're still going to get these products. Product one is called rabies immunoglobulin, and that's typically injected right into the wound if there's a bite wound. If there's no obvious bite wound, it'll be injected into the muscle. And the second product people will receive is a rabies vaccination that's given intramuscularly into the deltoid muscle like routine vaccines are.

BRIAN GOLDMAN: And Scott, you've been bitten by an animal. How important is it that the animal is isolated so it can be tested for rabies? Scott, why don't you tackle that one.

DR. SCOTT WEESE: So, if someone's been bitten by an animal or maybe bitten by an animal, identifying the animal is the first step, and then observing them is what we want to do if they're a dog or a cat. So if you've been bitten by a dog, let's say it's the neighbour's dog and you're bitten, and we realize it's going to be really, really low risk but we want to be certain, then we can observe that dog for ten days. If at the end of ten days that dog is neurologically normal, it could not have been shedding rabies virus at the time of the bite. So you don't need post-exposure prophylaxis, or if you've started it, you can have the discussion of whether to stop it. If it's a wild animal, it's a little bit different because we can't just observe them, because we don't have the same confidence in what time period they're going to become abnormal. So with wildlife, if they're accessible, they're often going to be euthanized and tested. And if they're negative -- through testing of their brain -- then the same thing, we don't have to worry about rabies exposure there. Now, are they always available? That's a bit of a challenge with wildlife. And even with dogs and cats, sometimes it's a challenge because people will have an encounter in a park, for example. They're bitten and then they don't realize that is an issue until they go to public health or go to their physician, and then they're scrambling to figure out who was that dog? Who do I contact? Because if I can't rule out rabies, we have to assume there might have been a risk.

BRIAN GOLDMAN: And Scott, how can we best protect ourselves against other animal bites?

DR. SCOTT WEESE: Well, I think the big thing for preventing bites is just staying away, right? If you're not within biting distance of an animal, it's not going to bite you typically. You know, you can't always prevent things. The dog comes running up and bites or the, the strange wildlife you corner by mistake. But it's a matter of, for wildlife, staying away from them, not trying to domesticate them. You know, raccoons are really curious, they're really cute. But we're best to watch somewhere from a distance. When people start feeding them, that's when they start getting closer and you start to get nipped in the finger when you've been feeding the raccoon. If you've got, you know, an area where there's a deck, where there are critters living underneath it, there are things we can do to discourage them from living around us, keeping food covered. So we want to provide more separation between us and wildlife physically as much as possible. And then with our interactions, we want to avoid things that will bring us in direct contact with them. When it comes to our domestic animals, a lot of that is just proper supervision and education of kids who bear the brunt of a lot of things. And bites are a good example of that. So, making sure kids are behaving properly and they know how to interact with a dog. Making sure that dogs are trained properly and supervised properly. Dogs are prone to bite, you know, if they're scared or if they're startled. Um, are managed so that we reduce the risk of that.

BRIAN GOLDMAN: So the bottom line here is that we need strong animal surveillance, strong public health. But rabies was, is and remains a rare condition that with prompt recognition of the risk and prompt vaccination, is substantially predictable, is substantially preventable. And I want to thank the two of you, Dr. Isaac Bogoch, Dr. Scott Weese for coming onto The Dose to talk about this very important subject of rabies.

DR. ISAAC BOGOCH: Yeah, my pleasure.

DR. SCOTT WEESE: Yeah, thank you.

BRIAN GOLDMAN: Dr. Isaac Bogoch is an associate professor in the University of Toronto's Department of Medicine, and an infectious diseases specialist and general internist at the Toronto General Hospital. Dr. Scott Weese is a veterinary internal medicine specialist, professor in the Department of Pathobiology, director of the Centre for Public Health and Zoonoses, and chief of infection control in the Health Sciences Centre at the University of Guelph's Ontario Veterinary College. Here's your dose of smart advice: Rabies is a highly dangerous viral infection that humans can get from infected animals. Rabies is found worldwide, but it's rare in Canada. The disease is more common in developing countries where stray animals, especially infected dogs, live close to humans. It is spread through close contact with the saliva of infected animals. Typically, that means a bite or a scratch, and less often from a lick on broken skin or inside the mouth or nose. Bats are the most common animal source of rabies in Canada. Other wildlife sources are skunks, raccoons and foxes. These animals can transmit the virus to dogs, cats, livestock and humans. Rabies attacks the nervous system. Early symptoms of the disease usually show up between three and eight weeks following exposure. They include numbness near the bite, fever, headache and feeling unwell. Later symptoms include delirium or paralysis. Once symptoms appear, rabies is nearly always fatal. Here's some first aid advice: if bitten, scratched or licked on broken skin or mucous membranes by an animal that might have rabies, immediately wash and flush the affected area for at least 15 minutes using soap and water and disinfectant. Seek immediate medical attention to attend to the wound and to evaluate the risk of rabies. See a health-care provider immediately if you've been exposed to a bat, even if you aren't sure you've been bitten or scratched. There are two kinds of immunization that can protect you from rabies: rabies immune globulin provides antibodies that give you immediate protection. Rabies vaccine builds up immunity to the disease. You need four injections over 14 days to get full protection. Public health units provide rabies vaccine free of charge to people who have had an exposure they deem to be sufficiently high risk. Finally, it's good advice to avoid contact with wild animals and to steer clear of domesticated animals that are acting in a highly unusual way. Rabies is a dangerous disease. Fortunately, it's rare in Canada, and recognized promptly, the danger is preventable. If you have topics you'd like discussed or questions answered, our email address is thedose@cbc.ca. If you like this episode, please give us a rating and review wherever you get your podcasts. This edition of The Dose was produced by Sameer Chhabra. Our senior producer is Colleen Ross. The Dose wants you to be better informed about your health. If you're looking for medical advice, see your health-care provider. I'm Dr. Brian Goldman. Until your next dose.

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What do I need to know about rabies? - Transcript

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