In early September 2024, I reported on human case of rabies in a resident of Brantford-Brant, Ontario, the first case of domestic human rabies recorded since 1967.
In a report today published in the Canadian Medical Association Journal titled “Fatal Rabies in a Child.”
The patient’s family reported that, during a visit to a cottage in northern Ontario 19 days before symptom onset, the boy had been awoken by a bat on his nose and mouth. He had swatted the bat off his face; his father had caught the bat in a cooking pot and released it outside. The child had no visible lesions on his face, and his parents did not consider that the bat had behaved erratically. Therefore, they did not seek medical assessment.
Because of the history of bat exposure, the emergency physician notified the local public health authority for consideration of rabies postexposure prophylaxis (PEP) the next day. The patient was discharged home with a presumed diagnosis of herpes gingivostomatitis.
Nineteen days later, he went to the hospital with some facial numbness, vomiting, and pain, and was ultimately diagnosed with rabies.
The patient’s hospital course was complicated by autonomic dysfunction, ventilator-associated pneumonia, and progressive neurologic decline. By day 5 of admission, his brainstem reflexes were absent. Life-sustaining therapies were withdrawn on day 17 of admission, and he died peacefully with his family at his bedside.
Everything you wanted to know about 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.
In the circumstance that the bat is available for rabies testing, and results can be obtained within 48 hours, PEP could be held pending the results. In the common circumstance that a bat is found in the bedroom of a sleeping person with no recognized physical contact, this is not considered an indication for PEP. The patient we described reported a bat resting on his face, which is an indication for PEP; however, medical attention was not sought because no obvious bite was noted. This highlights an important gap in public awareness. Although rabid bats may show unusual behaviour — such as appearing during the daytime, resting on the ground or someone’s face, having difficulty flying, or being easily approached — the absence of these behaviours does not exclude rabies.
More rabies interviews:
World Rabies Day Livestream Special
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