RABIES VACCINE FACT SHEET AND CONSENT
(RABAVERT, IMOVAX RABIES)
What is RABIES?
Rabies is a viral infection that has two clinical presentations and is a fatal disease. After infection, the usual incubation period is 20 to
60 days, although it may vary from several days to years. The more common, agitated (furious) form presents with the classic
symptoms of hydrophobia or aerophobia with a rapidly progressing encephalitis and death. The paralytic form of the disease manifests
as progressive flaccid paralysis has a more protracted course and is more difficult to diagnose.
How do you become infected with Rabies?
The rabies virus can infect any mammal. It is typically spread by being bitten by an infected animal. In North America, it occurs
mainly in certain wild terrestrial carnivore species and can spread to domestic livestock and pets. Over the past few years the overall
number of animal rabies cases in Canada has been steadily decreasing. There remain regional differences in the prevalence of animal
rabies across the country, and the specific species infected in each region vary over time. For up-to-date details on animal rabies
activity in Canada, please see the Canadian Food Inspection Agency (CFIA) Web site. During the past 6 years (2000-2005) a total of
2,238 cases of confirmed animal rabies were reported in Canada (average: 373 per year). Skunks accounted for 40% of the total cases,
followed by bats (26%), foxes (11%) and raccoons (8%). Bat rabies was detected in most regions across Canada, except the three
territories and Prince Edward Island (PEI). Three provinces accounted for the majority of cases: Ontario (43%), Manitoba (24%) and
Saskatchewan (14%). The species most affected, by region, during the 6-year period were as follows: skunks in Manitoba (434/540 or
80%) and Saskatchewan (243/316 or 77%); bats in British Columbia (91/95 or 96%), Alberta (20/21 or 95%) and Quebec (66/118 or
56%); foxes in the Northwest Territories/Nunavut (57/74 or 77%) and Newfoundland/Labrador (33/44 or 75%); and raccoons in New
Brunswick (55/70 or 79%). In Ontario the most affected species were bats (356/956 or 37%) and skunks (226/ 956 or 24%). Over the
past 6 years, PEI reported one case of animal rabies (cat), and Nova Scotia reported three. Yukon had no reported cases of animal
rabies. Spread to domestic species of animals, such as pets (e.g., cats and dogs) and livestock (horses and cows) has occurred. Dogs
and cats accounted for 4.5% of animal rabies cases.
How are Rabies vaccines given?
The Rabies vaccine is given as follows; One (1) ml is given intramuscularly in the deltoid muscle of the arm.
RabAvert/Imovax Rabies is given in 3 doses, at 0 and 7, and 21 days apart.
Are there any side effects?
As with any vaccine, side effects can occur – that is the reason you are required to remain in the Health Centre for 15 minutes after
receiving the vaccine. Soreness or swelling at the site of injection can occur, fever, headache, nausea, dizziness or fatigue. These
usually subside within 2 days. Please report any reaction to the Health Centre.
Seek medical attention if you develop a fever higher than 40.5C up to 3 days after being vaccinated or if you develop any allergic
reactions or other serious abnormality.
Do NOT have this vaccine if:
 Anyone who is ill with a fever (in the past 48 hours) or an infection worse than a cold.
 Anyone with a previous allergic reaction to the vaccine or any of its components: neomycin, bovine serum albumin, chicken,
eggs, gelatin, tetracycline, anti-fungal drugs.
 Anyone with a history Guillain-Barré.
 You are pregnant or planning to become pregnant and/or breast feeding.
Reference: Public Health Agency of Canada, www.public health.gc.ca Novartis, and Sanofi-Pasteur Product Monographs, CPS
Last updated May 2014
INFORMED CONSENT
RABIES VACCINE (RABAVERT, IMOVAX RABIES)
Health History:
Please answer the following questions:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
YES
Are you acutely ill or have/had a fever within the past 48 hours?.....................................................
Do you have a history of severe reaction to this vaccine or any other vaccines?................................
Are you pregnant (this includes unprotected sex in the last month) or breastfeeding?........................
Do you take any medications?............................................................................................................
Are you allergic to/or do you have any dietary restrictions to any of the following?
(Please check (√) if YES)
Neomycin
Bovine Serum
Chicken
Gelatin
Eggs
Tetracycline
Albumin
NO
Anti-fungal
drugs
Do you have any other allergies?........................................................................................................
Do you have a blood disorder?............................................................................................................
Do you have a weakened immune system?..........................................................................................
Have you ever had Guillain-Barré following a previous vaccine?......................................................
Do you have any other medical conditions?........................................................................................
I have read the RabAvert/Imovax Vaccine fact sheet and understand the benefits and possible risks of the vaccine. Any
questions I had were answered to my satisfaction.
Please check (√) if YES.
I agree to wait 15 minutes following injection to be observed for any potential adverse reactions. Please check (√) if YES.
Gender: Male
Female
Preferred Gender Identity: _________
_________yy _______mm______dd
________
Your Birthdate
Your Age
______________________________________________
___________________________________________
Last Name
First Name
______________________________________________
___________________
_______
______-______
City
Province
Postal Code
Street Address
(____)_________-______________________
______________yy ________mm ________dd
Today’s Date
Phone Number
____________________________________
_____________________________________
Signature
For RN use only, as per medical dierctive:
Witness
Rabavert (3 doses; 0,7, 21 days)
Imovax Rabies (3 doses; 0,7, 21 days)
#1-Date___________________Time__________ Signature____________________________
Lot# __________________________________ Exp.Date_______________
Diluent # ______________________________
R
or
L Deltoid (IM)
Lot# __________________________________ Exp.Date_______________
R
or
Health hx reviewed ________
L Deltoid (IM)
Paid __________
Exp.Date_______________
#3- To be given on day 21 (14 days after the second dose)
Date______________________Time____________ Signature____________________________
Lot# __________________________________ Exp.Date_______________
Diluent # ______________________________
Paid __________
Exp.Date_______________
#2- To be given on day 7.
Date______________________Time____________ Signature____________________________
Diluent # ______________________________
Health hx reviewed ________
R
or
Health hx reviewed ________
L Deltoid (IM)
Paid __________
Exp.Date_______________
Freedom of Information and Protection Privacy Act 1987. The information on this form is collected under the legal authority of the Colleges and Universities Act, R.S.O. 1980, C272, SS; Regulated
Health Professions Act, 1991, S. 36(1) for use by Health Centre Staff. This information is used for administrative purposes. For further information, please contact Megan Mascarin, Freedom of
Information Officer, Human Resources, Sheridan College, 1430 Trafalgar Road, Oakville, L6H 2L1, 905-845-9430 ext. 2163
Updated May 2014