Fatal rabies case with no visible wound shows why bat contact alone should trigger immediate vaccination, experts say

Ontario’s first fatal rabies case since 1967 provides critical guidance to help prevent deaths from rabies in future cases. The article was published in the Canadian Medical Association Journal.

Human rabies is caused by a virus and is almost always fatal, but post-exposure prophylaxis (PEP), with a series of rabies vaccines and human rabies immune globulin injections, can prevent death if given promptly and before symptoms develop. In North America, bats, raccoons, skunks and foxes are the main carriers of rabies. Bats are the most common cause of rabies and pose a heightened risk because scratches or bites may be small and hard to see.

This fatal rabies case occurred in an 11-year-old boy who awoke with a bat lying on his mouth and nose and had no apparent bite or scratch marks. Nineteen days after exposure, he went to an emergency department with a range of symptoms, including vomiting, facial “pins and needles” and numbness, and was later diagnosed with rabies. The health care team provided supportive care, as there is no cure once rabies symptoms develop.

The parents agreed to share their son’s case to help raise awareness of rabies.

“Any direct human contact with a bat, even in the absence of a visible bite or scratch, is an indication for PEP and should be discussed with public health authorities,” writes Dr. Brian Hummel, a pediatric infectious disease specialist at McMaster Children’s Hospital and assistant professor at McMaster University, Hamilton, Ontario, with co-authors.

“This is especially important to consider as we approach the summer months, when human–bat encounters are at their peak,” Hummel emphasizes.

People who may have been in contact with a wild animal that could potentially have rabies should seek medical attention promptly. In cases of possible rabies virus exposure, public health authorities should be notified and PEP started in consultation.

Although rabies in humans is rare, with only 28 cases reported since 1924, the authors recommend awareness, prompt action with PEP and clinical judgment in cases of suspected exposure to the rabies virus.

“Rabies is almost always fatal, with no established efficacious therapies, making prevention crucial. Rabies PEP is highly effective if administered promptly, in consultation with public health authorities, after any direct human contact with a bat, even in the absence of visible lesions. Bats may or may not show classic signs of rabies; hence, any direct human contact with a bat is considered high risk,” the authors conclude.

In people with neurological symptoms that may be compatible with rabies, clinicians should ask about exposure to potentially rabid animals.

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Gaby Clark

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Robert Egan

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