Public Health Physicians of Canada
Last updated: July 2023
Post-immunization titres to determine immunity following a complete vaccine series are often not necessary. For example, anti-HBs titres following completed hepatitis B virus vaccination series are unnecessary in the general population. Similarly, serologic testing for measles, mumps and rubella immunity following two doses of MMR is not necessary.
Rabies post-exposure prophylaxis (including rabies vaccine and immunoglobulin) should only be offered to individuals with known or highly probable contact with the saliva of a potentially infected animal. Risk assessment should be based on type of exposure, local rabies epidemiology, symptoms of the animal, ability to test or observe the animal for rabies, prior rabies immunization of the animal and exposed person, and if necessary, consultation with local public health officials. In general, the risk of rabies from domestic animals (e.g., pets) is extremely low.
De Serres, G et al. Bats in the bedroom, bats in the belfry: reanalysis of the rationale for rabies postexposure prophylaxis. Clin Infect Dis. 2009 Jun 1;48(11):1493-9. PMID: 19400689.
Middleton D et al. Human rabies postexposure prophylaxis and rabid terrestrial animals in Ontario, Canada: 2014-2016. Can Commun Dis Rep. 2019 Jul 4;45(78):177-182. doi: 10.14745/ccdr.v45i78a02. PMID: 31355826.
Understanding a patient’s perspective with a thorough social history will provide valuable information about their determinants of health, which is critical for nuanced diagnoses and a better adapted management plan. As barriers are identified and addressed management plans can be re-evaluated in collaboration with the patient.
Pre-placement TSTs should not be a universal requirement of employees and volunteers in settings where healthcare services are not delivered. Workplace TB screening policies should only be implemented based on the findings of an organization-specific TB risk assessment. If implemented, workplace TB screening should avoid universal TST/IGRA testing by screening for individual TB risk factors first. TSTs should not be used on patients suspected of having active disease as they are unhelpful and unnecessarily delay diagnosis.
Antibiotic prophylaxis for iGAS is currently offered routinely for household and other close contacts of those infected with severe iGAS. However, it may not be necessary for all such contacts. Individuals in which prophylaxis should be considered are those who are immunocompromised or may be more susceptible to infection, particularly neonates. Prevention and monitoring measures should be discussed with all household and close contacts of confirmed iGAS cases.
Health Protection Agency, Group A Streptococcus Working Group. Interim UK guidelines for management of close community contacts of invasive group A streptococcal disease. Commun Dis Public Health. 2004 Dec;7(4):354-61. PMID: 15786581.
Public Health Physicians of Canada (PHPC) member submitted recommendations from 2016 were reviewed for those relevant to CWC. Relevant previous suggestions as well as an informal brainstorm of PHPC executive with some external stakeholders was undertaken to develop a list of topic areas for consideration. Membership voted on 8 topic areas in Fall 2019. Approximately 100 votes were received and work proceeded with 6 topics in order to finalize at least 5 recommendations with experts.